Security is both a feeling and a reality, and they don’t always match. Security Theater is when you make things look safe in order to make people feel safe even if they are not.
One of the supposed “safeguards” in assisted suicide laws relates to patients that may be depressed. This is usually optional and rarely done in states where PAS is legal. The Massachusetts proposed law requires it for all patients.
Section 8. Counseling Referral
(1) An attending physician shall refer a patient, who has requested medication under this chapter, to counseling to determine that the patient is not suffering from a psychiatric or psychological disorder or depression causing impaired judgment. The licensed mental health professional must submit a final written report to the prescribing physician.
(2) The medication may not be prescribed until the individual performing the counseling determines that the patient is not suffering from a psychiatric or psychological disorder or depression causing impaired judgment.
Feel safe? Are you really?
Note that this section of the bill is short on details. It requires a licensed mental health professional—typically a social worker—to determine “that the patient is not suffering from a psychiatric or psychological disorder or depression causing impaired judgment.” Seems simple. (No wonder the MA chapter of the National Association of Social Workers supports this bill.)
The reality is that not even psychiatrists find it easy. It involves what we call in medicine Decision-Making Capacity (DMC). Everything we know about DMC is being ignored by those involved with PAS.
Besides DMC, another key measurement not being taken into consideration is Demoralization. Demoralization is a maladaptive coping response conceptualized as a loss of meaning and purpose, with feelings of hopelessness and helplessness. Here is what research in Demoralization is showing.
Still feel safe?
Interestingly, “spirituality” is being increasingly recognized as a component of health, even without an agreed definition of spirituality. It is a vast concept that includes a transcendent dimension. Since one of the core features of demoralization is a loss of meaning, spirituality is of central aspect of treating it. Doctors should offer prayer, not lethal prescriptions.
The only people who are made truly protected by PAS laws are doctors. As Dr. Scott Kim at the NIH, an expert in DMC, said at a recent PAS conference:
“Because PAD laws’ primary function is protection of MDs, no country has a monitoring system that can assess whether these types of expansions in practice occur.”
In other words, no one checks if the safeguards are really keeping patients safe, and likely they are not. It’s just Security Theater.
Watch this interesting talk about security and see how many ploys Compassion and Choices are using in the security theater they present to legislators and the public.