Discussion Mental capacity and suicide- a theoretical legal quandary.

[Forever Sleep]

So, on the phonecall to the crisis team, following my wellfare check, I emphasized that I didn't have immediate plans to kill myself- It was something I purchased to give me an 'out' later in life- if I get some debhilitating illness. The person on the line said something about 'mental capacity' which rattled me- I'm not sure if they were questioning my mental capacity now- or- later- if I decide to do it. Obviously- I'm concerned about being sectioned. I really don't think they would section me- but I also really didn't think they'd bother with a wellfare check- so- everything is troubling me now!

What I'm trying to get at is- I think at most- I have mild depression. I'd be utterly furious though if someone said that meant I didn't have mental capacity. My solicitor didn't question my mental capacity when I drew up my will. Employers haven't questioned it either. While my job isn't terribly responsible- there will be people out there with mild depression and much worse who have massively responsible jobs- which affect the safety of other people's lives. If we're not considered capable to make decisions for ourselves- then really- we shouldn't be responsible for the safety of others and we all ought to be on benefits.

Anyhow- that's off the point. What I really wanted to get into with this person was- Does someone wishing to kill themselves automatically mean they don't have capacity?

The Mental Capacity Act has the following criteria that a 'capable' person needs to achieve:

• Understand information given to them
• Retain that information long enough to be able to make the decision
• Weigh up the information available to make the decision
• Communicate their decision – this could be by talking, using sign language or even simple muscle movements such as blinking an eye or squeezing a hand.

They also mention being able to appreciate the situation in terms of its likely consequences.

I'd say likely all of us fulfill this criteria. Perhaps they will argue that we're mentally ill but I'd want them to prove that before I accepted it. Prove that my brain is defective to the point where I can't make decisions for myself.

My argument is I think you CAN have mental capacity- even with a mental illness. Put it this way- I've been around people with dementia. Sometimes- granted- they ARE confused. Other times though- they are obviously lucid. They understand what you are asking and can make decisions. I suppose these pro life people assume that ideation occurs in non lucid moments. But I've had ideation for 33 years- whether I was happy or sad! Could I really have been crazy all that time and no one noticed?

For me- my suicidal thoughts AREN'T frightening and they AREN'T intrusive. They seem logical to me. So- why would CTB ever be the wrong choice for me? Basically- I decided it was a reasonable choice FOR ME when I was 10.

Of course- I realise it wouldn't be a reasonable choice for those around me. It would likely hurt them very deeply. That's why I'm still here! I've done what that Mental Capacity Act talks about- assesed the situation- that my action could well have very bad consequences for those around me- so- held off for now- until those people have passed on themselves.

Still- the decision in terms of being reasonable/ unreasonable I have already made. It doesn't mean I'll ever do it necessarily but I really refute this notion that the moment you become suicidal- you have lost perspective and capacity (and autonomy.)

What I've taken a very long time to get to is this theoretical thought experiment- OBVIOUSLY I don't intend to do it! If you could somehow persuade these officials- ie. healthcare professionals that you DID have mental capacity IN SPITE of wanting to kill yourself- COULD they actually stop you? (Of course- I'm sure they'd still try to...) Suicide ISN'T illegal in most countries. People I imagine are usually stopped and sectioned if they are caught in the act but if you could prove you had capacity- how could they justify stopping you? Does the actual act of doing it suddenly propel you into the realms of insanity?!!

 

[LaVieEnRose]

Of course mental capacity and mental illness aren't mutually exclusive but a crisis team isn't going to be inclined to say that.

Even those old studies yielded the statistic that has traditionally been cited that only 90% of people who kill themselves suffered from a psychiatric disease. Even if that is true (which is plenty doubtful) 10% is not negligible. And it was the people entrenched in the System who came to that conclusion.

Any honest psychiatrist or psychologist examining you would easily conclude that you are rational.

 

[timetodie24]

I'm sorry it sounds like such a stressful situation with the welfare check and now the crisis team too.

Mental health services often throw around the word 'capacity' a lot without really understanding the actual meaning. (Often they actually say they can't do anything because someone has the capacity to end their life when they've begged for help. Which is another story but always makes me angry. They're the ones encouraging suicide ). And when people are sectioned it's actually under the Mental Health Act (which is different to MCA).

You can be detained under MHAIf you have, or are thought to have:

1. a mental illness which needs assessment or treatment which is sufficiently serious that it is necessary for
   a. your health or safety, or
   b. for the protection of other people
2. you need to be in hospital to have the assessment or treatment
3. you are unable or unwilling to agree to admission.

In my experience, you're unlikely to be sectioned for having a plan. Some people have but that's usually due to other history or other things going on. I was sectioned after barely starting an attempt but only because my mental health team had already been considering MHA after multiple previous attempts and serious self harm. Even if you have a MHA assessment doesn't mean they would section you, it requires like 2 doctors and 2 social workers i think.

Basically if someone caught you in the act then i think regardless of capacity they can stop you. Like section 136 if in a public place police can detain you and take you to hospital. As long as they have reason to believe you hVe mental health issue (obviously attempting is reason to believe that). But then whether hospital take it any further depends on capacity. And that's where it gets confusing. Like generally mild depression isn't enough to be sectioned under MHA, not even attempts are in many cases. BUT if you ended up in hospital after an attempt, most drs would say any mental illness is a reason to not have capacity . Even if you can weigh up decisions rationally, they may argue that your decisions are swayed by depression.

There was a famous case years ago where a women with BPD was believed to have capacity so they didn't give her lifesaving medical treatment her after she poisoned herself. But there was a lot of debate after it and i think now most hospitals would treat you if they believe your mental illness caused you to attempt.

