Tag Archives: mental-health

The Winds of Change

In the past few weeks, iaedp’s “Board” released an announcement advising its members that changes were coming and that the Board was launching a new initiative and strategic plan for the organization.

When I first read this, I equated this “major announcement” with the “major award” won by Old Man Parker in one of the best Christmas movies ever released, “A Christmas Story.” Visions of a fishnet stockinged leg lamp danced in my head.

However, the announcement, when it comes, will end up being quite significant, if not different than what the Board initially intended. Although iaedp has not yet issued its official announcement, the subject has become known in certain circles of the eating disorder community. And that is …

Bonnie Harken, iaedp’s Managing Director is … “retiring.” 

It is unknown whether she will also be stepping down as Chairperson of the Boards of Directors of all the “independent” corporate chapters. It is logical to presume that these positions will be included in her retirement.

Most people in the community know that I have significant issues with Ms. Harken and that we are in an adversarial capacity. But that should not diminish the accomplishments Ms. Harken achieved in the past.

According to her LinkedIn profile, Ms. Harken has been in the eating disorders treatment field since 1987. She states she was a founding officer of Remuda Ranch Centers serving as its Vice President until February 2002. Since February 2002 until two days ago, she served as the Managing Director of The International Association of Eating Disorders Professionals Foundation (iaedp). Certainly, twenty-one (21) years far exceeds the reign of any other leader of all other eating disorder organizations. Ms. Harken stated that she served many major eating disorders treatment facilities as a consultant.

In the past, she had a vision for eating disorder board certification. Under her leadership, this certification program was built. For that she should certainly be commended. She was instrumental in helping to bring information about eating disorders to the mental health community. 

However. 

After issues were brought to the attention of Ms. Harken and before the lawsuit was filed, Ms. Harken and iaedp’s attorneys attempted to deflect attention away from iaedp’s issues and stated their belief that the Morgan Foundation was operating illegally. This is generally known as a “straw man fallacy or argument.”

A straw man fallacy is the fallacious practice of attempting to refute an argument different from the one under discussion, while not recognizing or acknowledging the distinction. Ms. Harken failed to consider that in early 2020, I intentionally let the Foundation lapse.

Through my investigation and research, I found that there were people in the eating disorder community who instead of helping families, were hurting families suffering from this disease. I knew that to expose their conduct and get them out, I had to be aggressive and utilize social media and the court system. I had to become almost hated. I did not want my daughter’s name sullied with that which had to be done.

So, the Morgan Foundation does not, and has not solicited donations, accepted donations or co-sponsored any events since it closed. I regarded Ms. Harken’s attempt to use this to deflect attention away from her own alleged questionable conduct as a sin that cannot be forgiven.

To me, there are very few things/people beneath contempt. But, in attempting to take issue with, and besmirch the memory of my daughter is beyond all decency.

My daughter died after fighting eating disorders for seven (7) years. She possessed more courage, resolve and heart than people like Ms. Harken could possibly envision. However, Ms. Harken crossed the Rubicon of decency. For that, there can be no forgiveness. And that knowledge, that reality, hurts my heart.

Before the current situation, I was on a cordial basis with Ms. Harken. In fact, in one email she wrote:

“I have read Morgan’s journal entries several times.  I feel very honored that you shared those pages with me because I imagine the contents of her journal are so very precious to you.

My mother left me a diary that journaled her health issues for over a year before her sudden death.  She did not share the issues she was having with me or my brothers.  She did not seek medical help which I believe was due to the fact that my father had died four years prior and she didn’t want to go on.  Her diary was both a comfort and –sometimes– an agony for me.  So many feelings…  I am not comparing my experience for any other reason than to share that I know how precious those words on paper are and am so deeply touched that you shared them with me as someone you do not know.

I can’t even begin to fathom what feelings Morgan’s words stir in your father’s heart.

I have no context for her thoughts in terms of when she wrote them or how close it was to her death or the pages that precede or follow those you shared.  I do not need to know because the pages I read spoke to me of her journey from a “higher power” to the revelation that our Savior is real and a comforter who loved and cared about her even if she didn’t understand her own circumstances or feelings.

I read the pages repeatedly and thought about my own journey to Jesus and all I have learned since I began my imperfect journey nearly 40 years ago with a Savior who is real and present daily in my life.  I asked Him to guide my words to you.

My prayer is that my words comfort you. 

I do know this with certainty:  When Morgan closed her eyes here on earth, she opened them in the presence and love of Jesus.   Heaven is beautiful with colors beyond our imagination.  She is with God in perfect peace. 

God loves you and I believe He has a call on your life and your journey.”

One statement in that message is particularly poignant. “I can’t even begin to fathom what feelings Morgan’s words stir in your father’s heart.” No, Ms. Harken, you can’t. Consider yourself lucky that you can’t.

I wonder what happened to that person. The person who crafted those words. The person who crafted that message. It is that person I want to remember. That person who at one time strove to help others.  That person who made a difference. And yet, I fear that person no longer exists.

That person who could have remained an icon in the community … instead of an outcast.

iaedp’s crucible

“Life’s most persistent and urgent question is, what are you doing for others?” 

