More opioid and CPD discussion.

“I’ll remain this sort of vegetable” When I read “Physician-assisted suicide from a patient’s perspective” in the February issue,1 I was pleased that Canadian Family Physician had given copy to this important discussion and current topic. I thank Dr Jeff Sutherland for his important and personal contribution. My concern is the protection of those “not mentally capable,” including those with mental illness. I do not mean persons with schizophrenia or bipolar disorder but persons with major depression. There are millions of Canadians who are treated for this illness. Depression carries with it many “cognitive distortions” that might manifest by changes in concentration, forgetfulness, and impairment of executive function. These changes do not cross the line to have one rendered “incompetent,” but might influence understanding and the choices one makes. A 40-year-old female patient whom I had diagnosed with major depressive disorder of moderate severity had returned to review her screening and bloodwork results, which were all normal. I suggested she begin taking an antidepressant. She said, “You can go ahead and treat me, Doctor, but I’ve pretty well resigned myself to the fact that I’ll remain this sort of vegetable the rest of my life.” Her statement was so powerful and genuine that I wrote it down verbatim in her chart. Six weeks later, when she had improved considerably, I read it back to her. She laughed out loud and did not remember making the statement nor what would have led her to make the assertion then. She continued treatment and her depression resolved completely. She remains well to this day. If she had requested physician-assisted suicide in the midst of her depression and if I had granted it, it would have been a great tragedy. —Paul Bonisteel MD CCFP FCFP New Harbour, NL