TL:DR - the laws around MCA and MHA are confusing and many professionals don't even understand them. If your sectioned it's under MHA not MCA. MHA is for MH treatment and MCA is physical from what i understand. Non immediate plans with means is very likely to be insufficient justification for either acts

 

[Forever Sleep]

I'm sorry it sounds like such a stressful situation with the welfare check and now the crisis team too.

Mental health services often throw around the word 'capacity' a lot without really understanding the actual meaning. (Often they actually say they can't do anything because someone has the capacity to end their life when they've begged for help. Which is another story but always makes me angry. They're the ones encouraging suicide ). And when people are sectioned it's actually under the Mental Health Act (which is different to MCA).

You can be detained under MHAIf you have, or are thought to have:

1. a mental illness which needs assessment or treatment which is sufficiently serious that it is necessary for
   a. your health or safety, or
   b. for the protection of other people
2. you need to be in hospital to have the assessment or treatment
3. you are unable or unwilling to agree to admission.

In my experience, you're unlikely to be sectioned for having a plan. Some people have but that's usually due to other history or other things going on. I was sectioned after barely starting an attempt but only because my mental health team had already been considering MHA after multiple previous attempts and serious self harm. Even if you have a MHA assessment doesn't mean they would section you, it requires like 2 doctors and 2 social workers i think.

Basically if someone caught you in the act then i think regardless of capacity they can stop you. Like section 136 if in a public place police can detain you and take you to hospital. As long as they have reason to believe you hVe mental health issue (obviously attempting is reason to believe that). But then whether hospital take it any further depends on capacity. And that's where it gets confusing. Like generally mild depression isn't enough to be sectioned under MHA, not even attempts are in many cases. BUT if you ended up in hospital after an attempt, most drs would say any mental illness is a reason to not have capacity . Even if you can weigh up decisions rationally, they may argue that your decisions are swayed by depression.

There was a famous case years ago where a women with BPD was believed to have capacity so they didn't give her lifesaving medical treatment her after she poisoned herself. But there was a lot of debate after it and i think now most hospitals would treat you if they believe your mental illness caused you to attempt.

TL:DR - the laws around MCA and MHA are confusing and many professionals don't even understand them. If your sectioned it's under MHA not MCA. MHA is for MH treatment and MCA is physical from what i understand. Non immediate plans with means is very likely to be insufficient justification for either acts

Thank you so much for clarifying all of this. It's got to be a minefield for them to decide. I can see it from their point of view.

Plus- yeah- the whole- 'it was their illness that made them do it' sounds familiar. I suppose- if you're caught mid-act- the safest thing for them to do is to try and stop you. I guess I can see it from an outside perspective how the wish and action to end your life may look mentally unstable. I guess they have to make sure so- yeah- I see what you mean. You can be sectioned under the suspicion of being unstable if it looks like you'll do yourself or others harm.

Phew- thank you for clarifying all that. I'd find it really extreme- and a complete waste of resources if they did try to section me. Still- there's just something about talking to these people that makes you wonder how much power they have. I'm starting to see why people just outright lie to them to get rid of them. They haven't phoned again though- so hopefully, they'll just forget about it all now.

I expect I sound really awful and mean. I shouldn't really be bashing them so much. Perhaps they do do good. I didn't give them a chance but- that's surely my choice also. Treatment- meds/ therapy really ought to be optional.

Really- I should have just tried to get the police to go without them refering me but it didn't seem like they were at all happy with that. Seeing as they at least let me keep the SN- I thought it would be better for their peace of mind if they bundled me off onto the crisis team. It wasn't really their fault either- because they obviously have a job to do and need to tick certain boxes. I expect most people who call them actually want their help but perhaps referrals aren't quite so willing. I expect they're busy now with all this business! Makes you wonder just how many customers IC had. Really- again though- it probably would have been better if I'd outright lied. It's weird though- how does that help us as a society if we can't be honest?

I'm so sorry for your experiences. Was it frightening? Did it help you or make things worse? Out of interest- only if you feel like sharing of course.

Thank you for your response.

 

[Valky]

Wait, you told them you have the SN for no other reason other than ctb (not implying that you will) and they let you keep it??

 

[timetodie24]

Thank you so much for clarifying all of this. It's got to be a minefield for them to decide. I can see it from their point of view.

Plus- yeah- the whole- 'it was their illness that made them do it' sounds familiar. I suppose- if you're caught mid-act- the safest thing for them to do is to try and stop you. I guess I can see it from an outside perspective how the wish and action to end your life may look mentally unstable. I guess they have to make sure so- yeah- I see what you mean. You can be sectioned under the suspicion of being unstable if it looks like you'll do yourself or others harm.

Phew- thank you for clarifying all that. I'd find it really extreme- and a complete waste of resources if they did try to section me. Still- there's just something about talking to these people that makes you wonder how much power they have. I'm starting to see why people just outright lie to them to get rid of them. They haven't phoned again though- so hopefully, they'll just forget about it all now.

I expect I sound really awful and mean. I shouldn't really be bashing them so much. Perhaps they do do good. I didn't give them a chance but- that's surely my choice also. Treatment- meds/ therapy really ought to be optional.

Really- I should have just tried to get the police to go without them refering me but it didn't seem like they were at all happy with that. Seeing as they at least let me keep the SN- I thought it would be better for their peace of mind if they bundled me off onto the crisis team. It wasn't really their fault either- because they obviously have a job to do and need to tick certain boxes. I expect most people who call them actually want their help but perhaps referrals aren't quite so willing. I expect they're busy now with all this business! Makes you wonder just how many customers IC had. Really- again though- it probably would have been better if I'd outright lied. It's weird though- how does that help us as a society if we can't be honest?

