This is a nice elaboration on the “better world” argument that you have made before, Eric. It certainly bears repeating, since so many people seem to think that the problem is largely one of access to treatment (even when that treatment statistically has poor efficacy).
The other objection that we seem to hear from MAID critics is related to what we might call the “better future” argument. Even our cancer patients with poor odds of a cure or remission, or of finding relief for their suffering, are urged to defer their requests for MAID in the hope that some other remedy might be on the near or distant horizon. Perhaps because so many people come (especially) to academic medical centres with a desire to explore even long-shot interventions, requests for help to end their lives can seem like an affront to what healthcare professionals do, but we need to be insistent that paternalism isn't an acceptable default position even in a research and teaching hospital. After all, this flies in the face of the long-established right of patients to decline any and all offers of treatment that are unacceptable to them.
This isn't a problem unique to the mental health context, but the ever-shifting grounds of the objections to MAID have made this the latest strategic move in efforts to limit access. Lots to unpack here, but you have made some wonderfully clear efforts to communicate what's at stake in a manner that is accessible to non-philosophers. It's most appreciated.
Thanks Ann. The better future argument definitely plays a role. Providers keep recommending treatment, and patients and families will ask, "Why shouldn't we keep trying?" while missing that there are serious downsides to continuing aggressive treatment. Hope is useful, but it has costs too.
I agree treatment access for mental health is not the main issue.
I would like to add if Mental Health Providers took a page from the Cancer Area and utilize Patient Reported Outcomes. There are ways to relieve suffering when more than the standard questionaries and treatments are used. They might even find out the medication is not working earlier and side effects are worse than the original illness. As a patient lives with this every minute of every day and this source of information is often overlooked.
Like cancers, mental illness can be short term or long term chronic illness. Adding PRO’s can find other conditions that are not recognized in the standard questionaries, and tracking long term gains or loss in function impacting health.
Such as maybe pointing the way to other supports from dietitian, Occupational Therapy , Social Workers and disability programs for financial support.
One example I had very bad sleep with nightmares for years and when reported was told that is just depression or a side effect of medication.
It was not until after moving and a new provider I eventually mentioned this again and the addition Prazosin for a short term was long term relief.
Tracking over time such things as sleep quality including nightmares might of brought me relief years earlier.
I still am disappointed that MAID is delayed as I know one person that is suffering without relief and it not access that is the problem.
Good points, Shawna. I saw a specialist for a sleep condition when I was younger, which I actually had, but a big part of the issue was my iron was low. Stuff like that is easy to miss.
This is a nice elaboration on the “better world” argument that you have made before, Eric. It certainly bears repeating, since so many people seem to think that the problem is largely one of access to treatment (even when that treatment statistically has poor efficacy).
The other objection that we seem to hear from MAID critics is related to what we might call the “better future” argument. Even our cancer patients with poor odds of a cure or remission, or of finding relief for their suffering, are urged to defer their requests for MAID in the hope that some other remedy might be on the near or distant horizon. Perhaps because so many people come (especially) to academic medical centres with a desire to explore even long-shot interventions, requests for help to end their lives can seem like an affront to what healthcare professionals do, but we need to be insistent that paternalism isn't an acceptable default position even in a research and teaching hospital. After all, this flies in the face of the long-established right of patients to decline any and all offers of treatment that are unacceptable to them.
This isn't a problem unique to the mental health context, but the ever-shifting grounds of the objections to MAID have made this the latest strategic move in efforts to limit access. Lots to unpack here, but you have made some wonderfully clear efforts to communicate what's at stake in a manner that is accessible to non-philosophers. It's most appreciated.
Thanks Ann. The better future argument definitely plays a role. Providers keep recommending treatment, and patients and families will ask, "Why shouldn't we keep trying?" while missing that there are serious downsides to continuing aggressive treatment. Hope is useful, but it has costs too.
I agree treatment access for mental health is not the main issue.
I would like to add if Mental Health Providers took a page from the Cancer Area and utilize Patient Reported Outcomes. There are ways to relieve suffering when more than the standard questionaries and treatments are used. They might even find out the medication is not working earlier and side effects are worse than the original illness. As a patient lives with this every minute of every day and this source of information is often overlooked.
Like cancers, mental illness can be short term or long term chronic illness. Adding PRO’s can find other conditions that are not recognized in the standard questionaries, and tracking long term gains or loss in function impacting health.
Such as maybe pointing the way to other supports from dietitian, Occupational Therapy , Social Workers and disability programs for financial support.
One example I had very bad sleep with nightmares for years and when reported was told that is just depression or a side effect of medication.
It was not until after moving and a new provider I eventually mentioned this again and the addition Prazosin for a short term was long term relief.
Tracking over time such things as sleep quality including nightmares might of brought me relief years earlier.
I still am disappointed that MAID is delayed as I know one person that is suffering without relief and it not access that is the problem.
Good points, Shawna. I saw a specialist for a sleep condition when I was younger, which I actually had, but a big part of the issue was my iron was low. Stuff like that is easy to miss.