To view the video on YouTube , go here: https://youtu.be/B0z1XnuoSV0
CW: Suicide, ableism
In this vlog, we’ll explore the relationship between suicide prevention, disability, and assisted suicide, as well as the ways disabled people are endangered by policies that devalue our lives.
RESOURCES ON DEINSTITUTIONALIZATION WORK:
Project LETS: https://projectlets.org/advocacy
MindFreedom International: https://mindfreedom.org/about-mfi/
SOURCES:
1&2. APA Suicide Assessment Guidelines: https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/suicide.pdf 3. CDC Frequent Mental Distress survey: https://www.cdc.gov/mmwr/volumes/69/wr/mm6936a2.htm?s_cid=mm6936a2_w 4. Prejudice against disabled people: https://www.c-q-l.org/resources/articles/most-people-are-prejudiced-against-people-with-disabilities/ 5. Osteoarthritis stats: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2920533/#:~:text=pain%20and%20disability.-,Osteoarthritis%20(OA)%20is%20the%20most%20common%20joint%20disorder%20in%20the,%25%20in%20women%20(2). 6. Disability, vulnerability, and assisted death: https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-019-0426-2 7. Oregon “Death With Dignity” Act 2020 Report: https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year23.pdf
TRANSCRIPT
– Hello, and welcome back to the “Not Dead Yet Vlog”. My name is Jules Good. I use they/them pronouns, and I’m the assistant director and policy analyst at Not Dead Yet. I’m a white person with short, brown hair. I wear black hearing aids with pink molds in them. And today, I have on a blue and white houndstooth pattern button down shirt.
September is Suicide Prevention Month. During this month, we share stories of loss, grief, survival, and resilience. We share resources about where to get help if a person is feeling suicidal. We talk about suicide so that people struggling with suicidal thoughts feel more comfortable sharing their stories and seeking help. But one thing we rarely see discussed during this month is the relationship between disability, suicidal ideation, and assisted suicide. That’s what we’re here to explore today.
Let’s explore two scenarios. The first will feature a non-disabled person, and the second will feature a disabled person. While other factors like race, gender, and size, among others, certainly impact the way patients are treated, let’s assume for the sake of this hypothetical scenario that the only difference between these two patients is their disability status.
In scenario one, we have a person who does not have disabilities other than mental health challenges. This person shows up to the hospital with an intent and plan to die by suicide. Maybe they’ve already made an attempt, and have been brought to the hospital by someone else. When this patient is admitted, they are evaluated by a medical professional. This evaluation includes several core components to learn more about the patient’s current state and prior history. These include current plans for suicide, current and previous diagnoses or presentations of psychiatric illness, history of prior suicidal behavior, potential external triggers for the current episode, and the strengths and vulnerabilities the patient has that will inform a treatment plan. Based on the information gathered from the evaluation, the medical professional will prescribe a treatment plan to the patient.
The treatment plan gives the patient instructions, and hopefully support for recovering after a suicide attempt. Sometimes, the patient may choose to stay in the hospital or another inpatient facility, but they should not be forced to do so. Other parts of a treatment plan could be medication interventions, types of psychotherapy, and management of external factors in the person’s life that could trigger future suicidal ideation. The treatment plan is enacted. If the person completes the plan, they can go back to their normal life, hopefully with more tools and resources for managing their mental health. Sometimes, a person may face additional challenges in completing the plan, so the plan is revised, and the person may continue receiving care.
People face many, many barriers in accessing appropriate care after a suicide attempt, including but not limited to forced institutionalization. We can’t cover all of that in this video, but we will link some resources down in the description so you can learn more about these issues and the amazing work being done to combat them.