— Martin Luther King, Jr.

“We make a living by what we get, but we make a life by what we give.” 

— Winston Churchill

Iaedp’s Symposium 2024 has begun. As per its custom, this year it is being held in Orlando, Florida. To say the Symposium is completely engulfed by controversy and discord is an understatement.

Some BIPOC iaedp members chose to boycott the Symposium because of the Florida Board of Education changing the state’s standards on African American history in July 2023.

The iaedp petition calling for Ms. Harken’s resignation and revising the certification process, which was started by concerned iaedp members in December 2023, has reached 277 signatures. Until very recently, a reasonable inquiry would have been whether Symposium attendees would exceed the number of signatures on the petition. Purportedly, the numbers are close.

The on-going lawsuit. Complaints filed with state and federal administrative agencies and taxing authorities.

Iaedp corporate chapters demanding dissolution. Ms. Harken demanding that those chapters pay over to iaedp national, any monies those chapters may have in their meager bank accounts. Demands for the resignation of Bonnie Harken.

Iaedp’s Board of Directors have no members with any business or legal experience and did not even place Ms. Harken on Administrative Leave while they conducted an investigation. For that matter, did the Board conduct ANY independent investigation?

There is no doubt that iaedp is under increasing pressure from many different sources. It finds itself in a fiery crucible where irrelevancies and subterfuge are burned away thereby exposing questionable conduct and the flaws of human nature.

And above all, we as a community, cannot and should not be looking upon the inevitable dismantling of this organization and Ms. Harken with any satisfaction or pleasure. Schadenfreude should be so remote from our conscious thoughts or feelings as to be non-existent. 

Whether you agree or disagree with the lawsuit. Whether you have positive or negative thoughts or feelings directed toward me for pursuing this matter. Whether you believe or not believe that iaedp and the certification process needs substantial revamping … the sparsely attended 2024 Symposium should serve as a stark example of what could happen when we, as a community drift away from the sacred trust placed with our medical and mental health providers who treat eating disorders.

When NEDA was sued in December 2020, I pushed for an early mediation. My sincere hope was that improvements and positive changes could be made and that NEDA, yes would go through some difficult times, but would emerge more vibrant and stronger than before. In addition to the attorneys appointed by the Directors & Officers insurance company, NEDA also had an experienced, wise attorney who had been involved with NEDA for a number of years. That attorney understood the importance of an early resolution. And in less than six (6) months after filing, the NEDA case was settled. NEDA served and serves a purpose.

In past writings, I mentioned the great Chinese General, Sun Tzu. He believed that when you have your foe surrounded and their defeat is inevitable, you should offer that foe an honorable exit. And so it was.

With iaedp, an early resolution will not happen. Settlement offers have been made, the latest as recently as last week. Each offer has been met with silence. Iaedp also does not have an experienced attorney independent from the insurance providers to lend wisdom and knowledge of eating disorders. NEDA had and still has experienced business people on its board. Iaedp does not. NEDA had a semblance of oversight over its officers by its board, oversight which resulted in its former CEO and the person who mainly caused the damage to be let go. Iaedp does not.

Brantley is Whitfield. Whitfield is Brantley. Iaedp is Ms. Harken. Ms. Harken is iaedp.

I do not believe iaedp can, nor will, survive the investigations which may be conducted by state and federal authorities.

In this matter, a road to redemption was offered. And was not accepted.

The consequences for that lack of vision will inevitably lead to the conclusion from which Ms. Harken and iaedp are desperately running.

In litigation as in war, you achieve victory by engaging in a relentless, aggressive, well-orchestrated and carefully designed plan to obtain victory and deprive your opponent of the initiative. You make your opponent pay a price higher than it expected for choosing the path of war. In litigation, an attorney has the power of the legal system at his/her beck and call. Issuing subpoenas for relevant documents not just from the named parties but also from third parties and witnesses. Deposing people who may have information of relevant facts. Uncovering lies. Exposing fear, arrogance, greed and collusion. Discovering facts which support long held suppositions. Where necessary, including third parties as possible liable parties. Hundreds of hours spent on the process. The uncertainty.  The unexpected. For example, did United Behavioral Healthcare dare to consider that in the Wit case, it would lose its ability to control its own claims process and possibly must pay attorneys’ fees exceeding $3o million dollars?

The greatest truth to embrace, the truth that keeps one focused through this mighty process is the reality that people who suffer from eating disorders will undoubtedly benefit from this challenge. Families who suffer from this disease may find comfort and greater opportunities to heal. Fraud, and those who perpetrate it will at long last be exposed.

We must continually be looking forward, always forward. We must place our families who suffer from eating disorders first and foremost. As a community, our nondelegable duty must be to help those who are suffering. Somewhere on the path, iaedp lost that vision. It lost its way. And those who are supposed to be overseeing iaedp have lost iaedp’s mission… if not its very soul.

THAT is what the iaedp lawsuit is about. Trying to salvage a broken system so that more lives can be helped. To burn away the falsehoods and nonsense in the crucible.

