00:00:00.000You're not saying, no, no, don't feel like that, you know, you're not a burden, we will look after you whatever it takes, suddenly you change it, you say, maybe you're right, maybe you are a burden, what does it do for suicide prevention in mentally ill people to change from saying, whatever happens, we will always support you to, in certain circumstances, we will actually help to kill you, that's crazy.
00:00:22.200That must be a hard practice to be in, no?
00:03:49.140So that the idea that, you know, somebody who could expect to suffer unbearably for the next 30 years also had the right to an assisted death.
00:04:02.940In Australia, most of the states have assisted dying and their laws are either six months or 12 months.
00:04:14.700So that the expected death must be within six to 12 months.
00:04:19.140And in all cases, the issue of an assisted death means that a clinician, a doctor, or a nurse practitioner can prescribe a medication that would end the death or actually give the medication.
00:04:38.680We have, in addition to our laws, we have a number of regulations and standards and guidelines that we have to follow.
00:04:46.880Well, these are through our province, through our professional organization, by the people who license us.
00:04:57.580So, we're covering elections coming from every direction.
00:04:59.740And so, in Canada, it's rare that anybody gets the medication to drink and do it themselves because our regulations are that we must be there.
00:05:14.160Right. And that I have to have the intravenous medication ready in case something goes wrong.
00:05:27.460So in Europe, this is called euthanasia when a doctor actually injects the medication,
00:05:35.180actually gives the medication to a patient. But in Canada, we don't use the word euthanasia
00:05:41.200except for involuntary, like that's what we use for our pets when nice them.
00:05:49.440Here we call it assisted dying and in some places it's called assisted suicide and especially
00:05:57.380in a place like Switzerland or the US where they're required to ingest and or to do it
00:06:08.080themselves. And so that's sort of how the terminology goes.
00:06:15.200Okay. So in Switzerland, so you just said they're required to do it themselves. So you
00:06:20.380don't have a doctor administering it. They have to administer it?
00:06:24.060Yes. And so one clinic uses IVs, but the person must actually push the button.
00:06:34.420that allows the variety fluid to come through.
00:06:39.840And another clinic generally gives people something to drink.
00:06:45.260Hey guys, if you enjoy a few glasses of wine once a week
00:06:48.760or a drink at any point in your life in any amount,
00:06:52.360you need to try the supplement I launched, After Party.
00:14:33.000They gave it a sunset clause, which meant that it expired in two years, which was next month.
00:14:39.340But then I just gave an extension for a year.
00:14:43.020So in 2024, March 17, people will be eligible for psychiatric suffering when that is their sole underlying medical condition is the psychiatric condition.
00:14:59.040But we have lots of experience now with concurrent disorders.
00:15:03.700I mean, lots of people who have both physical and mental illness.
00:15:06.700And when I first was dealing with this, you know, I was a bit of a struggle because in all my practice, if somebody said they wanted to die, I would think, oh, they were depressed.
00:15:22.640And now I was listening to people who had perfectly logical reasons to say I want to die because they had ALS and they had a line in the sand.
00:15:37.980I'm not going past this line in how much I'm willing to degenerate and become dependent on others.
00:15:46.340And so I had to figure out, okay, okay, okay, so what do we know about depression and how it can interfere with people's ability to think and make decisions?
00:15:57.380And of course, I wasn't alone. I had all my colleagues and psychiatrists had to consult.
00:16:04.420And so seven years later, I have, and 47 years of being a doctor, I have a lot of experience with people who have concurrent disorders, serious mental illness plus a physical condition that would make them eligible for an assisted death.
00:16:24.000And in my research, we are looking now at what's been happening since 2021 when we could help people with the chronic conditions, the ones where they still had a long life expectancy and expectation of suffering for maybe a decade or more.
00:16:45.340And so we have discovered in our research that a majority of these people have serious mental illness.
00:16:55.300Now, as you can imagine, if you are suffering unbearably from some physical condition for decades, would that make you have mental distress?
00:17:12.640But there also was a mental illness that's just concurrent and the more serious ones, you know, schizoaffective and bipolar with psychosis and personality disorders, the severe ones and so on.
00:17:34.520So we have now had quite a bit of experience with concurrent mental disorders where people are suffering terribly from a mental condition in addition to physical conditions.