I'm so sorry for your experiences. Was it frightening? Did it help you or make things worse? Out of interest- only if you feel like sharing of course.

Thank you for your response.

Nah you don't sound awful and mean at all. They obviously think they're helping but I don't think they consider how frightening it can be for this to happen out of the blue, and to feel as though your own choices and freedom is taken away. For many people, it's comforting to have their plan there and it can be hard when that safety net is taken away or threatened. Yeah I agree police like to refer to crisis team to tick a box. But crisis teams are generally overstretched and understaffed as it is so usually want to move on as quick as possible to next caller. So I think they're unlikely to call again.

i didn't find being in hospital helpful personally. It didn't really make things worse overall but didn't help. It was just lonely and boring. Didn't have any therapy there, just changed meds . Some staff had awful attitudes but weren't abusive, so i think i was actually pretty lucky. It's sad that ' i wasn't abused' is a surprising and really positive thing when it comes to psych wards . The ward was pretty relaxed when it came to what I could bring in, how much leave i could have. Was meant to on 15min obs but Understaffing meant was left without observation for hours which suited me tbh.

 

[TAW122]

I agree with your premise:

My argument is I think you CAN have mental capacity- even with a mental illness. Put it this way- I've been around people with dementia. Sometimes- granted- they ARE confused. Other times though- they are obviously lucid. They understand what you are asking and can make decisions.

This is something that I've always stood by, even in pre-pandemic and pre-SaSu days (before Reddit shutdown subreddit SaSu and TrueSaSu). Of course, many pro-lifers stubbornly and ignorantly believe that it cannot be possible and a oftenly incorrect premise that "wanting to die is indicative of mental illness", which has been debunked and disproven time and time again.

The Mental Capacity Act has the following criteria that a 'capable' person needs to achieve:

• Understand information given to them
• Retain that information long enough to be able to make the decision
• Weigh up the information available to make the decision
• Communicate their decision – this could be by talking, using sign language or even simple muscle movements such as blinking an eye or squeezing a hand.

They also mention being able to appreciate the situation in terms of its likely consequences.

Furthermore, yes, I believe we fit this criteria really well, even if militant pro-lifers disagree with us. Many pro-lifers refuse to see reason and logic, especially when it is not convenient or challenges their worldview.

For me- my suicidal thoughts AREN'T frightening and they AREN'T intrusive. They seem logical to me. So- why would CTB ever be the wrong choice for me? Basically- I decided it was a reasonable choice FOR ME when I was 10.

Absolutely on point. I have made my decision many years before and while I wavered between passive and active, I have ultimately settled with the fact that I will CTB at some point in my existence, not just to spare the indignities of life, sentience, and other tragedies, but also to end current suffering. Even in a perfect life (which is NOT the case for the vast majority of us here or even in the world), from a philosophical perspective CTB'ing is indeed logical and rational.

 

[LaVieEnRose]

I forgot to mention, you might want to read the book Rational Suicide by Susan Stefan, A mental health lawyer.

 

[Tuurngait]

I actually wrote an essay on this - medical law in general is my forte.

Without writing tons and tons of (probably to most people boring) stuff, the main thing I found interesting was the concept that having anorexia nervosa does not inherently remove your capacity... until you decide you do not want to be treated. This creates a catch 22, where if you express that you do not want treatment and yet still will not eat, you thus lose capacity, but on the other hand, you are deemed capacitous if you do decide you want the treatment. Basically, you're stuck getting that treatment either way.

Also, echoing @readytoleave00 - entirely correct. Anything regarding treatment related to a mental health issue is under the Mental Health Act 1983 (amended 2007). If somebody is mentally ill but wishes to decide treatment unrelated to their mental illness, then this is when it is decided under the Mental Capacity Act instead. Leading cases like Re C demonstrate this perfectly. Schizophrenic patient decided they did not want a leg amputation that was required as a result of gangrene - they tried to argue that he did not have capacity to decide this, as he was schizophrenic. The court ultimately decided that he did as it was unrelated to his mental illness and he had demonstrated (in his own odd way) that he understood the information and had weighed up the consequences. I think it boiled down to him believing he was a world-class medical professional himself and he did not want to live without a leg.

Also I believe the case @readytoleave00 is referring to is called "Kings College" from 2015. She actually wasn't diagnosed with anything but suddenly tried to commit suicide. Afterwards she required dialysis (failed paracetamol attempt) but didn't want it. The hospital tried arguing they were able to section her but the court decided it was unrelated to any potential mental health issue, thus she was allowed to essentially die... slowly and painfully. This case kinda irritates me because I'd rather it go all the way in one direction that this halfway thing we have now. If you're going to leave her to die, then she may as well be euthanised to not be in pain the entire time, but then euthanasia is deemed "too far." Go one way or the other!!

Lots of other cases, it is a constantly contested area of law. Part of why I love it! But it is definitely confusing and convoluted, particularly with how the MHA and MCA interact.

 

[endofafoxtwo]

I think it is completely immoral to stop a person from ctb, except in states of extreme and sudden anguish. Like, if someone lost their shit because something horrible happened, id get restraining them until they are calm enough to make a decision. But once they are calm if they still want to die that is their fucking choice. The state has no right to force us to live.