That is the absolute reality which keeps one focused, which guides one through the turbulent days, weeks, months and years which lie ahead. Saving lives.

And so, as I previously plagiarized from Willie Bob Shakespeare, “Once more unto the breach dear friends, once more …”

Take Dead Aim

In the past few months, Physician Assisted Suicide (“PAS”) or Medical Aid in Dying (“MAiD”) has been a frequently discussed or considered issue both domestically and internationally.

Canada delayed until 2027, implementation of PAS for people whose primary diagnosis is a mental illness.

Colorado is seeking to expand its existing MAiD law to allow anyone in the United States to benefit (?) from its proposed, expanded MAiD law wherein life-ending medication can be prescribed by an “Advanced Practice Registered Nurse” and a “consulting provider” only needs to be qualified by specialty or experience to make a professional diagnosis and prognosis regarding a terminally ill individual’s illness.

According to the Death with Dignity organization, there are 19 states either considering, or opposing implementation of PAS or MAiD legislation. These states and bills can be found here:

Bills We are Tracking

“Fer it … or Agin’ it.” That seems to be our current society. Our world has devolved into black or white. Right or wrong. Coke or Pepsi. Republican or Democrat. Far Right Religious Loon or Far Left, Extremist Socialist Loon. Your choice has been made easy. Press this button or that button.

So too, with PAS/MAiD. You must either support those bills. Or you must oppose those bills. After all, topics as simple as our very existence, whether we have a soul, what constitutes a sentient being can readily be pigeon-holed into one of two choices.

“Fer it … or Agin’ it.”

In general, people who oppose PAS/MAiD bills show up during subcommittee hearings, present arguments opposing the proposed bill and seek to have the entire bill defeated. The politician’s aide then contacts the money people behind the politician and asks them how they want the politician to vote. The money people make their views known and the politician dances to that tune.

But what if there was another way?

Instead of supporting or opposing PAS/MAiD legislation, what if a specific carve out excluding eating disorders from these bills were proposed as a rider. Therefore, the position would be regardless of whether that legislative bill passes or expires, eating disorders must be excluded. And that is because we simply do not have enough medical and mental health information and knowledge about this illness.

When does Anorexia Nervosa become terminal? Does the medical community even have a remotely accurate understanding of the way eating disorders impact the brain? And if so, why haven’t effective, biologically based treatments been researched, studied and implemented?

We also know there are no generally accepted standards of care. The “experts” in the community cannot even agree about the most effective medical and mental health interventions to treat this deadly mental health illness. For that matter, should anorexia even be classified primarily as a mental health illness?

We know there is no effective collaboration with any other medical or mental health community.

Private equity companies dictate residential “standards of care” and the way this mental health illness is treated. Emphasizing profits over patient safety. Running treatment guidelines through their finance department. Even a former CEO of a residential treatment center is now admitting to this reality.

There are no pharmaceutical drugs which have been specifically researched, trialed and then approved to treat eating disorders. The drugs being used today were all designed to be used for other mental health and medical issues.

What criteria and protocol would be utilized to establish that which constitutes the highest level of treatment care before patients can utilize PAS/MAiD?  

How many years would a patient have to be afflicted with Severe and Enduring Anorexia before a death protocol is appropriate for them? For that matter, can any mental health or medical doctor, within all reasonable medical probability, opine that death will come within six months?

How often has this legion of information been presented to politicians when PAS/MAiD legislation is being considered?

Envision testifying before a legislative subcommittee and instead of making “Coke or Pepsi” arguments before the politicians (arguments they have heard numerous times), an advocate presents the above information and statistics plus much more. Advocates present compelling information, facts, reasons and logic why eating disorders must be excluded from the legislation.

And the law of unintended consequences may result in, while the discussion of PAS/MAiD is going on, we educate those politicians and society about the dangers of eating disorders. The high mortality rate. The dysfunctionalities and lack of understanding of this illness.

We must start to aim for the specific target before us instead of the zip code sized area of discussion and dispute on this topic which is currently raging.

Harvey Penick, the late, great golf coach and instructor had a famous saying, “Take Dead Aim.” This saying is more about a technique for focusing than a philosophy on how to play. By narrowing down to a very specific target you end up focusing in better on what needs to be done.

With regard to PAS/MAiD, we need to “Take Dead Aim.”

When Not Awkward Becomes …

On January 8, 2024, I had the pleasure of appearing on the “Making it Awkward” podcast hosted by Jessica Wilson, MS, RD, and Whitney Trotter, DNP.

As I stated in a prior article, there is no doubt that on some issues, our views are very different… at times even opposite. However on that day, I thought there was a feeling of respect, of professionalism, of courtesy. I certainly extended those qualities to the two hosts. However, it would appear that those feelings of respect and professionalism on the part of the esteemed hosts may have ended that day, if they existed at all.

After my appearance on the podcast and before it was disseminated, I contacted Ms. Wilson and Ms. Trotter, thanked them for the opportunity and on two occasions discussed iaedp’s certification process and how the BIPOC community could get involved at the earliest level. The exact language I used was:

(The First email)

“Also, I will be sending to you in the next few days an email talking about iaedp’s certification process. The BIPOC Committee at iaedp, and the BIPOC community as a whole, have an incredible opportunity to be on the ground floor in helping come up with new certification guidelines. More to follow.”

