David Lounsbury

Dear Colleagues, I would like to echo and support some of the objections raised by others with respect to extending (so-called) MAID to mental health patients in such an unfettered fashion. 1. By definition, insight is lacking in such patients (at least when they are acutely unwell). We often advise people "not to make major decisions" when they are in emotional or traumatic states. Choosing to end your own life must surely fall under such an umbrella. Would we let an acutely suicidal or psychotic person apply for a bank loan or change the terms of their will? 2. Pragmatically, even for a physician who is theoretically completely neutral on this topic, such situations (MAID in the context of mental health disorders) seem to be inherently confused. Typically, a suicidal patient is the "code blue" of Psychiatry. It is our moral duty as doctors to try and "talk people off the ledge" ... to link them to supports, to medicate if needed, to form / restrain if needed, but most of all, to use our shared humanity to try and shed light on the dignity inherent in all human life. 3. (Yes, this next point is a slippery slope argument, but it should still be considered.) People in crisis often feel like (and sometimes actually ARE) a burden to those around them. Despite this, we try to respect and help even our "weakest" members of society. By having "let us help you die" as an option, we are codifying and admitting to this burdensomeness as a society and might actually seem to be promoting death as "the answer" for their existential angst. 4. Unique to my current field (correctional medicine) ... incarceration in many ways is a guaranteed "poor quality of life" (especially at higher security levels). To the extent that MAID is widely adopted in our prison populations, is this not just Capital Punishment by another name? Respectfully submitted.

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