Tuesday, October 6, 2009

Depression and the Advance Directive.

A number of religious sites have taken up the recent case of Kerrie Wootorton who drank antifreeze last week, pinned a living will to her shirt and called an ambulance. Because of respect for her living will, doctors did not revive her. She was 26, depressed by her infertility, and had attempted to kill herself nine times before. Many in Britain, where the Debbie Purdy case and a recent clarification of prosecutorial guidelines for assisting suicide have brought the issue to the fore, fear that the case will now open the "back door" to assisted suicide.

Watching the case, I have been concerned by the tie being made between assisted suicide as legalized in the US - also called death with dignity, which requires a mentally competent, terminally ill patient self-administer lethal medication - and depression. When the case is made that no one wishes for death unless they are depressed - and therefore incompetent - assisted suicide is lumped in with suicide. When depression is considered the only cause of desire to end ones life, the argument for death with dignity is skewed. An article by Rebecca Smith, Medical Editor for the Telegraph (linked via Anglican Mainstream), goes there. Wait for the last line:

The case was highlighted by the Daily Telegraph after an inquest ruled that doctors had no choice but to allow Ms Wooltorton, 26, from Norwich, to die after she had written a letter saying she did not want to be saved.


Doctors in the case said it would have been considered assault if they had treated her against her wishes.

The case has prompted Andy Burnham, Health Secretary, to signal that the law may need to be changed because living wills or advance directives were not intended for this purpose. He said it made him ‘uncomfortable’.

Dr Luk Ho, a consultant psychiatrist at the Queen Elizabeth Hospital in King’s Lynn, wrote in response to a British Medical Journal blog: "My biggest concern with this case is that it could lead to ‘assisted suicide by the backdoor.

"I am well aware of the euthanasia debate about whether it is ethical to use the distinction between ‘act and omission’ to justify withdrawing or withholding life-sustaining treatment in incapacitated terminally ill patients.

"Could professionals be legally permitted in the future to allow patients to commit suicide ‘in their best interests’, because it is the patient who commits the ‘act’ and the professionals merely ‘omit’ treatment?"


Dr Luk also questioned whether Ms Wooltorton’s advice directive was applicable because her history of mental illness and previous suicide attempts raised issues over her mental ability to refuse treatment.

"Is is ever possible for a person wishing to commit suicide to have full capacity?"

Emphasis mine. We don't know what counseling Wooltorton received after each of her previous suicide attempts, what extent her doctors went to to address her depression, or what fertility options she was informed of.

Those who oppose assisted suicide, however the laws are constructed to protect the mentally infirm, determine that the desire to end one's life is a sign of depression. Kerrie Wooltorton's sad death helps to make their case for them.

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