A Psychiatrist’s Personal Perspective on Medical Aid in Dying

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FROM OUR READERS

While reading Mark Komrad, MD’s June cover story for Psychiatric Times^TM on Medical Aid in Dying (MAID), I was disturbed by his implication that it is the psychiatrist who kills the patient.

That statement is a misunderstanding of what actually happens. My mother killed herself in 2015 via assisted suicide in Switzerland. She ended her own life by suicide, with her 3 sons present. The process involved 2 in-depth interviews by a local Swiss physician, who clearly confronted our mother with numerous questions to assess whether she was of sound mind and why she would want to commit suicide. Mind you, there was never a question of whether she wanted to be killed by the doctor. In fact, it was abundantly clear throughout the process that she would be the one to direct each and every step until the very last act of digesting the pentobarbital. Equally, on the day of her death, the 2 health care workers who oversaw the process asked our mother numerous times whether she wanted to end her life. She had numerous chances to change her mind, either to postpone or relinquish her wish. And this process during the last hours does not do justice to her months of preparations.

Our role as doctors is to be compassionate, and particularly for psychiatrists, it is almost impossible to practice our roles without having empathy. I have numerous times in my life felt the agony of my patients’ predicaments and could readily understand why some of them seriously contemplated suicide. I have always spent time to gain a deeper understanding of a patient’s feelings and thoughts, until such a point as I could credibly empathize with a his or her point of view and feelings. This task demands a willingness to go beyond one’s own limitations in order to sense and perceive more broadly. It is in that moment of deeper connection that opportunities arise for reviewing alternatives. I have been fortunate not to lose a patient to suicide.

The physician-assisted approach requires that the patient is in command at all times. It is not easy to kill yourself when you have to go through a review process, during which you are continuously asked if you really want to do it. The process is lengthy; it takes a few weeks, if not months. During that time, it typically becomes a family issue, and friends weigh in too. There are numerous goodbyes, and numerous interactions with friends who insist that the patient should not go through with it. There are community and peer and family pressures not to do it. It requires a unique level of resolve and courage to commit suicide under those conditions. Those who have the resolve should have the option to end their own lives.

Dr Poelnitz is a staff psychiatrist for St Clare’s Behavioral Health Counseling Services.