6 - Suicide and Civil Commitment

Summary

Involuntary commitment of the mentally ill and forced treatment of suicidal persons are practiced worldwide, with underlying premises that contrast with the respect for autonomy upon which Medical Assistance in Dying (MAiD) (euthanasia and assisted suicide) for the mentally ill is based. We trace the transition from paternalistic mass incarcerations to hospitalisation only for dangerousness. In response to criticisms that predicting dangerousness is indefensibly inexact, criteria have shifted to emphasise incompetence. In carceral institutions with inhumane conditions, controversial forced feeding protocols pit the desire to save lives against forced living with extreme suffering. As MAiD for persons suffering from a mental disorder is increasingly debated, arguments in favour focus on recognition of the capacity for self-determination, the benevolence of ending interminable suffering and MAiD as a human right which the mentally ill should be able to access without discrimination. Opponents cite research on the unpredictable course of mental disorders and inability to predict when the disorder is irremediable. They emphasise pervasive ambivalence in suicidal desires and that legalising MAiD for mental illness is inherently stigmatising.