 

[Linda]

So, on the phonecall to the crisis team, following my wellfare check, I emphasized that I didn't have immediate plans to kill myself- It was something I purchased to give me an 'out' later in life- if I get some debhilitating illness. The person on the line said something about 'mental capacity' which rattled me- I'm not sure if they were questioning my mental capacity now- or- later- if I decide to do it. Obviously- I'm concerned about being sectioned. I really don't think they would section me- but I also really didn't think they'd bother with a wellfare check- so- everything is troubling me now!

What I'm trying to get at is- I think at most- I have mild depression. I'd be utterly furious though if someone said that meant I didn't have mental capacity. My solicitor didn't question my mental capacity when I drew up my will. Employers haven't questioned it either. While my job isn't terribly responsible- there will be people out there with mild depression and much worse who have massively responsible jobs- which affect the safety of other people's lives. If we're not considered capable to make decisions for ourselves- then really- we shouldn't be responsible for the safety of others and we all ought to be on benefits.

Anyhow- that's off the point. What I really wanted to get into with this person was- Does someone wishing to kill themselves automatically mean they don't have capacity?

The Mental Capacity Act has the following criteria that a 'capable' person needs to achieve:

• Understand information given to them
• Retain that information long enough to be able to make the decision
• Weigh up the information available to make the decision
• Communicate their decision – this could be by talking, using sign language or even simple muscle movements such as blinking an eye or squeezing a hand.

They also mention being able to appreciate the situation in terms of its likely consequences.

I'd say likely all of us fulfill this criteria. Perhaps they will argue that we're mentally ill but I'd want them to prove that before I accepted it. Prove that my brain is defective to the point where I can't make decisions for myself.

My argument is I think you CAN have mental capacity- even with a mental illness. Put it this way- I've been around people with dementia. Sometimes- granted- they ARE confused. Other times though- they are obviously lucid. They understand what you are asking and can make decisions. I suppose these pro life people assume that ideation occurs in non lucid moments. But I've had ideation for 33 years- whether I was happy or sad! Could I really have been crazy all that time and no one noticed?

For me- my suicidal thoughts AREN'T frightening and they AREN'T intrusive. They seem logical to me. So- why would CTB ever be the wrong choice for me? Basically- I decided it was a reasonable choice FOR ME when I was 10.

Of course- I realise it wouldn't be a reasonable choice for those around me. It would likely hurt them very deeply. That's why I'm still here! I've done what that Mental Capacity Act talks about- assesed the situation- that my action could well have very bad consequences for those around me- so- held off for now- until those people have passed on themselves.

Still- the decision in terms of being reasonable/ unreasonable I have already made. It doesn't mean I'll ever do it necessarily but I really refute this notion that the moment you become suicidal- you have lost perspective and capacity (and autonomy.)

What I've taken a very long time to get to is this theoretical thought experiment- OBVIOUSLY I don't intend to do it! If you could somehow persuade these officials- ie. healthcare professionals that you DID have mental capacity IN SPITE of wanting to kill yourself- COULD they actually stop you? (Of course- I'm sure they'd still try to...) Suicide ISN'T illegal in most countries. People I imagine are usually stopped and sectioned if they are caught in the act but if you could prove you had capacity- how could they justify stopping you? Does the actual act of doing it suddenly propel you into the realms of insanity?!!

Your best strategy may be to make it plain to everyone, especially at times when you are very obviously in excellent mental health, that althugh you hav no intention whatever of committing suicide in the near futur,e, you have made a rational, logical and carefully considered decision that you may do so in the future if/when you consider that your circumstances call for it. It would be hard to argue that someone who has been living a normal and productive life for years, and who has been consistently saying the same thing about something throughout that priod, doesn't have "mental capacity" when the time comes to do it.

 

[Forever Sleep]

I actually wrote an essay on this - medical law in general is my forte.

Without writing tons and tons of (probably to most people boring) stuff, the main thing I found interesting was the concept that having anorexia nervosa does not inherently remove your capacity... until you decide you do not want to be treated. This creates a catch 22, where if you express that you do not want treatment and yet still will not eat, you thus lose capacity, but on the other hand, you are deemed capacitous if you do decide you want the treatment. Basically, you're stuck getting that treatment either way.

Also, echoing @readytoleave00 - entirely correct. Anything regarding treatment related to a mental health issue is under the Mental Health Act 1983 (amended 2007). If somebody is mentally ill but wishes to decide treatment unrelated to their mental illness, then this is when it is decided under the Mental Capacity Act instead. Leading cases like Re C demonstrate this perfectly. Schizophrenic patient decided they did not want a leg amputation that was required as a result of gangrene - they tried to argue that he did not have capacity to decide this, as he was schizophrenic. The court ultimately decided that he did as it was unrelated to his mental illness and he had demonstrated (in his own odd way) that he understood the information and had weighed up the consequences. I think it boiled down to him believing he was a world-class medical professional himself and he did not want to live without a leg.

Also I believe the case @readytoleave00 is referring to is called "Kings College" from 2015. She actually wasn't diagnosed with anything but suddenly tried to commit suicide. Afterwards she required dialysis (failed paracetamol attempt) but didn't want it. The hospital tried arguing they were able to section her but the court decided it was unrelated to any potential mental health issue, thus she was allowed to essentially die... slowly and painfully. This case kinda irritates me because I'd rather it go all the way in one direction that this halfway thing we have now. If you're going to leave her to die, then she may as well be euthanised to not be in pain the entire time, but then euthanasia is deemed "too far." Go one way or the other!!

Lots of other cases, it is a constantly contested area of law. Part of why I love it! But it is definitely confusing and convoluted, particularly with how the MHA and MCA interact.