Now, let’s talk about person two. Person two has a disability that significantly impacts their ability to independently perform activities of daily living, such as feeding themself and using the bathroom. They land in the hospital after a medical event unrelated to mental health. Even if they did not come into the hospital with psychiatric symptoms, the American Psychiatric Association recommends that the patient should potentially undergo a suicide assessment. They cite, quote, “Functional impairments, pain, disfigurement, increased dependence on others, and decreases in sight and hearing,” end quote, as a risk factors for suicide. Now, this is not a wholly unfounded assumption. A 2018 survey of more than 430,000 US adults found that respondents with disabilities were over three times more likely to experience, quote, “Frequent mental distress,” than respondents without disabilities. The problem with these studies is that they draw surface-level correlation between having a disability and being suicidal, when in reality, the barriers disabled people face as a result of living in an ableist society often cause more emotional distress than the disability itself. It is understandable that hospitals would see this data and want to perform a suicide assessment on disabled patients as a preventative measure, since we are much more likely to struggle with, quote, “mental distress”.
But there’s a big difference between using data trends to inform care decisions, and reinforcing the assumption that disabled people must want to die because our lives are so tragic and difficult, an assumption rooted in ableism. For example, osteoarthritis, a joint disorder, is more common in women than in men. But if a woman showed up to the hospital with zero symptoms of osteoarthritis, it would make no sense for doctors to start testing for it rather than managing the issue at hand. It takes time and attention away from the care the patient actually needs in that moment. The same can be said about assuming suicidality in disabled persons.
But what about when a disabled person actually does want to die by suicide? Since we have all this data showing that disabled people are more likely to struggle with mental distress, we should have excellent care measures in place for disabled people who present as suicidal. But in reality, a disabled person’s desires to end their life maybe validated or even encouraged by medical professionals in places where assisted suicide is legal, especially if they have a serious or advanced chronic condition. In short, assisted suicide is death by lethal drugs requested by a person, and prescribed by a medical professional. A person can die by assisted suicide if they feel that the physical pain and/or the emotional struggles of living with a serious illness or disability are too much to live through. If the doctor agrees, the doctor can write a prescription for a medication that will kill the person quickly.
Many proponents of assisted suicide say that it is not the same thing as traditional suicide because people who die this way want to live, but feel they can no longer endure their illness or disability. However, you could make the same argument for unassisted suicide. People who die by suicide don’t want to die for no reason, but rather, because they feel they can’t continue to live given their circumstances. Both assisted and unassisted suicide produce the same result, the intentional, self-inflicted death of a person. The actual and far more dangerous distinction between assisted and unassisted suicide is that the former is deemed a rational response to illness or disability, while the latter is usually seen for the tragedy it is. Therefore, when a disabled patient expresses suicidality, it is seen as rational.
Let’s examine how this puts disabled people at risk. First, we have to acknowledge that if a person meets the criteria for pursuing assisted suicide, they are disabled, whether they identify that way or not. We’ll get into the nitty gritty of the assisted suicide process in a future video, but for now, just bear that fact in mind. One of the first steps in the process is that the doctor who prescribes lethal drugs determines, quote, “That the patient is capable and not suffering from a psychiatric or psychological disorder or depression causing impaired judgment,” end quote. Based on reports about people who died by assisted suicide in Oregon, in only 3% of cases was this determination made by a psychological professional.
We can see that quote, “impaired judgment” is a subjective criterion. If the doctor or professional evaluating the patient holds true the ableist notions pervasive in our society, that disabled people are burdens, that our care needs or society’s failure to meet those care needs makes us unable to live happy lives, that our conditions are humiliating, then when a patient gives those reasons for wanting to die, the doctor or professional will not consider that as evidence of impaired judgment. They will write suicidality off as a logical conclusion to being disabled.
The illustration by Toujours Vivant, or Not Dead Yet Canada, pointedly sums up the disability double standard in treatment of suicidality. Illustration is a cartoon drawing depicting a person using a power wheelchair. On their left is a set of stairs leading up to a door with a sign above it marked, “Suicide Prevention Program”. On their right is a ramp that is marked as wheelchair accessible, leading up to a door with a sign above it, marked “Assisted Suicide”. The person’s wheels on their wheelchair are pointed toward the ramp up to the door that says “Assisted Suicide”. It will always be easier to let us die than to give us the tools we need to live. It will always be more cost effective to prescribe us a lethal drug, than a course of treatment. And for these reasons, it will always be dangerous for disabled people to live in a society where assisted suicide is legal. Suicide does not have to be our fate. Thank you for watching. Please visit www.notdeadyet.org to learn more about our work. Bye.