Angela S. Guarda, a professor of psychiatry and behavioral sciences at the Johns Hopkins School of Medicine, quoted in "Should anorexia ever be called ‘terminal’?
One doctor argued yes, igniting a furor over hope, self-determination and treatment in the world of eating disorders" (WaPo).
Another quote, from Joel Yager, professor emeritus at the University of Colorado School of Medicine: "All we were pointing out in our article was to be sensitive to end-of-life issues for people with anorexia. I can’t discount someone’s unwillingness to stay alive. People who say, ‘I can’t do this anymore’ have to be respected. You’re harming and infantilizing patients who can think for themselves."
ADDED: Please understand that this is an article about physician-assisted suicide. It begins with the story of a woman who received a life-ending injection:
In 2011, when she was 21, Esther registered with The Hague-based End of Life Clinic (now the Euthanasia Expertise Center), which provides physician-assisted suicide for patients who meet the requirements of the Netherlands’ Termination of Life on Request and Assisted Suicide Act. Before accepting a patient’s request, the physician must, among other things, be satisfied that it’s voluntary, well thought out, and that the suffering is “unbearable and that there is no prospect of improvement.”...
That's in the Netherlands. In the United States, no state permits euthanasia for psychiatric conditions.
Terminal anorexia isn’t an official diagnosis in the Diagnostic Statistical Manual-5, the psychiatric bible. And the eating disorders community hasn’t reached a consensus on the definition of severe and enduring anorexia....
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42 comments:
There are many problems in this world that do not have pleasant solutions. It is common for certain persons to claim that they can solve these problems, even though they cannot. Some of these people are themselves deluded, and imagine that they can help others. Some of them are simply con artists, and are well aware that they can't solve the problem. They merely want to profit from other people's suffering. I suppose the dividing line is not sharp.
--- "You’re harming and infantilizing patients who can think for themselves."
No, heavens no. Mustn't treat those patients as sick -- they are perfectly capable of starving themselves to death and no stupid doctor should get in the way of their sovereignty. In fact, stop calling them patients at all. You dishonor these self-extinguishers.
Shades of R.D. Laing. All the old bad ideas of two generations ago have returned. The freedom and self-discovery of psychedelics. Madness as normalcy. Starvation as a rational choice. Go for it, professor emeritus Yager. Why not be an a terrible ass on your way out. Maybe you've been one all along.
But these people are living in a fat person's body.
Why don't we support them with lap band surgery and diet pills?
We must believe them when they tell us who they really are.
If not, you are a bigot.
"All we were pointing out in our article was to be sensitive to end-of-life issues for people with anorexia. I can’t discount someone’s unwillingness to stay alive. People who say, ‘I can’t do this anymore’ have to be respected. You’re harming and infantilizing patients who can think for themselves."
This is someone who's abandoned the concept of mental illness. I wouldn't trust such a person.
I had a friend, now long since dead whose adult daughter, aged 33, died of anorexia. She left two small children. The friend, his wife, and the daughter's husband all agreed that the surviving husband could not or would not take care of the kids. So Jim and his wife got to raise their grandchildren to an adult age. So don't tell me that anorexia may not be terminal. Well that's the 20th century.
But long ago (I've been reading the Annals of Tacitus recently) starvation was offered as a gentler form of suicide. It was during the reign of Nero. His mother or Aunt--Messalina--makes Hillary Clinton look like an innocent child. Nero or Messalina got put out by some Roman Senator and ordered that the Senator commit suicide. The Senator's friends petitioned Nero asking that the Senator be allowed to die from starvation. No dice--the Senator had to choose a quicker method.
Remember when medicine was a branch of the sciences? Ah, well...
Wasn't this the malady that was shown to be one of those mass psychoses type things? A lady's magazine wrote an article and then suddenly an epidemic of anorexia nervosa was sweeping the land, in a certain age group? Not trying to trivialize the illness in any way, nor am I trying to deny it exists. It doesn't seem like the kind of illness that should be constructing a protocol for 'end of life' though. If you don't understand something, then your work isn't done.
It is her Choice to self-abort in darkness. The issue is if Choice should be assisted, even celebrated with diversity - number, not color.
You featured a tick tok star that died of starvation recently.
I understand the lure- but, it’s definitely an illness.