Thank you for sharing these cases. They are all really interesting- and tragic of course. I agree with you- it seems utterly cruel to just leave people suffering. Surely- they could have at least been heavily sedated at the end.

This has frightened me in the past- if you refuse treatment for an illness- will they still give you pain meds? Or will they get all petulant about it- and say- more or less- if you don't help us- ie. let us perform whatever treatment we want on you- we won't help you either. I don't know- I wouldn't put it past them. My friend was pretty much blackmailed into getting a smear test once- she didn't really want it done but the GP was like- go for this test and I'll renew your contraception prescription...

That's so odd- that- to refuse treatment- you can be found to lack mental capacity in the case of anorexia nervosa. Yet having the actual condition doesn't mean you have lost all capacity.

Really- to lose all capacity is SO extreme too. Even people with severe mental illnesses can surely understand their situation well enough to make a decision on whether they want to go on.

I don't know- it's kind of weird. Like there's this set way of thinking and feeling about your life, your prospects, your future, your hopes- and if you don't feel like that- no matter what your actual life is like- you're wrong basically. Your thinking has become distorted and you can no longer make 'correct' decisions. I'm not doubting that having something like depression CAN push your thoughts and feelings towards the negative. Still- many people do REALISE that they are depressed. I know for instance that when it's my time of the month (sorry to be crude,) no matter what is going on- I will be ESPECIALLY suicidal. It's a different feeling to my regular ideation. I wouldn't act on it in those moments because I know it's emotionally driven. If I ever do it- I'll want it to feel like a rational decision- not an emotional one.

I just feel like- some people may actually realise that it is their 'illness' or the particular way in which their brain works that may be making them feel like this. What if that's just them though? Isn't it fair enough for them to refuse treatment and refuse meds because they don't want to lose themselves? Sorry- kind of went off topic there.

It's an interesting subject. I bet it was pretty sickening to study at times though. I bet there are some horrific stories out there. Miscarriage of justice is the wrong term- maybe a miscarriage of humanity. Sounds like all these poor people wanted to do was to escape their pain. But because they had the audacity to go against the system and not become willing little guinea pigs- seems like they were just made to suffer more because the red tape was too complicated to work through.

Your best strategy may be to make it plain to everyone, especially at times when you are very obviously in excellent mental health, that althugh you hav no intention whatever of committing suicide in the near futur,e, you have made a rational, logical and carefully considered decision that you may do so in the future if/when you consider that your circumstances call for it. It would be hard to argue that someone who has been living a normal and productive life for years, and who has been consistently saying the same thing about something througout that priod, doesn't have "mental capacity" when the time comes to do it.

Thank you for your response. I think this is in some way what I was trying to do actually. I didn't want to lie to the police, or the crisis team. There again- I didn't want them to take my SN and section me. I really wanted to have rational conversations with these people. Still- it became quickly apparent that they are both pretty much working from a checklist. In order to get them to leave me alone and not take further action- it seemed best to demonstrate that I wasn't in immediate 'danger' of CTB. That also seemed to incorporate saying that I wasn't currently experiencing ideation. I just got the impression that ANY form of ideation wouldn't be ok to them. I don't know- I just got the feeling that both of them had this narrow idea of what being suicidal is.

Like I say- I would have liked to have just a rational conversation but you can't help but feel the power dynamic. You don't quite know how much power they have. When they start throwing out terms like 'mental capacity' and questioning you on- 'Why did you but it?' You kind of start to wonder where your honest responses will lead you.

Ultimately- I don't think they care if you have mental capacity. If it sounds like you may well kill yourself in the near future AND there is a record of them being in touch with you- I bet all they're really worried about is their own jobs and liability.

My friends and family don't actually know the extent to which I'm suicidal. They likely realise I'm unhappy but it would likely upset them to know the full extent of it and I don't want that.

I think in some ways- this place ought to demonstrate to the powers that be out there that there are PLENTY of suicidal people out there who very likely have just as much mental capacity as them. There are clearly some VERY intelligent and deep thinking people on this forum who articulate how they feel and why they feel it brilliantly. Many people are clearly weighing up all their options and have been doing so for years- sometimes decades.

I just get so tired of what I perceive as the regular viewpoint that ideation just fleetingly comes along and people just feel so overwhelmed by it that they can't think any more. As one of the people from the Crisis team said- 'Don't you think we ought to talk about these troubling thoughts you're having?' I REALLY wanted to say- 'No- because they aren't 'troubling'!' Still- I didn't think that would go down well- so, I just said I felt fine. That's the problem really. I don't think people REALLY do want to listen to us. They just want to categorize us and deal with us according to a tick sheet.

 

[LaVieEnRose]

I think it is completely immoral to stop a person from ctb, except in states of extreme and sudden anguish. Like, if someone lost their shit because something horrible happened, id get restraining them until they are calm enough to make a decision. But once they are calm if they still want to die that is their fucking choice. The state has no right to force us to live.

The problem is the determination that someone is a rational actor cannot be made in an instant.

I think in some ways- this place ought to demonstrate to the powers that be out there that there are PLENTY of suicidal people out there who very likely have just as much mental capacity as them. There are clearly some VERY intelligent and deep thinking people on this forum who articulate how they feel and why they feel it brilliantly. Many people are clearly weighing up all their options and have been doing so for years- sometimes decades.

