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December 8, 2020

Mental Illness & the Good Death

This blog entry has been prompted by the recent wave of law reform occurring in Australia and its neighbour, New Zealand.

From a rocky start some 25 years ago when the Northern Territory (one of Australia’s 3 territories vis a vis states) passed the Rights of the Terminally Ill Act (the law lasted only 9 months before it was overturned by the Federal Australian government).

Fast forward to 2021 when Victoria and West Australia have passed assisted suicide/ dying laws, and the cogs of the legislative wheel are now turning in Tasmania and Queensland.

Every place in Australia (and New Zealand for that matter) that has passed or is contemplating the introduction of end of life choices laws, is excluding people with a mental health diagnosis.

In the area of mental illness and assistance to die, Australia and New Zealand are following the lead of countries like the US and Canada in excluding mental illness as a qualifying criteria.

Australia is not following the lead of countries such as the Netherlands, Belgium and Luxembourg where euthanasia is not only available to children, but to the mentally ill.

While Swiss law mandates ‘mental capacity’ before a person can be helped to die, that country has also, wisely, decided against a conflation of mental illness with a loss of capacity.

For this they are to be commended.

As a position statement, Exit International fully supports the right of a mentally ill adult to  a) take their own life and b) request assistance to take their own life, as long as they have the mental capacity to make an informed choice and to understand the consequences of their actions.

While mental capacity is usually determined by a psychiatric assessment (as is the process at Pegasos in Switzerland), Exit is currently exploring AI (artificial intelligence) possibilities in this regard.

This exploration of AI is intended to contribute to the demedicalisation of death: to finally, and once and for all, remove control over the decision to die from the medical profession.

It is indefensible, and ignorant, for a law on end of life rights to automatically exclude a person with depression, dementia or other mental illness from being able to request assistance to die. Or to be able to take their own life themselves.

This is the medical model of ‘mental capacity’ determination run wild.

It raises the question that never goes away. What right should the medical profession have over a person’s right to die?

The more progressive scholarly literature shows that mental capacity cannot, and should not, be determined (or predicted) solely on the basis of a mental illness diagnosis.

Nor should a civilised society wash its hands of those who are mentally ill: people who may present with a long-held, considered wish to die.

Exit welcomes people who have mental illness to subscribe to the Peaceful Pill eHandbook.

We do what we can to be egalitarian in access.

What we request is that subscribers show they have the mental capacity to make informed decisions. One’s diagnosis is much less important.

Exit’s approach mirrors that of western legal systems where mental capacity is assumed, unless there is evidence to the contrary.

Adam Maier-Clayton (27 years) made contact with Exit and had several conversations with Philip Nitschke about the end of life options available to him.

Adam then used the Peaceful Pill eHandbook to obtain end of life drugs.

He did this with the support of his parents who did not want him to live a life of suffering.

Adam had multiple mental health diagnoses including severe anxiety, obsessive-compulsive disorder, and dissociative disorder. Did he have mental capacity? Without doubt!

What upset Adam’s parents (and Philip Nitschke) was that Adam died alone in a strange motel room.

Adam wanted to shield his parents, Margaret and Graham, from any accusation that they assisted him.

Adam Clayton was a young, intellectual man with a deeply considered (and considerate) outlook on the world.

Vice told Adam’s story in their 2019 feature documentary, Time to Die.

Adam Maier-Clayton remains an inspiration to Exit in our work towards ensuring that ‘a good death is everybody’s right’: not only those who are terminally ill with < 6 months to live as Australia’s new laws demand!

Adam Maier Clayton