As a father whose 22-year-old daughter is still in the midst of the battle after seven years, I can certainly see the false allure of allowing people to give up the battle and drift off into nothingness. As parents, we always have to balance the desire for a bright future with the reality that this is a lifelong disease that can at times get better, but also at times get worse over decades. The constant worrying is beyond tiring. I think any researcher that gives the message that “giving up and committing the slow suicide” is in any way legitimate is a dangerous researcher.
If a person has body dysphoria.. WHO can tell THEM, what sort of "body" they should have?
Let them diet themselves down to the body they WANT! it's THEIR body!!
A combination of appetite suppressants, liposuction, and stomach stapling will HELP Them get the body shape, THEY KNOW is Right for THEM.
WHAT do you want? a living skeleton or a unhappy "normal" girl?
Is it being the pale for me to assume our host is only partly talking about anorexia?
And by the way...
a gentle, easy death
What the hell? Is there sedation involved? I remember a friend's mother's dying of cancer in a state of quiet euphoria, which her doctors chalked up to the pain relief medications and the shutdown of her kidneys, which - my friend says the doctors said - may have allowed toxins, sort of like psychedelics, to circulate through her system.
But starvation? I haven't ever heard that's anything other than slow misery. You're just too weak to complain.
So a person who is starving him or herself to death because he or she viewed him or herself as too fat is a "person who can think for themselves?"
Anyone who is "unwilling to stay alive" who is not quadriplegic is quite free to end their own life. Is misguided and regrettable as this may be, it is always an option for them, and all the laws in the world won't change that. What is morally objectionable is making it a supposed medical procedure. Killing people is not a proper role for medical professionals.
Back in the 70's I worked as an attendant on locked psych wards and anorexia always felt weirder than the other conditions, so agree with "Anorexia is a very unusual disorder". I'd love to know the criteria used in the second quote for determining "patients who can think for themselves". In my anecdotal experience with anorexia there's a lot of thinking going on, but in a driven, sort of possessed, way. Definitely thinking for themselves, but pretty much all on the negatives of themselves and others.
The field of Medicine in this country has fallen so far in a mere generation. Doctors used to be about treating illness, not enabling it. Now they are affirmatively taught to be ghouls. I say this as someone with multiple doctors in the family.
In the big book of alcoholism they talk about an “incomprehensible demoralization”. This description of the anorexic in this post is similar to the description in the chapter “more about alcoholism”.
I’m on the road right now so the phone won’t let me copy paste. But I recommend you check it on your own and see if you see what I see. I could be wrong.
link to ”more about alcoholism”
It is varied. We should therefore be wary of people who say they understand what is happening in any individual's emotions. Tied up in identity? I have heard this claimed many times, but I don't think I was fully convinced of that in any of my patients. It's one of those things you can "see" via confirmation bias, but if you approach skeptically, it vanishes. People are sure it is about sex, or a form of OCD, or self-esteem. I do believe it can become part of your identity, but then so can an amputation, or obesity, or metabolic syndrome, or cancer. That doesn't mean it was ever identity based to begin with.
It is frustrating for providers, because so many patients are treatment-refractory, so we get these extreme reactions from the providers.
Pity the parents who have to go through this. If it's cancer, or another random disease, they don't have the added burden of blame.
I've known a few anorectics. Two were lovely and fought and overcame it. But the others seemed vindictive and co-dependent, almost as if to punish their parents.
But who really knows what goes on in other families?
"So don't tell me that anorexia may not be terminal."
Yes. The article is clear that anorexia is often fatal, but the question here is whether doctors should declare it "terminal" and thus make the patient eligible for physician-assisted suicide.
We're not just talking about whether an anorexic person might starve to death or even whether doctors should accept the person's decision to seek death through starvation. We're talking about whether doctors should participate in euthanasia.
"In the big book of alcoholism they talk about an “incomprehensible demoralization”. This description of the anorexic in this post is similar to the description in the chapter “more about alcoholism”."
Presumably, you would never accept the choice of an alcohol to seek euthanasia. You might want to say the mental capacity to decide is inherently missing.