(The Second email)

“Regarding the “certification program,” we are facing a unique challenge. In one of two ways, the eating disorder certification program is going to change, to grow, to evolve in the next few years.  First, the Court may very well take away the certification program from iaedp and assign it to an established board specializing in overseeing certification programs.  Or two, Ms. Harken will decide she has had enough and will step away. These are inevitabilities.”

“And the BIPOC Committee of iaedp as well as BIPOC advocates have the opportunity to have their voices heard, to be part of the process which changes certification, to have the certification program become much more fair and available to all. However, this requires that the BIPOC community come together, to reach agreement on how best the certification process can be changed to meet the needs of the BIPOC community and to speak with one, mighty, united voice.”

“But, that voice has to be clear. That voice has to provide real life, workable, reasonable solutions which can be implemented.

I believe you two are in a place where you can be the harbingers of this change, this voice. But, this must be organized expeditiously and wisely. I also have no doubt that the obstacles are many and the way forward is difficult. Then again, what great thing was ever accomplished without hardship?”

So, what was their response?

Ms. Trotter responded with:

“Thanks so much for the feedback. We’ve heard positive reviews as well- which has been encouraging. There are several folks on the IADEP BIPOC subcommittee who I’m sure would be interested in helping with the certification process. It’s not a task that I can undertake but I appreciate you reaching out and asking.” 

Ms. Wilson responded with:

“I cannot take on the full task of improving the certification, but I’m happy to provide paid consultation to those who are interested in my experience.”

Interesting. It appears as if their collective response was tantamount to, “We cannot be bothered to undertake such a momentous task knowing that progress and obtaining results which could help the BIPOC community is beyond us. And in Ms. Wilson’s case, “unless of course, you pay me to participate.”

To be on the ground floor of building a foundation that would inevitably help the BIPOC community. What an incredible opportunity. But Ms. Wilson and Ms. Trotter chose to not participate. To not be influencers. To not engage in bettering the community in this manner.

Ms. Wilson and Ms. Trotter then conducted Part 2 of the discussion and invited Meghan Cichy to appear. A majority of that podcast was dedicated to, “Steven Dunn is a loon, he has it all wrong, let’s run down him and his views, read his mind and epitomize the name of their podcast, ‘Making it Awkward.’”

After listening to Part 2 of the Podcast, and its many inherent flaws, it would have been so very easy to go on the attack, pick apart Part 2 of the Podcast, pointing out the many inaccuracies, inconsistencies and false narratives. But, to what end? What would be accomplished other than causing a few more rifts in the community? Of hurting others for their views no matter how misguided.

Instead, I reached out to Ms. Wilson and Ms. Trotter.  My email stated the following:

“I had the chance to listen to your Litigation Podcast 2. I can tell you I do enjoy the different points of views you bring out from different guests. And what a learning experience it is hearing other’s opinions. So, thank you!

There were a number of points that could use clarification but, it is what it is.

Again, I appreciate the opportunity to be on the podcast and would welcome any future interaction.

Oh… and I am SOOOO sending you both Christmas cards!”

To date, Ms. Trotter and Ms. Wilson have not responded to that email.

There comes a point where the hand we extend in friendship cannot be turned into a fist. A point where we continue to seek understanding and compassion even if those around us do not. Someone must show compassion and understanding for those who are in such internal turmoil and pain.

In this matter, damage was done and opportunities lost. Why compound it? An opportunity to collaborate, to bring together people of divergent viewpoints and opinions for the betterment of those suffering from eating disorders was not recognized and was lost. Perhaps grace, acceptance of other people’s viewpoints, respecting them even if you disagree with them are foreign concepts to some.

As I reflect upon my interaction with Ms. Trotter and Ms. Wilson, I have no doubt I gained some insight especially on sensitive issues and topics which have the potential to be incredibly awkward. Respecting the person, treating them with courtesy, with respect, with civility is the best weapon to diffuse awkward topics and issues. To turn awkward issues into issues upon which we can work together even as we maintain divergent points of view. That is a special gift. That is the essence of making awkward not awkward.

Because undoubtedly, our end goal is the same. That is, saving as many lives as humanly possible. Helping as many people in pain and suffering as we possibly can. Aren’t we all working toward that same, end goal?

The Power of the Message CANNOT be lost because of the false narrative that the Image of the Messenger is far more important. When the focus is on the messenger and not the message, the message is lost, the end goal is pushed further away and we as a community suffer.

Which results in more pain, more harm, more loss endured by families suffering from eating disorders. And when that happens … we all lose.

Ohhhhhhhh Colorado

A few weeks ago, I wrote of Canada’s decision to delay until 2027, implementation of Physician Assisted Suicide (“PAS”) for people whose primary diagnosis is a mental illness.

Reasons given included: Canada’s healthcare system was not ready to handle the increase in requests for PAS from patients with mental health issues; the expansion of PAS could undermine efforts to prevent suicide; politicians casting blame on the opposing party; and the risk of medical practitioners recommending assisted suicide as a cost-cutting measure to alleviate strain on Canada’s health care system.

