A Right to Assisted Suicide for the Institutionalized Mentally Ill

Assisted suicide proponents always promise that facilitated death will be offered solely and strictly to the mentally competent. But once a society accepts the premise of euthanasia—that it is acceptable to eliminate suffering by eliminating the sufferer—there is no way to restrict the putative “right to die” to the mentally healthy.

Mental illness often causes greater anguish than any physical disease and, indeed, for a far longer time. Thus, no one should be surprised that euthanasia of the mentally ill is a growing phenomenon in the Netherlands, where the practice has even been boosted by psychiatric journals, and in Belgium. In the latter country, doctors now condone the medicalized killing of mentally ill people with consensual organ harvesting!

Whenever I warn that the same progression will eventually happen here if assisted suicide becomes normalized, supporters of doctor-facilitated death sniff that America is different. But that assurance has already proved empty. California’s End of Life Option Act, which went into effect earlier this year, legalized assisted suicide for the terminally ill who have the “capacity to make medical decisions.” (Please note that having this capacity is not the same as being mentally “competent.” That implied conflation is a ruse often deployed in assisted-suicide legalization schemes.) If the death-prescribing doctor suspects a mental illness, he or she “shall refer the individual for a mental health specialist assessment.” Thereafter, a lethal prescription should be written only “if the patient is not suffering from impaired judgment due to a mental disorder.”

Those provisions would seem to preclude access to assisted suicide for patients who are involuntarily hospitalized in state psychiatric institutions. After all, these are people with severe psychosis or emotional disturbance. But apparently state bureaucrats don’t see it that way. Soon after the California law went into effect, a regulation was quietly promulgated guaranteeing institutionalized mentally ill patients access to assisted suicide if they have been diagnosed with a terminal illness. Not only that, but the rule permits such people to receive a court-ordered release from institutionalization—not because their underlying condition has been successfully treated, but for the specific purpose of killing themselves with drugs prescribed by a doctor. From 9 California Code of Regulations § 4601 (my emphasis):

A terminally ill patient, as defined by the End of Life Option Act, may petition the superior court for access to participate in activities under the End of Life Option Act by requesting release from the custody of the Department of State Hospitals from the court. If the court orders release from the custody of the Department of State Hospitals, the Department of State Hospitals shall release the patient to the ordered entity or person.

Think about this: These are people denied their very freedom due to diagnosed severe mental disease! They are undoubtedly being treated with powerful psychotropic medications. In what universe could they possibly be deemed “not to be suffering from impaired judgment due to a mental disorder”?

The ironies are disturbing. For example, if a patient is hospitalized because he is acutely suicidal from deep depression, no court would free him for the purpose of committing suicide. Indeed, in such a circumstance, preventing that lethal act is the very point of the institutionalization! But if that same suicidal patient can show that he has been diagnosed with terminal cancer, he can be freed for that same purpose—even if the reason he wants to die is the depression and not the terminal diagnosis.

And what if a court decides that the patient is too dangerous to be let out, or if it can’t find an outpatient setting in which the death may take place? The state must then take action to ensure that the institutionalized mentally ill patient has access to assisted suicide:

If a court orders that the patient meets the qualifications under the End of Life Option Act, and that the Department of State Hospitals shall facilitate the patient’s access to participate in activities under the End of Life Option Act, the Department of State Hospitals will facilitate the patient’s access to an off-site facility that allows the patient the ability to participate in activities under the End of Life Option Act. …

If the court orders that the patient meets the qualifications under the End of Life Option Act, and the Department of State Hospitals is unable to find an off-site facility for the patient to participate in activities under the End of Life Option Act, the Department of State Hospitals will facilitate the patient’s ability to participate in activities under the End of Life Option Act on-site.

This boggles the mind. The regulation puts the state in the business of directly causing the deaths of mentally ill patients under court-ordered custodial care. It goes beyond merely legalizing assisted suicide; it elevates euthanasia access for the institutionalized mentally ill into a court-enforceable right—all without public debate, passage through the usual legislative process, or so much as a news story to alert the people of California that the scope of their new assisted-suicide law has been radically extended.

The state is abandoning the institutionalized terminally ill to their darkest impulses. This isn’t compassion. The so-called “death with dignity” movement is driving us out of our collective minds.

Wesley J. Smith is a senior fellow at the Discovery Institute’s Center on Human Exceptionalism and a consultant to the Patients Rights Council.

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