00:17:48.180And so I am facing 2024 with the confidence that we can do our assessments well and help people after that time.
00:18:11.300The assessments that we need to do are, first of all, for capacity.
00:18:16.420can this person make this decision reasonably? If you're actively psychotic, you can't. I mean,
00:18:24.660but if you're delusional about certain things, you can. Like for example, I had a patient who was
00:18:31.620dying of a really nasty bone cancer or in awful pain. Now she was delusional. She was totally
00:18:39.300The FBI were watching her in that nursing home, which seemed to be a lot.
00:18:45.260But she was not delusional about the fact that she had pain caused by bone cancer.
00:19:24.280And, you know, I mean, I have a family member with schizophrenia, and there are, in the last 17 years since he was diagnosed, there were four occasions on which his rights were taken away.
00:19:40.860he was hospitalized against his will and treated against his will. But all of the rest of the time,
00:19:47.820he has the same rights as any other citizen. He can direct his own care. He can do everything.
00:19:53.980And he doesn't always make wise decisions that his parents agree with. But he has true rights.
00:20:03.500And that's also what I realize when I'm talking to my patients who have the Concord Disorders.
00:23:09.720They can choose their date whenever they want.
00:23:14.360And anybody whose natural death is not reasonably foreseeable has a three-month waiting period.
00:23:20.740And during that time, we must make sure that they have explored everything that is available in terms of dealing with symptoms generally that had their condition for a decade or more, and they have explored everything.
00:23:42.320But sometimes we can figure out, oh, well, there is a new treatment.
00:23:46.660And, you know, the last time you saw a specialist in your area was four years ago.
00:24:06.040And do you know if that's similar in the U.S. and in Switzerland?
00:24:10.180Yeah. So in the U.S., some of the states have waiting periods, but they're short. They're like two weeks. And none of them have formic illness allowed. It's all their expected death, six months or 12 months.
00:24:32.560And how long, I mean, you probably know this, but how long has that, I didn't know that that was available because you said it wasn't available in Canada before 2016. So there have been states in America that have had medically assisted dying for illnesses that were going to end lives for a while?
00:24:49.820Over 20 years. Oregon got their law over 20 years ago. Washington state was next. California was the same time as we were in 2016. So, yeah. So, as I said, 20% of the population of the U.S. are in states where they do have the right to inter-sisting DACA.
00:25:13.940Hmm. Okay. And was Switzerland one of the first places to have this? Because I'd heard of Switzerland for a while.
00:25:19.600In Switzerland, what happened was all the countries, most Western countries, had a law
00:25:27.460against suicide where people actually got put in jail if they'd failed a suicide attempt.
00:29:06.140You need to know what's available and how best to plan the end of your life, whether you want a natural death or an assisted death.
00:29:15.160So that's really part of informed consent for the whole end-of-life care.
00:29:25.040And in an ideal situation, that's part of the serious illness conversation by somebody.
00:29:35.140And, you know, it's not at the time of diagnosis.
00:29:38.680Usually, I told you that my friends who got their horrible diagnoses in the last seven years, that was one of their first thoughts was, I've got to figure this bad stuff out and make sure I have an exit if I get to a point where I can't stand it anymore.
00:29:56.360But it's not necessarily that you say to somebody, I'm sorry, your tests show that the cancer has spread, the chemo is not working anymore.
00:30:05.920and we need to talk about providing the best possible comfort for you
00:30:41.120No, I don't think that a diagnosis itself takes all your rights away because that's what you're talking about, right?
00:30:50.520So, as I said, I mean, just because you have a diagnosis of schizophrenia does not mean you have all your rights taken away for the rest of your life.
00:31:01.460Sometimes when you're acutely psychotic, you cannot make decisions for yourself.
00:31:07.040And illegally, your rights will be taken away from you.
00:31:10.180But once the acute psychosis is over, then you, like Marnie's stepson, you have total right over your own body and more.
00:31:22.640Do you have any comments for people who might be skeptical about this procedure or who might not understand it or something?
00:31:35.560Yeah, yeah. Just this is a basic right that people should have and luckily do in many places to help control their own dying.
00:31:50.360And so it's important that we have the safeguards in our law and in our standards and guidelines and so on to make sure that vulnerable people are not pressured.