And so reasonable, hopefully rational studies will be funded addressing the issue of PAS for patients with mental health issues.

Brava Canada!

In opposition to this reasoned, rational, logical approach, we have ‘Murica … specifically the State of Colorado.

In 2006, the movie, “Idiocracy” had a limited release in the U.S. It was directed by Mike Judge and co-written by Mr. Judge and Etan Cohen. Mr. Judge was the creator (or co-creator) of Beavis and Butthead, King of the Hill and Office Space.

The plot of Idiocracy follows U.S. Army librarian Joe Bauers, (played by Luke Wilson) who wakes up five hundred years in the future after a botched government hibernation experiment. He finds himself in a dystopian society run by corporations, where evolution has made humanity stupid because the benefits of technology made it unnecessary for people to be intelligent and physically fit to survive. Idiocracy serves as social satire that touches on issues including anti-intellectualism, commercialism, consumerism, dysgenics and overpopulation.

Colorado already has in place an overly liberal (or accommodating depending on your viewpoint) law on PAS. But then, certain Colorado politicians embraced some of the over the top aspects of the Idiocracy movie and are seeking to expand Colorado’s PAS law.

This is the proposed bill:

Click to access 2024a_068_01.pdf

The Colorado bill could have been drafted by Mike Judge as a script for an Idiocracy sequel entitled, “Idiocracy: How to Die in Colorado Without Really Trying.”  And yet, to date, there is no registered opposition to the bill in Colorado’s lobbying database.

So, let’s review some of the key provisions of this Idiocracy bill.

First, we know how busy Colorado medical doctors are. Overworked. Underpai.. well, overworked. So, let’s take some of the burden off them by allowing “Advanced Practice Registered Nurses” to make the determination that a patient qualifies for PAS. We also want to take even more burden off physicians so let’s allow Advanced Practice Registered Nurses to also serve as “consulting providers.”

Of course, this “consulting provider” must be qualified by specialty or experience to make a professional diagnosis and prognosis regarding a terminally ill individual’s illness. [emphasis added] Qualified by experience? That certainly gives an entirely new meaning to the phrase, “Expert by Experience.”

Naturally, with Colorado being an enlightened, beneficent land of opportunity, they surely cannot restrict their expanded PAS to residents of Colorado alone. When the bill is passed, ANY ADULT is eligible to apply for PAS. Even those who reside outside the State of Colorado. The bill does not restrict its implementation and activities to the State of Colorado. Which brings up a number of intriguing and troubling issues.

With the expansion and proliferation of the Interstate Medical Licensure Compact Act and the use of tele-health, the bill does not address whether a provider can make his/her diagnosis via telehealth and whether the opinion of the consulting provider may be provided via telehealth. If the attending provider has the requisite DEA certificate and complies with any applicable administrative rules, that provider can send the poison cocktail medications directly to the patient.

Then there is the current mandatory waiting period for PAS in Colorado which is 15 days. Presumably, that is far too long to consider and contemplate the end of one’s existence. So, let’s shorten that puppy up to 48 hours! After all, one can squeeze a lot of living in 48 hours … champagne, five-star dining, complaining about the latest Taylor Swift conspiracy. What more does one need? However, if the attending provider believes that death will come within that 48-hour window, even that waiting period can be waived.

But, what to do about those pesky life insurance companies which have exclusions in their policies for insureds who commit suicide? The Colorado bill thought of that too. The bill provides that a life insurance company doing business in Colorado cannot deny nor alter benefits otherwise available to its insured who chooses to undergo the Colorado PAS process.

At this point, we should also ask if this is merely a tempest in a teapot.  How prevalent is PAS in Colorado?

Since 2017, [when Colorado’s medical-aid-in-dying law went into effect] and 2022, according to data gathered by state health officials more than 1,090 patients were prescribed life-ending medication. Of those, 838 picked up the medication. [This information can be read by clicking on the link underlined in the prior sentence.] It’s unknown how many people used the medication to end their lives.

Over that six-year period, aid-in-dying prescriptions were provided by 219 Colorado doctors.

Interestingly, a survey was published in January 2022 of 583 physicians in Colorado carrying for potential medical-aid-in-dying patients. This survey can be found here:

https://link.springer.com/article/10.1007/s11606-021-07300-8

This survey provides some fascinating insight into those providers who are involved in medical-aid-in-dying for their patients.

The survey’s general conclusions were, “Many physicians in our sample are both willing and prepared to discuss MAiD with patients and to provide MAiD referrals. Fewer are prepared and willing to serve as an attending or consultant and fewer have provided these services. MAID consultants and attendings largely report the experience to be emotionally fulfilling and professionally rewarding, but all respondents reported multiple barriers to participation.”

The survey was transparent about the ethical concerns which included: “Ethical concerns include, but are not limited to, issues of equity and justice, patient autonomy, the nature of human suffering, slippery slope arguments, the proper roles of physicians, and the potential for devaluing human life. Religious beliefs have led some religiously affiliated hospitals to prohibit employed physicians from providing MAiD.”