I just get so tired of what I perceive as the regular viewpoint that ideation just fleetingly comes along and people just feel so overwhelmed by it that they can't think any more. As one of the people from the Crisis team said- 'Don't you think we ought to talk about these troubling thoughts you're having?' I REALLY wanted to say- 'No- because they aren't 'troubling'!' Still- I didn't think that would go down well- so, I just said I felt fine. That's the problem really. I don't think people REALLY do want to listen to us. They just want to categorize us and deal with us according to a tick sheet.

After becoming acquainted with the way you feel I'm not convinced that the concept of "mental illness" best describes your situation. I think your situation could be better characterized as a different "emotional neurotype". You just naturally derive less reward from life than the average person and there's no restoring you to "health" (i.e. relishing life) because this is your normal state. Is there anything inherent about life that makes it such that we *should* find it rewarding? I don't think there is. Most people do but that's not an argument in favor of that.

 

[Tuurngait]

Thank you for sharing these cases. They are all really interesting- and tragic of course. I agree with you- it seems utterly cruel to just leave people suffering. Surely- they could have at least been heavily sedated at the end.

This has frightened me in the past- if you refuse treatment for an illness- will they still give you pain meds? Or will they get all petulant about it- and say- more or less- if you don't help us- ie. let us perform whatever treatment we want on you- we won't help you either. I don't know- I wouldn't put it past them. My friend was pretty much blackmailed into getting a smear test once- she didn't really want it done but the GP was like- go for this test and I'll renew your contraception prescription...

That's so odd- that- to refuse treatment- you can be found to lack mental capacity in the case of anorexia nervosa. Yet having the actual condition doesn't mean you have lost all capacity.

Really- to lose all capacity is SO extreme too. Even people with severe mental illnesses can surely understand their situation well enough to make a decision on whether they want to go on.

I don't know- it's kind of weird. Like there's this set way of thinking and feeling about your life, your prospects, your future, your hopes- and if you don't feel like that- no matter what your actual life is like- you're wrong basically. Your thinking has become distorted and you can no longer make 'correct' decisions. I'm not doubting that having something like depression CAN push your thoughts and feelings towards the negative. Still- many people do REALISE that they are depressed. I know for instance that when it's my time of the month (sorry to be crude,) no matter what is going on- I will be ESPECIALLY suicidal. It's a different feeling to my regular ideation. I wouldn't act on it in those moments because I know it's emotionally driven. If I ever do it- I'll want it to feel like a rational decision- not an emotional one.

I just feel like- some people may actually realise that it is their 'illness' or the particular way in which their brain works that may be making them feel like this. What if that's just them though? Isn't it fair enough for them to refuse treatment and refuse meds because they don't want to lose themselves? Sorry- kind of went off topic there.

It's an interesting subject. I bet it was pretty sickening to study at times though. I bet there are some horrific stories out there. Miscarriage of justice is the wrong term- maybe a miscarriage of humanity. Sounds like all these poor people wanted to do was to escape their pain. But because they had the audacity to go against the system and not become willing little guinea pigs- seems like they were just made to suffer more because the red tape was too complicated to work through.

Thanks for replying! Definitely was quite a sickening subject at times, although that sickening response is what drives me on, I think. Yeah, the anorexia nervosa in particular really annoyed me, and it still is basically ignored. Complete oversight by the law, courts and hospitals - to say one has capacity until they make a decision you don't agree with completely ignores an individual's autonomy. This links into your point about the correct way of thinking, it's so binary and objective. It completely ignores that people have different values and goals and everything.

Mental Capacity in general has some really oddly decided cases, it does seem that as time goes on we are progressing greatly. It used to be (not even too long ago, pre 90s) that the patient's desires meant nothing. It was completely up to the doctor. Now the law has correctly changed to realise that these are humans and sensitive issues; it isn't ever black and white and every person is different. Still definitely not completely all the way though, as the Kings College case shows - leaving somebody to slowly die just because you think that euthanasia is "wrong" is evil. Either help them or help them die, don't prohibit their death but accept that they don't want help. I think I read a report of that and she spent a whole month in pain before dying, really sad. Hopefully the UK will progress to realise the need of euthanasia. It seems it is, although with how often society fluctuates on issues we could be back to square 1 again at any time. I genuinely do wish people realised the danger in prohibiting suicide only means that people turn to dangerous underground methods, rather than being aided to safely end their own lives.

With regards to your question about refusing pain meds if you refuse treatment, by law they shouldn't and if they did you'd definitely have a case to fight! 2015 in general was a massive year for Medical law and respecting patients, another big case called 'Montgomery v Lanarkshire Health Board' basically established finally the concept of 'informed consent.' A doctor should be providing alternative treatments and explaining each to the patient for every procedure. This doesn't mean you can demand treatment, but you have an irrefutable right to deny any treatment. Any treatment you do 'demand' should also be provided if it is reasonable... like contraceptive is perfectly reasonable.

A point that I've always noted which you've brilliantly reminded me of is that even though the courts see and notice these people's right to refuse treatment irrespective of whatever ailments they may have... that is the courts. They quite literally almost always get dragged into court by a hospital which seems to constantly go against the law and then have no repercussions. It would also be really interesting (and scary) to know how many people tried to resist a hospital's treatment, got told that they can't and they now have no capacity, and didn't think to fight that decision and instead submitted thinking they couldn't do anything. I expect that figure would be insanely high, even if a lot of brilliant judges we have in the UK recognise the complex issue, healthcare and society in general does not seem to. I suppose this and the previous paragraph kind of highlights the insane power dynamic doctors have over patients. Even if they are required to do things by law... they often don't.

