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Disability, chronic illness, suicide and assisted suicide

People with disabilities or chronic illness are an at-risk group when it comes to suicide.

 

The promotion of “assisted dying” (assisted suicide) contributes to the problem,
because it is based on the notion that illness and disability are valid reasons to want to die.

Connecticut Suicide Prevention Plan 2020

The State of Connecticut Suicide Prevention Plan for 2020 includes people with disabilities and chronic health conditions as a high-risk group (along with military veterans and members of the LGBT community). The plan mentions that legal assisted suicide poses unintended consequences for this at-risk group.

It’s important to remember that there is no bright line between terminal illness, chronic illness and disability. Often people who feel they are suffering because of a terminal or chronic condition, feel that way because the condition makes them less able to do something. In short, the terminal or chronic condition involves a disability.
 

 

Here is an excerpt from the Connecticut Suicide Prevention Plan 2020

 
Pages 43-44 (emphasis ours):
 
 

People with Chronic Health Conditions and Disabilities

 
Living with chronic or terminal physical conditions can place significant stress on individuals and families. As with all challenges, individual responses will vary. Cancer, degenerative diseases of the nervous system, traumatic injuries of the central nervous system, epilepsy, HIV/AIDS, chronic kidney disease, arthritis and asthma are known to elevate the risk of mental illness, particularly depression and anxiety disorders. In these situations, integrated medical and behavioral approaches are critical for regularly assessing for suicidality.
 
Disability-specific risk factors include: a new disability or change in existing disability; difficulties navigating social and financial services; stress of chronic stigma and discrimination; loss or threat of loss of independent living; and institutionalization or hospitalization.1
 
Until recently, the [Connecticut State Advisory Board] CTSAB was considering assisted suicide of the terminally ill as a separate issue from suicide prevention. The active disability community in Connecticut, however, has been vocal on the need for suicide prevention services for people with disabilities.
 
“There may be unintended consequences of assisted suicide legislation on people with disabilities.
 
Peace (2012)2 writes that “Many assume that disability is a fate worse than death. So we admire people with a disability who want to die, and we shake our collective heads in confusion when they want to live.”
 
“People with disabilities have a right to responsive suicide prevention services. The CTSAB intends to continue to explore the needs of the disability community for such services.”

 
 
The Plan includes some “targeted recommendations”, which push back against the idea of rational suicide for people with disabilities:
 

  • “Do not “assume” suicide is a “rational” response to disability.
  • “Treat mental health conditions as aggressively as with a person without disability.”

 
 
There seems to be a tendency in society to think that it’s “understandable” to be depressed when one has a disability or terminal illness. An OnMedica editorial on depression and terminal illness stated that doctors sometimes think that a terminally ill person has “understandable depression” and then refrain from treating it.
 
“Many doctors do not recognise depression or know how to assess for its presence in terminally ill patients. 3 Even when recognized, doctors often take the view that “understandable depression” cannot be treated, does not count or is in some way not real depression. So in terminally ill patients, depression often goes untreated and in some cases PAS or euthanasia is provided anyway.4
 
 
 

 

  1. Gill, C.(1992). Suicide intervention for people with disabilities. Issues Law Med, 8(1),37–53.
  2. Peace, W.J. (2012). Comfort care as denial of personhood. The Hastings Centre Report, 42(4), 14-17. Retrieved from http://www.tc.umn.edu/~ston0235/3302/readings/peace-personhood.pdf
  3. Bowers & Boyle, 2003; Kissane & Kelly, 2000; Passik et al., 1998; Stiefel et al., 2001; Thompson et al., 2000. See http://suicideinquiry.nz/depression-and-terminal-illness
  4. Dinwiddie, 1999; Groenewoud et al., 2004; Meier et al., 2003. See http://suicideinquiry.nz/depression-and-terminal-illness