For diseases like cancer, the availability and applicability of MAiD is much more compelling. Medical knowledge has shown the human body constantly produces new cells. Normal cells follow a typical cycle: They grow, divide and die. Cancer cells, on the other hand, don’t follow this cycle. Instead of dying, they multiply out of control and continue to reproduce other abnormal cells. These cells invade body parts, such as the breast, liver, lungs and pancreas. They may also flow through the blood and lymphatic system and spread to other parts of the body. Within a reasonable medical likelihood, death can be estimated.

But PAS for mental illnesses? For Anorexia Nervosa? Without having any objective medical criteria to determine a person’s capacity to make a life-or-death decision? Not even requiring a licensed psychiatrist or physician to be involved? Our wisdom and knowledge have not expanded to address mental health issues and PAS. To believe otherwise is clearly Idiocracy material.

One day, will our understanding of the human body, the brain, the complexities of our psyche reach a level which turns Physician Assisted Suicide into Medical-Aid-in-Dying for mental health issues? Perhaps so. But that day is certainly not today. Today, we are subjected to Idiocracy bills like Colorado’s law, short on wisdom and long on pedantic naivete.

Without the need of a physician to oversee the process, opening the process to everyone, and shortening the mandatory wait period to 48 hours, Colorado could become a mecca for PAS tourism.

Imagine Colorado’s new state slogan:

Medical Aid in Dying or Physician Assisted Suicide?

Words matter. Words are one of the strongest ways in which we communicate. We use words to express every human emotion. When words are used passionately and honestly, they can inspire us to greatness. Motivate us to dare mighty deeds. To, in the name of humankind, be open to exploring the greatest mystery facing us, that is, our very existence.

Close your eyes. Now, embrace the rapture you feel when the most special person in your life holds you in his/her arms, looks you in your eyes and says, “I love you.” Revel not just in those words, but the feelings and emotions they evoke.

Contrarily, words can also be used to inflict the deepest, darkest scars on a person’s soul. Words can cause such pain, such rage … such defeat, that they can push us prematurely closer to our graves.

Again, close your eyes. And try to imagine how you may feel when the most special person in your life looks you in the eyes and says, “I do NOT love you.” One word. One small word. One word changes everything. It changes feelings, emotions. That one small word changes … life.

Recently, end of life issues in the mental health community have come to the public’s attention, not just domestically, but internationally. Are physicians in the Netherlands prescribing death-inducing medications for autism? Is the UK government allowing life support measures to be removed from a child against a parent’s and their doctor’s wishes? Canada’s recent decision to delay until 2027, end of life measures for persons whose primary diagnosis is a mental health issue. And of course, here in the U.S., end of life options for persons suffering from severe and enduring anorexia.

And yet for these great emotional debates and issues, we cannot even agree which term of art to use … Medical-Aid-in-Dying (MAiD) or Physician Assisted Suicide (PAS). Each phrase engenders very different thoughts and feelings. Granted, this was not much of a debate when MAiD was first being considered for biologically based diseases for which the medical community did not have viable cures. It is now.

Dr. Matthew Wynia, director of the University of Colorado’s Center for Bioethics and Humanities, states: “There is a significant, a meaningful difference between someone seeking to end their life because they have a mental illness, and someone seeking to end their life who is going to die in the very near future anyway.”

As Lee Corso, a college football pundit and legend is fond of saying, “Not so fast my friend!”

Now, a once relatively clear line is being blurred.

In the United States, ten states and the District of Columbia allow patients to receive life ending medication. However, among these states, I could locate no provision specifically including, or excluding mental health issues. 

Instead, the statutory language focuses on the requirement of a “competent, terminally ill patient.” A vague, ambiguous term. When a person’s life hangs in the balance, there are few things as egregious as including terms which are vague, subjective to numerous interpretations and which are not readily definable.

So, what is the difference, if any, between MAiD and PAS?

Some health advocates and medical professionals insist that a terminally ill patient with a recognized, biologically based, somatic disease taking medication to hasten the end of their life is doing something fundamentally different than suicide. The term “medical aid in dying,” they say, is meant to emphasize that someone with a terminal diagnosis is not choosing whether to die, but how to die. Their death is immediate and inevitable.

Anita Hannig, an anthropologist at Brandeis University and author of the book, “The Day I Die: The Untold Story of Assisted Dying in America,” stated, “A phrase like “medical aid in dying” would reassure patients that they were taking part in a process that was regulated and medically sanctioned. Medicine has that legitimating power, like it or not, that really removes a lot of the stigma.”

Now, look at the language used by Ms. Hannig.

A process that was regulated.

A process that was medically sanctioned.

I would add, a process focused on a biologically based, somatic diseases, thoroughly researched and studied. Diseases in which relatively objective findings, treatment regiments and outcomes had been thoroughly vetted and are considered reliable. A disease, which in an advanced state, medical science cannot effectively combat nor cure.

For this, yes, Medical Aid in Dying may very well be accurate, understandable and compassionate.

But for circumstances in which a mental health issue is the primary diagnosis? Particularly, Severe and Enduring Anorexia? A legion of questions abound.

