December 01 , 2002

New Book on Assisted Suicide

Dr. Barbara Olevitch has just published a fine new book on assisted suicide. This book is the first comprehensive discussion of assisted suicide from a purely psychiatric perspective. It is written to be understandable for patients, family members and interested students, while also being thorough and scholarly.

Doctor Hamilton, co-founder of Physicians for Compassionate Care, has written a forward for this fine book. He recommends it to all who are interested in any side of the assisted-suicide issue. His forward follows, with the publisher's permission.

Purchase information:
Protecting Psychiatric Patients and Others from the Assisted-Suicide Movement by Barbara A. Olevitch can be ordered from Greenwood Publishing Group, Inc. by telephone at 1-800-225-5800. A 20% discount is available until December 31, 2002 if you mention the source code F238.

Protecting Psychiatric Patients and Others from the
Assisted-Suicide Movement: Insights and Strategies
by Barbara A. Olevitch
(Greenwood Publishing Group, 2002)

Forward
N. Gregory Hamilton, M. D.

Joan Lucas, a 65-year-old woman, made a suicide attempt using sleeping pills she'd hoarded. Her adult children watched her as she lay on her bed throughout the day. They couldn't make up their minds what to do, according to the Medford Mail Tribune (June 25 and 26, 2000). When Joan eventually awakened, instead of getting evaluation and treatment for her suicidal despair, her family called George Eighmey, executive director of Oregon's Compassion in Dying Federation, a politically active assisted-suicide group. Mr. Eighmey helped arrange Joan's assisted suicide in Oregon, where such a practice was legal at the time.

The doctor wouldn't reveal his name but told a news reporter he
decided to get a mental health opinion, which is not required in Oregon, to cover himself. The psychologist he hand picked sent an MMPI to the patient, because Joan could not easily come into the office. Joan's family helped her fill out the paper-and-pencil test. Then, the psychologist cleared her for a second, more effective overdose. This one killed her.

Never before had families, friends, doctors, and mental health
professionals had to struggle with such a dilemma - whether to evaluate and treat a desperate person or offer her legalized assisted suicide.

Now, the struggle for assisted suicide continues - with profound
implications for the health and safety of mentally ill individuals, as
well as the physically ill, their families, and those who care for them.
That's why Protecting Psychiatric Patients and Others from the
Assisted-Suicide Movement is so important. This book is the first
comprehensive discussion of assisted suicide from a purely psychiatric perspective. It is written to be understandable for patients, family members and interested students, while also being thorough and scholarly enough to serve as an up-to-date resource for mental health professionals.

According to a well-known Oregon assisted-suicide guidebook, "If the mental health professional finds the patient competent, refusal of mental health treatment by the patient does not constitute a legal barrier to receiving a prescription for a lethal dose of medication" (Ganzini & Farrenkopf, 1998, p. 31). This opinion by Veterans Administration psychiatrist, Linda Ganzini, is in stark contrast to the 1996 Oregon Psychiatric Association report on the ethics of assisted suicide. The association determined that assisted-suicide referrals to mental health professionals are implicitly requests "for treatment, NOT just for an assessment of psychiatric diagnosis."

Not too long ago, every suicide threat was considered a cry for help. But now, debate over assisted suicide has set up two competing paradigms for responding to patients with suicidal feelings and impulses - evaluate and treat or provide a competency evaluation with little or no therapeutic intervention.

Assisted-suicide and "rational suicide" activists are already demanding that mental health professionals shift from caring for vulnerable individuals to providing a gatekeeper function for assisted suicide. It's a bit shocking that with an issue of this
magnitude, with its life and death implications for the mentally ill as well as the physically ill, there has been no previous comprehensive book addressed exclusively to the mental health implications of this looming paradigm shift in handling suicidal despair.