00:32:08.380But we have those and I'm really confident that everywhere I've investigated and know about, like the European countries and Australia and U.S. and Canada, people take this very seriously and do their assessments carefully and are following the safeguards in our law.
00:32:35.460Okay. Dr. Ellen Wiebe, thank you very much for coming on. You said you had a website. Could you tell everybody what the website is if people want to find out more?
00:33:27.140Just go to nordvpn.com slash TMPP or use promo code TMPP for 61% off their premium plan and their free anti-malware feature, as well as NordVPN's 30-day money-back guarantee.
00:33:41.880Mark Pickering, welcome to my podcast.
00:33:44.500Thank you very much. Great to be here.
00:33:46.460Before we jump in, can you give a brief background about who you are and what it is you do?
00:33:50.620Great. So my name is Dr. Mark Pickering. I'm a GP, family practitioner by background. Most of the clinical work I do is in prisons and other secure environments. And I lead the Christian Medical Fellowship in the UK. So that's an organization of just under 5,000 doctors, nurses, midwives and students.
00:34:10.340So we try to help them live out their faith as Christians in whatever that means.
00:34:16.080And part of what we do is looking at public policy and bioethics issues.
00:34:19.940So things at the beginning and end of life are very important in that.
00:34:22.980So assisted dying is really important because there's a lot of pressure to change the law all around the British Isles.
00:34:31.020Okay. Okay. Well, let's delve into that a little bit.
00:49:49.380And I think there is a certain argument for that.
00:49:51.440But then you look at another country like Canada and you think, why has it gone so far, so fast, so quickly and really changing the culture very fast? And people will sometimes point to Oregon in the USA and say, well, they've had it since 1997. The law hasn't changed much. You know, that's the kind of law we want.
00:50:10.200but you can't promise that when you ask for Oregon
00:55:10.500Of course, it's dementia. It's hard to judge their mental capacity. It may fluctuate.
00:55:15.660And so then the family and the clinical team decided, OK, we're going to go ahead with it because that's what they said before.
00:55:22.340We'll give them some medication to make them drowsy. Then we'll give them further medication to end their life.
00:55:27.720The patient was actually refusing, fighting it off.
00:55:31.440And actually then someone held them down while the doctor euthanized them because they believed that that's what the patient would have wanted.
00:55:39.560And there was a criminal investigation there.
00:56:00.900Yeah, so my understanding is that quite a number of organs for transplant are now coming from
00:56:09.840patients with euthanasia. Clearly, if you have a medically controlled euthanasia, you can have
00:56:16.480everything set up to go. It may take place within a hospital. You could have an esthetist and
00:56:21.400transplant surgeons on hand so that the quality of the organs that you get is coming is actually
00:56:28.300very good you can have it very quickly between euthanasia and then organ harvesting now um and i
00:56:34.680understand that organs coming from euthanasia cases that the majority of those in the world
00:56:40.200are coming from canada now you can look at that and you say well you know isn't that a good thing
00:56:46.260because you know this patient wants to die but they want to contribute to help someone else live
00:56:51.960isn't that altruistic and yes it might be but then goodness what what sort of um conflict is
00:56:59.660that putting someone in to say well actually you know maybe i don't want to live or maybe my maybe
00:57:05.420i'm a burden on my family maybe i should ask for euthanasia oh and actually i could then give my
00:57:11.280organs to someone else who may benefit from them so there's an emotional pressure um that really
00:57:16.820shouldn't be there. We would quite reasonably be very upset to think that executed prisoners
00:57:25.740in China might be having their organs removed without their consent. But actually, if it's
00:57:31.440coming from euthanasia patients who might be influenced by that decision, then that could
00:57:37.720be a problem indeed. It doesn't have to be a massive problem, but you can see there's
00:57:42.580a real danger of that complicating the decision that the patient makes.
00:57:48.660That could easily complicate it if you're suffering from a mental disorder that's making
00:57:54.120you feel like a burden, like you said. So you already feel like a burden. You've had this
00:57:58.220mental disorder for 20 years. You're not getting the proper care. And hey, you can go out,
00:58:04.400stop your suffering and save some people. Yeah, absolutely. And mental illness is a
00:58:10.660massive problem within this situation. So I mentioned before that when the Canadian law
00:58:17.940changed a year or two ago to remove that reasonably foreseeable death criterion,
00:58:25.720then they put a clause in to say that in, I think, 2023, so coming up this year,
00:58:31.640then it would then open out to people who purely had mental health conditions as well.