Euthanasia has proven to be the slipperiest of slopes. Every county that legalized it immediately began expanding criteria for approving it. In the Netherlands, a 29-year old with mental health issues was euthanized despite being physically healthy. In 2017, 83 of the almost 6600 euthanizations there were for mental illness alone. Autism counts as one condition for approving euthanasia. In Canada it's even worse. One family failed to get their brother out of a hospital that was pressuring him to sign euthanization papers -- the form he signed listed only "hearing loss" as his need to die. Euthanasia teams encourage chronically ill and disabled people to kill themselves. And there are no medical oversight teams reviewing cases as there are in European countries. One elderly Canadian woman was euthanized because of her extreme loneliness due to Covid restrictions. Most countries dropped the "terminally ill" requirement immediately.
Canada's rates are skyrocketing: from 10,000 in 2021 to more than 13,000 in 2022. If the same population percentage occurred in America, 140,000 people would have been euthanized here in 2022. And Canada is expanding its definitions yet again.
Justin Trudeau locked up his citizens for longer and more fiercely than any other Western nation and now is encouraging them to die. Yet the Catholic Joe Biden thinks he's great.
"Angela S. Guarda, a professor of psychiatry and behavioral sciences at the Johns Hopkins School of Medicine..."
Angela Guarda = Guardian Angel. Hmm. ¿Ángel de la muerte?
MAID in Canada:
Canada is expanding categories for medically assisted death (NPR)
"Canada has allowed terminally ill patients to end their lives with medical assistance since 2016. And eventually, even as early as next March, Canadians living with severe mental illness could also be eligible under the law known as medical assistance in dying, or MAID. But as you might imagine, that has raised many difficult ethical and moral questions, both about the motivations of health care workers who might offer the option and also about the competence of patients who might request it.
We suspect that this is the kind of dilemma that might resonate across borders. So we called Dr. Madeline Li to walk us through some of these thorny issues. She is a cancer psychiatrist who works in end-of-life care. And Dr. Li actually developed the medical assistance in dying program for the University Health Network in Toronto, Canada...."
Much more at the link.
Condensed excerpt from the aforementioned article:
"MARTIN: Who can currently request medical assistance in dying in Canada?
LI: The issue in Canada is that it's actually never been clear who assisted dying was intended for...It's unlike the States where - in the States where it's legal, assisted dying is only for terminal illness and people who have less than six months left to live. So their deaths would occur whether they were medically assisted or not. In Canada, it was always the case, from the beginning in 2016 when it was legalized, that people with chronic diseases who still naturally could live for several years were qualifying for assisted dying.
MARTIN: And so do you have a sense of how many people in Canada have taken advantage of this option since it became legalized?
LI: There have been - over 30,000 people have received assisted dying since it was first legalized - 10,064 patient (ph) in 2021. That accounts for 3.3% of all deaths in Canada.
MARTIN: What is being contemplated here in expanding the program? And how does mental illness play into it?
LI: Assisted dying has been legal since 2016. And then, in March of 2021, it expanded so that you no longer needed what was called a reasonably foreseeable natural death. They excluded, specifically excluded, situations where a mental disorder was the only medical condition that was causing the suffering. And it was introduced originally because they felt that this was a more complicated group, and we needed more time to figure out how to safely assess and provide MAID to people with mental disorders. And that is now set to expire in March of next year. And so patients with only a mental disorder as the basis of their suffering can request and receive MAID if they meet all the eligibility criteria."
Kind of a very passive way to leave. Don't you think? Alcoholism is an agressive way to die slowly. Sort of," I'll show you bastards!" one bottle at a time.
As adults we all have agency until we prove we don't. Anorexia is proof that there is a mental disorder involved.
Me? I ain't goin' without a fight.
rrsafety: I am sorry that your daughter is struggling with anorexia, that sounds like a really painful struggle for you, too, as a parent. Sending up a prayer right now for peace and healing for her and for all who love her.
We're not just talking about whether an anorexic person might starve to death or even whether doctors should accept the person's decision to seek death through starvation. We're talking about whether doctors should participate in euthanasia.
... and ...
Presumably, you would never accept the choice of an alcohol[ic] to seek euthanasia. You might want to say the mental capacity to decide is inherently missing.
And yet, I understand that coming to Canada in February: adjustments to MAID to permit euthanasia for people whose only complaint is a mental illness.
I have read that surgeons are psychopathic at rates higher than the general population. Some few of them just like to cut, and fortunately have found a way to turn that desire into something that benefits others, even if they themselves don't particularly care about that benefit because of their personality disorder. It wouldn't surprise me to find that there are some few non-surgeon doctors who kind of get a charge out of being present at a death, and for society to provide a means for those few doctors to cause death... well, it seems like a terrible idea to me.