When did Anorexia become terminal? Does the medical community even have a remotely accurate understanding of the manner in which eating disorders impact the brain? And if so, why haven’t effective, biologically based treatments been researched, studied and implemented?

For that matter, regarding eating disorders, we also know the following:

There are no generally accepted standards of care. The “experts” in the community cannot even agree about the most effective medical and mental health interventions to treat this deadly mental health illness. For that matter, should anorexia even be classified primarily as a mental health illness?

There is no effective collaboration with any other medical or mental health community.

Private equity companies have been allowed to dictate residential “standards of care” and the way this mental health illness is treated. Emphasizing profits over patient safety. Even a former CEO of a residential treatment center is now admitting to this reality.

There are no pharmaceutical drugs which have been specifically researched, trialed and then approved to treat eating disorders. The drugs being used today were all designed to be used for other mental health and medical issues.

If the statistics can be believed, the mortality rate for eating disorders is worsening.

It is with this background, despite these harsh facts, that some people are attempting to legitimize end of life options for Severe and Enduring Anorexia.

Seriously. What criteria and protocol would be utilized to establish that which constitutes the highest level of treatment care before patients are welcomed into the warm embrace of death? Some pro PAS professionals may even look upon death as not being a failure or even a bad outcome.

How many years would a patient have to be afflicted with Severe and Enduring Anorexia before a death protocol is appropriate for them?

What objective testing exists to determine brain atrophy? Testing which would give more objective evidence showing that a patient either has or does not have the capacity to make life and death decisions?

As it is, no state has set forth any minimum, objective biological standards which must be met before a death protocol is made available for patients suffering from mental health issues.

With many biological based, somatic diseases such as cancer, objective testing and decades of research support a medical finding that death is inevitable. And as a compassionate society, Medical Aid in Dying, with effective oversight and clear protocols, very well may be in humanity’s best interest.

However, with Physician Assisted Suicide for mental health issues, because of the dearth of medically objective criteria, the diagnosis of “terminal” is based not so much on whether a patient will die, but how they will die.  

That patient’s death may not be pending, may not occur soon and may not be inevitable. That is the heart of Physician Assisted Suicide. Besides subjective criteria experienced by some mental health providers, there appears to be no medically recognized protocols or standards supporting those person’s views.  That is not and should not be acceptable.

For the treatment of Severe and Enduring Anorexia, the brightest and the best medical and mental health doctors cannot collaborate and come up with treatment standards utilizing the latest technological and science-based knowledge and innovation. There are no protocols to preserve life.

When the community cannot come up with and implement a legitimate, generally accepted protocol for life, how can anyone seriously consider a protocol for death?

OHHHHHHHHH Canada …

A number of countries set aside March 17 as a celebration of St. Patrick’s Day.

The first St. Patrick’s Day parade in Ireland was held in Waterford in 1903. Strangely enough, this came hundreds of years after the first parade in North America. 

One of the longest-running and largest Saint Patrick’s Day parades in North America occurs each year in Montreal whose city flag includes a shamrock in its lower-right quadrant. This yearly celebration has been organized by the United Irish Societies of Montreal since 1929.

The parade has been held yearly without interruption since 1824. St. Patrick’s Day itself, however, has been celebrated in Montreal since as far back as 1759 by Irish soldiers in the Montreal Garrison following the British conquest of New France.

But this year’s St. Patrick Day promised a much darker, very somber day of international concern. This was the day Canada was prepared to implement medically assisted suicide for people whose primary health issue was a mental health disorder.

In 2015, Canada introduced medically assisted dying after its Supreme Court ruled that requiring people to cope with intolerable suffering infringed on fundamental rights to liberty and security. In 2021, the Canadian law was expanded after the Superior Court of Quebec struck down the government’s original assisted death law on constitutional grounds because it only applied to people whose deaths were “reasonably foreseeable.”

The 2021 law then expanded eligibility to people experiencing “grievous and irremediable” conditions. It included a separate provision for people suffering from mental illnesses. This provision was added to the law by Canada’s unelected Senate.

Perhaps understanding that the mental health aspect of the law was not just controversial but beyond the pale of the act of a compassionate, informed society, the implementation of this aspect of the law was postponed until 2023. It was then again postponed until March 17, 2024.

In the last two weeks, Canada announced it was postponing implementation of the mental health aspect of the law until 2027.

The reasons given were varied. The official, governmental explanation was, “… a special parliamentary committee studying the law concluded that there are not enough doctors, particularly psychiatrists, in the country to assess patients with mental illnesses who want to end their lives and to help them do so.” A committee spokesperson stated, “The system needs to be ready, and we need to get it right … It’s clear from the conversations we’ve had that the system is not ready, and we need more time.”  

 Many other reasons for this delay have been speculated. These reasons include:

It is a consequence of the inability of Canada’s public health care system to offer adequate psychiatric care, which is chronically underfunded and facing demand that outstrips its availability.

Many psychiatrists say the plan would undermine efforts to prevent suicide, and they have expressed fear that patients with complex problems will abandon treatments that can take years to achieve results in favor of a medically assisted death.