00:58:36.520Now, there's been a lot of resistance to that more recently, I understand, and I think
00:58:43.780that's been paused, but I don't think there's been any intention to remove it.
00:58:49.340And I listened to a Canadian documentary recently by, I think it's a senator who was a psychiatrist
00:58:55.420who was the one who pushed for that clause to be inserted, and it was really quite frightening
00:59:00.960to hear him saying you know it's terribly it's terribly stigmatizing to people with mental
00:59:05.520mental illness you know they should have access to what everyone else does you know if it's good
00:59:10.080enough for other people mentally ill people should be able to get it as well and there's a terrifying
00:59:14.640cold logic to that as well but then you think goodness if your only problem is a severe depression
00:59:22.400or schizophrenia or a personality disorder if you are suffering mentally then you know how will that
00:59:32.140affect your decision making power you know how do we know that um some more time on treatment or
00:59:38.480some different treatment might actually make things a lot better and and i look after a lot
00:59:44.400of people with schizophrenia personality disorders in my clinical work and many of them have chronic
00:59:50.600suicidal thinking. So an emotionally unstable personality disorder that often goes along
00:59:55.940with self-harm, that could be present for 10, 20, 30, 40 years, and that person will
01:00:02.900every day feel like killing themselves. They may sometimes self-harm, they may sometimes
01:00:08.360attempt suicide, but that doesn't go away. There's no pill that you can give to necessarily
01:00:15.400remove that with psychotherapy. You may be able to help it significantly, help it to
01:00:20.440control it but once you say that a person in that situation should be eligible to say
01:00:25.960that's enough i you know i want to have euthanasia as well okay but you know how much
01:00:33.400are you um opening that up to other people whose suffering may be short-lived they may simply not
01:00:40.080have had good um psychiatric care there may be so much else they can do and then when people feel
01:00:45.460a burden, which is a massive reason why people opt for euthanasia, then you're not saying,
01:00:52.480no, no, don't feel like that, you know, you're not a burden, we will look after you, whatever
01:00:55.840it takes. Suddenly you change it. You say, maybe you're right, maybe you are a burden,
01:01:00.660maybe this would be a good thing. That's how you feel we agree with you. What does it do
01:01:05.360for suicide prevention in mentally ill people or mentally suffering people to change from
01:01:12.640saying whatever happens we will always support you to in certain circumstances we will actually
01:01:18.240help to kill you that's crazy yeah so yeah it it's crazy what are you working on specifically
01:01:28.800to kind of push back against this well i think one of the things in the british isles um is is
01:01:34.160really helping to show people the logical consequences of what they are proposing so
01:01:40.560here in the british isles or in the uk that the main campaigning organization is called dignity
01:01:46.240and dying and they're very focused on their campaign goals they say we only want um assisted
01:01:52.240suicide not euthanasia and we only want it for adults who are mentally competent so they they
01:01:59.920can make that decision genuinely that they're terminally ill and that they have less than six
01:02:05.760months to live and that's very tight campaign they've changed those campaign
01:02:10.620goals over the years because they've realized they've had many decades of
01:02:13.920being unsuccessful in changing the law and so now they're saying okay we're
01:02:17.820going to focus it down on this there's much more chance of getting a law passed
01:02:21.480through Parliament and there is because when you put it that way you say look
01:02:24.360this is just a small change just for a small number of people at the end of
01:02:28.020their life you know why would you force them to suffer but the trouble is there
01:02:32.900are other organizations who don't think they go far enough. Here in the UK, there's another
01:02:38.440group called My Death, My Decision that looks to Canadian euthanasia and says, that's great.
01:02:43.620That's what we want to have in the UK. So Dignity and Dying, I think, are being very
01:02:50.920naive or possibly something worse than that when they say, don't worry, if we get our
01:02:57.920law, then it won't extend further. Because you know there are people already campaigning
01:03:01.960to to push it further um you know we look and see in canada how how fast things have gone and why
01:03:09.160you know why would we think that things wouldn't go like that you know we're a similar country in
01:03:13.320many ways in terms of our culture and i think it's foolish to just believe that that wouldn't happen
01:03:19.320here even if it didn't go half as far or half as fast that would really worry me um and also when
01:03:26.920When we're looking at how the law can change in a country, it's really important to see, well, in the different jurisdictions around you, what are the rules that they're trying to put across?