Nobody ever particularly wants to go through a gruelling court procedure, especially if they're unwell - it's the last thing you want. Doctors definitely take advantage of this and push their limits. The situation with your friend sounds really horrible, I'd personally count that as malpractice on the doctor's part; unless they can explain a reason for a smear test and how that is related to contraception... which they can't... they shouldn't be withholding what is really a human right of the 21st century. Yet, they will, because they know they can get away with it. This wasn't even fixed at all with the MCA, whilst it's generally considered a "great" act that respects autonomy, it also created a court specifically for these issues. I only see this as a failure, if you're acknowledging that you're going to need a standalone separate court to deal with these issues then you probably haven't done a great job at creating law!

Sorry this was so messy, been super tired recently with finals coming up! Thanks for replying again, and thank you OP for the thread! :)

 

[timetodie24]

I actually wrote an essay on this - medical law in general is my forte.

Without writing tons and tons of (probably to most people boring) stuff, the main thing I found interesting was the concept that having anorexia nervosa does not inherently remove your capacity... until you decide you do not want to be treated. This creates a catch 22, where if you express that you do not want treatment and yet still will not eat, you thus lose capacity, but on the other hand, you are deemed capacitous if you do decide you want the treatment. Basically, you're stuck getting that treatment either way.

Also, echoing @readytoleave00 - entirely correct. Anything regarding treatment related to a mental health issue is under the Mental Health Act 1983 (amended 2007). If somebody is mentally ill but wishes to decide treatment unrelated to their mental illness, then this is when it is decided under the Mental Capacity Act instead. Leading cases like Re C demonstrate this perfectly. Schizophrenic patient decided they did not want a leg amputation that was required as a result of gangrene - they tried to argue that he did not have capacity to decide this, as he was schizophrenic. The court ultimately decided that he did as it was unrelated to his mental illness and he had demonstrated (in his own odd way) that he understood the information and had weighed up the consequences. I think it boiled down to him believing he was a world-class medical professional himself and he did not want to live without a leg.

Also I believe the case @readytoleave00 is referring to is called "Kings College" from 2015. She actually wasn't diagnosed with anything but suddenly tried to commit suicide. Afterwards she required dialysis (failed paracetamol attempt) but didn't want it. The hospital tried arguing they were able to section her but the court decided it was unrelated to any potential mental health issue, thus she was allowed to essentially die... slowly and painfully. This case kinda irritates me because I'd rather it go all the way in one direction that this halfway thing we have now. If you're going to leave her to die, then she may as well be euthanised to not be in pain the entire time, but then euthanasia is deemed "too far." Go one way or the other!!

Lots of other cases, it is a constantly contested area of law. Part of why I love it! But it is definitely confusing and convoluted, particularly with how the MHA and MCA interact.

Thanks for your insight it's really interesting.

That's interesting about the case you mention. I was actually on about one from 2007 with antifreeze. She had an advance directive stating she didn't want life saving measures. Turned out the AD wasn't actually legally binding but regardless they felt she had capacity. Sad in the 2015 case she had to suffer so much in final days. In the case I was referring to she accepted measures to make her comfortable and i believe it was 24hrs before she died. So hopefully she wasn't in too much pain. Although i think with antifreeze you'd be in some pain no matter what.

 

[Tuurngait]

Thanks for your insight it's really interesting.

That's interesting about the case you mention. I was actually on about one from 2007 with antifreeze. She had an advance directive stating she didn't want life saving measures. Turned out the AD wasn't actually legally binding but regardless they felt she had capacity. Sad in the 2015 case she had to suffer so much in final days. In the case I was referring to she accepted measures to make her comfortable and i believe it was 24hrs before she died. So hopefully she wasn't in too much pain. Although i think with antifreeze you'd be in some pain no matter what.

Oh wow, that is really fascinating! I found the case you're speaking of - hadn't heard of it before, weirdly (I suppose because we were just taught Kings College as it's newer (newer cases are considered "better law")).

The AD thing is tricky, from a brief look I can't find the reasons they gave - I'd assume maybe they're arguing under s25(5) that ADs don't apply for life-saving treatment, but this conflicts her recognising that she still wouldn't want life-saving treatment (protected in 25(5)(a)). When I have more time free after finals I'm definitely gonna look at it more, thank you!

It is so sad that things like this can't just be avoided with assisted suicide/euthanasia. It really is unnecessary pain, and anyone who is going to commit suicide will do it regardless of help or not; society really needs to recognise this and help make their final hours as comfortable as possible, rather than leaving it up to them to do things like drink antifreeze or botch an attempt. Really sad.

Thank you again. :)

 

[Forever Sleep]

Thanks for replying! Definitely was quite a sickening subject at times, although that sickening response is what drives me on, I think. Yeah, the anorexia nervosa in particular really annoyed me, and it still is basically ignored. Complete oversight by the law, courts and hospitals - to say one has capacity until they make a decision you don't agree with completely ignores an individual's autonomy. This links into your point about the correct way of thinking, it's so binary and objective. It completely ignores that people have different values and goals and everything.

Mental Capacity in general has some really oddly decided cases, it does seem that as time goes on we are progressing greatly. It used to be (not even too long ago, pre 90s) that the patient's desires meant nothing. It was completely up to the doctor. Now the law has correctly changed to realise that these are humans and sensitive issues; it isn't ever black and white and every person is different. Still definitely not completely all the way though, as the Kings College case shows - leaving somebody to slowly die just because you think that euthanasia is "wrong" is evil. Either help them or help them die, don't prohibit their death but accept that they don't want help. I think I read a report of that and she spent a whole month in pain before dying, really sad. Hopefully the UK will progress to realise the need of euthanasia. It seems it is, although with how often society fluctuates on issues we could be back to square 1 again at any time. I genuinely do wish people realised the danger in prohibiting suicide only means that people turn to dangerous underground methods, rather than being aided to safely end their own lives.