Dr. Barbara Olevitch doesn't hail from either the pro-assisted-suicide or the pro-life movements. She is a highly regarded psychologist who has spent most of her career helping individuals with chronic and serious mental illnesses recover feelings of being accepted as worthwhile human beings. Her first book, Using Cognitive Approaches with the Seriously Mentally Ill: Dialogue Across the Barrier, teaches therapists to assist vulnerable and marginalized patients in using cognitive skills to find hope and meaning in the midst of suffering. Interestingly, the seriously
physically ill are now becoming marginalized like the mentally ill. Their suffering is beginning to share more fully the attributes of
stigmatization, pessimism, and neglect once reserved for those considered psychologically disturbed.

It should come as no surprise that someone who has studied how to overcome despair in the chronically mentally ill has a great deal to offer professionals and the public concerning despondency in the physically ill.

There is so much overlap between the two populations. The physically ill have extraordinarily high rates of depression and anxiety, as often as not overlooked by their primary care physicians. And the most severely affected mentally ill are clearly known to have complex biological illnesses, as well as the psychological, social, and spiritual struggles everyone shares.

Dr. Olevitch places the issue of assisted suicide within the context
of suicide in general. She begins by addressing the long history of
hopefulness and triumph in the field of suicide prevention. In doing so, she raises an important question. Would physician-assisted suicide lead to more suicides? Cogently, she observes, "The difference between the ordinary suicidal person and the terminally ill suicidal patient is the reaction he meets with in the therapist."

This issue of therapist response is something that concerns all of us, clinicians and patients alike, because it is upon the caring of the caretaker that we all depend when suffering and vulnerable.

Dr. Olevitch goes on to consider whether or not physician-assisted suicide would inevitably lead to euthanasia. This very question was of prime importance to the U.S. Supreme Court in its 1997 determination that there is no constitutional right to assisted suicide. She reviews the fear of medical technology and how the assisted-suicide and the euthanasia movement has capitalized on that fear. She discusses the important role of shifting medical economics and HMOs in creating an environment favoring
assisted suicide over medical care.

On a more hopeful note, Dr. Olevitch offers a fine chapter on how
health professionals can establish a productive frame of reference for addressing psychological problems in the seriously ill. She describes what all patients and their family members should come to expect, even demand, as the appropriate response to distress in the face of medical catastrophe. In closing, she suggests practical steps health professionals, especially mental health professionals, can take to insure that all people have available to them an appropriate, considered, and professional response to the powerful emotions that arise when, in all likelihood, one is close to death. These are the very steps patients should encourage their doctors and other health care professionals to take as a matter of public health policy.

Not all patients, however, receive the good care and advocacy Dr. Olevitch recommends. Personally, I did not fully understand the implications of this fact until I learned that my former medical school classmate, Peter Reagan, rode his bicycle over to the house of a patient he called Helen and gave her a lethal overdose. Helen had recently been diagnosed as depressed and as having a serious medical illness. Instead of giving her effective treatment for her depression, Peter gave Helen a deadly drug. Would Helen have died by suicide if she had been given good treatment for depression along with good palliative care for her physical
concerns? As I eventually described elsewhere, many possible approaches could have helped Helen with her depression, feelings of helplessness, and suicidality. But, these problems were never adequately treated, a fact which eventually led to Helen becoming the first publicly reported legalized assisted-suicide in America.

It's high time the psychiatric community raised the issues inherent
in Helen's case, the Joan Lucas case, and others like them. It's high time the psychiatric issues, including a risk to the lives of the mentally ill, become included in the national debate over assisted suicide.

This is an important book. It's the first book to discuss thoroughly
from a purely psychiatric viewpoint how the notion of offering assisted suicide as a response to distress among the seriously ill affects all of us - health professionals, doctors, clergy, psychologists, patients, families, anyone who cares about the seriously ill or who may become seriously ill themselves. This is an important book. And it's a good read!

Reference
Ganzini, L. & Farrenkopf, T. (1998). "Mental health consultation and referral," The Oregon Death with Dignity Act: A guidebook for health care providers. Portland, OR: Oregon Health Sciences University.

Purchase information"
Protecting Psychiatric Patients and Others from the Assisted-Suicide Movement by Barbara A. Olevitch can be ordered from Greenwood Publishing Group, Inc. by telephone at 1-800-225-5800. A 20% discount is available until December 31, 2002 if you mention the source code F238.