01:03:40.460So in Jersey, for instance, they do what's called the citizen's jury, which is when you ask people from the population what they think should happen.
01:03:47.280and the general public are generally more liberal or more lax in the rules that they would have than
01:03:53.980politicians are because politicians at least have the professional responsibility to think
01:04:00.120what about the unintended consequences whereas most individual people just think well i'd want
01:04:05.160that for me or for my loved one and it's not their job to think well what could go wrong with this
01:04:10.220whereas for a politician you hope it is so dignity and dying were campaigning heavily
01:04:15.260in jersey to change the law and it's quite possible they may change the law now we're
01:04:20.800looking for waiting for some draft uh a draft bill to their parliament to look at but the
01:04:26.880citizens jury said we don't want just want assisted suicide we want euthanasia as well we don't just
01:04:31.700want it for terminals we want it for chronic illness and disability and some of the people
01:04:37.520in there in there said we want it for those under 18 those uh with dementia that sort of thing not
01:04:42.960all of those got through but it's a significantly wider law than dignity and dying actually
01:04:47.680were asking for so we often say be careful what you wish for okay mark i think that answers all
01:04:56.000my questions um i didn't know that about belgium so that's freaky it is um yeah yeah do you want
01:05:05.120to talk just a little bit about how faith impacts on that sure sure go ahead so i mean it's one of
01:05:11.260the common responses that people who are campaigning to change a law will say to someone
01:05:15.840like me, they say, oh, it's just because you're religious, you know, you believe in the sanctity
01:05:19.900of life. I don't believe in that. So, you know, your reasons don't matter. But then
01:05:25.440on the other hand, you have lots of religious people who say, well, you know, Jesus taught
01:05:29.600us compassion, you know, therefore we should relieve suffering. So the former Archbishop
01:05:34.920of Canterbury in the UK, George Carey, who's now in the House of Lords, he's a supporter
01:05:39.980of assisted dying but really interestingly he campaigns for dignity and dying who have that
01:05:47.020very tightly focused campaign but the actual situations the cases that changed his mind were
01:05:52.860people who had chronic disability and chronic illness they were not terminally ill so he even
01:05:58.540admits that the people that changed his mind the situations are not the ones that he's campaigning
01:06:03.740for. So, you know, of course he's going to, if he gets his law that he wants a tightly conscripted
01:06:11.120law, he's still going to want to have compassion on those other people who are going further. So
01:06:16.320you see that law change has got the seeds of its own expansion within it. But it's not about
01:06:22.080whether you have a faith, it's about how you apply that. And for many people, you know, the way I
01:06:29.120look at it is it's about making sure that vulnerable people are not put at risk by law
01:06:34.620that um that the autonomy of one group of people doesn't impact on the safety of others and these
01:06:41.500are just generic things you don't have to have a faith to understand that there are plenty of
01:06:45.900humanists and atheists who oppose to it as well so i think we must be really careful before writing
01:06:51.640off somebody just because they have you know one faith or another view or the wrong kind of view
01:06:57.260very often the the reasons behind um opposition to law change they are the same across all faiths
01:07:05.400and none okay i'm actually glad you brought that up because yesterday i was like okay mark pickering
01:07:10.880um and then you're you're part of it and i'm a christian but i didn't want the christian
01:07:17.000perspective on this because i was like so so many people will write that off right it's like
01:07:21.920but so i'm very glad you covered that um and i think everything you spoke about makes sense
01:07:28.440so thank you again is there anywhere i can lead people to online where they can learn more about
01:07:34.300this yeah absolutely so within the uk we've got care not killing.org.uk so that's an organization
01:07:40.740that i speak on behalf of uh for clinicians and health care workers there's a a linked group
01:07:47.400called ourdutyofcare.org.uk. And then for those working in parliament, dyingwell.co.uk,
01:07:57.080which is a group of parliamentarians in Westminster, particularly who are opposed
01:08:02.840to changing the law. So all of those have got great information on the links to other places.
01:08:09.880I'd really encourage people to go and have a look at those.
01:08:13.800Okay. Thank you very much for joining us.
01:08:15.880Michaela, you're very welcome. Thank you.