With regards to your question about refusing pain meds if you refuse treatment, by law they shouldn't and if they did you'd definitely have a case to fight! 2015 in general was a massive year for Medical law and respecting patients, another big case called 'Montgomery v Lanarkshire Health Board' basically established finally the concept of 'informed consent.' A doctor should be providing alternative treatments and explaining each to the patient for every procedure. This doesn't mean you can demand treatment, but you have an irrefutable right to deny any treatment. Any treatment you do 'demand' should also be provided if it is reasonable... like contraceptive is perfectly reasonable.

A point that I've always noted which you've brilliantly reminded me of is that even though the courts see and notice these people's right to refuse treatment irrespective of whatever ailments they may have... that is the courts. They quite literally almost always get dragged into court by a hospital which seems to constantly go against the law and then have no repercussions. It would also be really interesting (and scary) to know how many people tried to resist a hospital's treatment, got told that they can't and they now have no capacity, and didn't think to fight that decision and instead submitted thinking they couldn't do anything. I expect that figure would be insanely high, even if a lot of brilliant judges we have in the UK recognise the complex issue, healthcare and society in general does not seem to. I suppose this and the previous paragraph kind of highlights the insane power dynamic doctors have over patients. Even if they are required to do things by law... they often don't.

Nobody ever particularly wants to go through a gruelling court procedure, especially if they're unwell - it's the last thing you want. Doctors definitely take advantage of this and push their limits. The situation with your friend sounds really horrible, I'd personally count that as malpractice on the doctor's part; unless they can explain a reason for a smear test and how that is related to contraception... which they can't... they shouldn't be withholding what is really a human right of the 21st century. Yet, they will, because they know they can get away with it. This wasn't even fixed at all with the MCA, whilst it's generally considered a "great" act that respects autonomy, it also created a court specifically for these issues. I only see this as a failure, if you're acknowledging that you're going to need a standalone separate court to deal with these issues then you probably haven't done a great job at creating law!

Sorry this was so messy, been super tired recently with finals coming up! Thanks for replying again, and thank you OP for the thread! :)

Thank you so much for responding. It's all really interesting and what you said made a lot of sense. In the small amount of dealings I have had with the healthcare profession- there has definitely been emphasis on consent- for the main part. I had both ERCP and gall bladder romoval and for both- they were good at letting me know the risks and benefits and making sure I knew what was going to be done. So- I hope you're right- I hope things are moving in the right direction.

I've also worked a little in a care setting with people with reduced capacity and there was a lot of emphasis in the training about facilitating the person's choices as much as possible.

I think we may be further off when it comes to widely available assisted suicide- especially as that might pertain to mentally capable adults. Still- I'm also pretty confident we'll soon see it for people with terminal/chronic illnesses.

You're clearly really well read and knowledgable on this subject. I really look forward to reading more of your posts. Thank you.

The problem is the determination that someone is a rational actor cannot be made in an instant.


After becoming acquainted with the way you feel I'm not convinced that the concept of "mental illness" best describes your situation. I think your situation could be better characterized as a different "emotional neurotype". You just naturally derive less reward from life than the average person and there's no restoring you to "health" (i.e. relishing life) because this is your normal state. Is there anything inherent about life that makes it such that we *should* find it rewarding? I don't think there is. Most people do but that's not an argument in favor of that.

Thank you @LaVieEnRose . That's an interesting thing to think about. I'm not really sure. I think I can and do still find things interesting, even joyful in life. I wouldn't say my ability to enjoy life is diminished as such.

This is going to sound SO lame but I think it's maybe more the case that very early on, I got stuck in a rut- I became entirely obsessed with art as a coping mechanism to get through some childhood shit. I probably have abandonment issues because so many people in my life have either died or left and moved on with their lives- so- I've learnt to not really trust people. Plus- my crushes have all been crazy limerance- which I also recognize as unhealthy.

I basically put all my eggs in one basket. It's so difficult to make it financially with a creative profession- especially when you'd rather not work with others. Plus, now, even that has lost some of it's appeal. I guess I don't have the balance in life that some people have and I have neither the finances or the will to get it.

I think my response to my Mum dieing when I was 3- and more close family members after her was to see life as being cheap and disposable. Whatever a person actually does or wants is sometimes irrelavent- we can be gone just like that. Whereas I suppose that could have made me view life as precious- it just really didn't. It had the effect of me seeing it all as basically pointless- if death can come along and just delete everything. Not to say we shouldn't be kind to one another and try and make good memories while we are here. I suppose, I've gotten to a stage where I know I'm not going to achieve really amazing things. I can't even be bothered with it now. I just feel more comfortable treading water as best I can till I can go.

I don't know really whether any of that is 'illness' as such. I'd definitely say I was maladjusted- especially socially. I guess a lot of it is learned coping mechanisms and behaviour. I think a lot of it is just deep rooted habit by now. I'm sure it sounds so pathetic to many people. That maybe with a few adjustments- I could actually live a life I wanted to live. I just can't be bothered though. I don't see why that should be compulsory. It's not that I don't admire people who 'work' on themselves to 'get better.' It's just not something I see much point in for me.

Anyhow- thanks so much for taking an interest and suggesting that. Sometimes, I suppose it puzzles me- why have we turned out so differently to 'the normies'? Do you feel like you have a firm grasp on why you think/feel the way you do?