In fact, if memory serves, one of the Canadian docs in the forefront of their euthanasia movement is a woman who used to be a surgeon, but who decided she could "do more good" - or something like that - by getting involved with "end of life care" through MAID.
Please know that I have the greatest respect for medical providers at all levels who provide hospice care - to be allowed to die with dignity, at home, surrounded by loved ones, and with as little pain as possible is a gift that people dying of terminal illnesses just fifty years ago often weren't afforded. And I'm not a fool - I realize that doctors have always, quietly and in particular cases, been called on to help a dying patient travel that road a little faster. I'm just deeply worried about transmuting compassion into action, especially for people not in full command of themselves, and doing so by means of government panel.
Sorry, March is when Canada affirms mental illness alone as a criterion for MAID, as others have pointed out.
rrsafety, best wishes for your family's triumph over your struggles, and especially for your daughter. I am a person of faith, but if you're not, I hope you'll forgive my presumption when I say that I pray that she may always fight with the strength and determination of heroes.
"Progressivism" is a death cult and it's only getting warmed up.
Tina Trent said...
Euthanasia has proven to be the slipperiest of slopes.
Yeah. . . .I've been torn on this subject for years. It feels cruel to me that a person who is terminally ill and in pain or long-term severe disability is not allowed to end their own suffering. But then, it's a given that it'll be abused. I suspect that's where the taboo came from, at least in the West.
My mother was in a nursing home for three years after a stroke which debilitated her. She hated it and was miserable. Eventually after yet another bad UTI, she quit eating, drinking, and taking her meds, and lasted only a few days. I respected her for that, as sad as I was that it had come to that.
"Elon Musk:
"The real battle is between the extinctionists and the humanists."
I am not necessarily against assisted suicide, but I think I have an idea for how it should be administered. As we are seeing in many places, the profit motive, or the cost motive, very quickly and insidiously begins to assert itself in the formulation of criteria and decision-making. You'll notice that in nearly all of these cases, the families and sometimes the patients have been taken by surprise by the lack of procedural obstacles and the professional enthusiasm for proceeding with the plan of death.
Here's what I propose: A very strict set of rules are inflexibly put in place for any 'assisted suicide' program. There are some people that wish to end their life for a variety of personal reasons, like terminal unendurable pain; Fine.
Then, to remove the administrative impulse to meddle, to eliminate the profit/cost motive, and to constrain the morbidly diabolical 'death-cult'-minded, any changes to criteria, process, or decision-making must be proposed by the person advocating it. One person. And the changes can't be adopted until that person agrees to be the very first candidate to by 'assisted' onward under the new rules.
"Elon Musk:
"The real battle is between the extinctionists and the humanists."
11/2/23, 10:31 AM
Well, this is odd coming from Elon, since I am still suspended from Twitter/X for expressing concern for the life of a young woman who was severely anorexic. I'm accused of committing "violent speech" for saying that her life was in danger. Seriously.
I can kinda / sorta identify. I've experienced essential tremor since high school (73 now) and even though I've chased down multitudinous remedies and am currently taking a couple of drugs, I just expect to shake. I just know that I can't pick up a full cup of coffee. Must not try to eat soup in public. I can only drink a can of soda / beer / whatever using both hands. I KNOW every new thing I try will not work. Sometimes, if by some fluke, I find myself NOT shaking, I will immediately start to shake, so it must be at least partially psychosomatic.
Having written all that, I'm certainly not ready to end it all. It's a pain in the ass, yes, but, hey, it is part of who I am.
"Alcoholism is an agressive way to die slowly. Sort of," I'll show you bastards!" one bottle at a time."
As an alcoholic, I am not sure I have ever seen a more succinct or accurate description of my personal demon. Thank you.
I'm accused of committing "violent speech" for saying that her life was in danger. Seriously.
That sounds like a failure of the algorithm. I hope it gets cleared up fast - if what you said is as you describe, it obviously shouldn't have resulted in your suspension!
Dan, one day at a time! Down with the demon!
It was as I said, and I appealed, but have yet to hear from them. It's been well over a month (Sept 18). I suspect my offense was saying that she needed to "see herself as she really is", which is dangerously malnourished. Apparently the X algorithm doesn't allow comments that question people's self-perception, even when it's life-threatening.
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