Not wanting to be left out, political viewpoints have entered the fray. The opposition Conservative Party charged that the liberal government of Prime Minister Justin Trudeau is promoting a “culture of death.” Some on the left oppose the expansion for mental illnesses and have said they want to focus on further expanding psychiatric care. At least one conservative member in Parliament favors an indefinite extension stating, “I don’t see any indication that the fundamental issues that are at the heart — or should be at the heart — of putting a pause on this expansion will be resolved.”

There are still other speculations. Canada has a socialized health care system. One analysis conducted in 2020 estimated a potential annual health care cost savings of $66 million. Certainly, the risk of medical practitioners recommending assisted suicide as a cost-cutting measure to alleviate strain on the health care system is alarming.

Then, there are religious aspects being taken into consideration. In Canada, in every province but one, the government exempts taxpayer-funded religious institutions from providing services deemed contrary to their beliefs. In 2016, these exemptions were extended to specifically cover assisted suicide. Last week, a Catholic archbishop filed a challenge to Canada’s law on physician-assisted death, which includes both medically assisted suicide and euthanasia.

Lack of access to quality care has been a baseline, foundational issue for as long as there has been a health care system. If you are wealthy or have health insurance coverage, you have the keys to unlock the door of the healthcare system. If you do not have that key, you are confronted with a “No Trespassing” sign. Shouldn’t a compassionate enlightened society be known not for how it treats the elite in its society, but the downtrodden?

In addition, readily being presented with assisted dying services—instead of treatments or alternatives—can create a sense of being undervalued or marginalized. It implies that end-of-life choices should be prioritized over efforts to provide care, support, or treatments that could improve one’s quality of life or extend their lifespan.

I have the good fortune of being included in a small group of professionals studying eating disorders and end of life options. The issues are many and daunting. Any real progress is problematic, albeit not impossible, at best.

And then, I read a question which so eloquently encapsulated a fundamental concern about physician assisted suicide. That is …

“Why is their suffering acknowledged enough for euthanasia but not enough to fund clinical research?”

Why indeed.

The Old Gray Lady and Assisted Suicide

The New York Times was founded in 1851. In its long and storied history, it has been at the heart of important legal decisions pertaining to journalism and the freedom of the press. Since 1896, its slogan has been, “All the News That’s Fit to Print.”

For many Americans, the Times is at the forefront of their consciousness regarding the journalism industry. It is a major news outlet in the United States’ most prominent city. The Times often sets this nation’s news agenda.  All of which makes it that much more surprising when the Times lowers itself to publishing an outdated, tag along storyline devoid of substance and not current on the latest events on a crucial topic.

In this case, the January 3, 2024 article entitled, “Should Patients Be Allowed to Die from Anorexia?” To say that this article fell down the deepest well far below the Times usual standards would be charitable. In fact, this article could have jeopardized on-going debates, discussions and interactions which are currently taking place among mental health professionals on the highly controversial topic of assisted suicide and mental health, particularly anorexia nervosa.

The Times Article attempts to frame issues designed to draw the reader away from one of the most complex issues we as sentient beings face … our very mortality … and simplify it to a plug and play game devoid of any nuance, substance and morality.

The manner in which the Times article fails is legion. So, let’s address just some of its shortcomings.

First, the Times article comes across as a less informative follow up piece to the outstanding article written by Abby Ellin and published in the Washington Post on November 1, 2023. Ms. Ellin’s article was obviously thoroughly researched, and included information from doctors, research professionals, mental health advocates, families and people who have been directly impacted by anorexia’s deadly nature. It explored both sides of this highly volatile issue. Ms. Ellin’s article endeavored to stay current with the rapidly evolving events on this topic.  All of which are missing from the Times article.

The Times article was not current regarding events which have transpired on this issue since June 2023. It did not address retraction of certain articles, medical complaints being withdrawn, or the fact that a broad-based summit occurred in Denver, Colorado on November 17, 2023, or the fact that perhaps our mental health professionals are looking at new ways to address controversial topics. Instead of engaging in seemingly endless academic articles ping-ponging back and forth, face to face respectful engagement took place. Professionalism. Mutual respect. All this important information was missing from the Times Article.

The Times Article focusing on Naomi’s story was understandable. Her story is compelling. How can we not sympathize with her? Her story touches our heart. Her story and the extreme issues and measures she has faced in her life are designed to attract readers and perhaps gain support for assisted suicide for mental health issues. And yet, her story is not representative of the millions of people suffering from anorexia nervosa. There was no counterbalance showing those people who are greatly suffering and yet who are still scratching, clawing and fighting for life.

Now make no mistake. Palliative psychiatry is a topic that has arisen as an important topic of discussion and worthy of studied research and contemplation. However, the Times Article takes this topic and renders it fodder for click bait. If people are looking for substantive information on this topic, the article fails. No mention of criteria or guidelines. No mention of studying biological or more objective signs of mental impairment.

The Times Article also failed in that it did not address the ever evolving understanding of possible biological causes of anorexia nervosa. It did not address the fact that we do not completely understand the biology and neurobiology of anorexia nervosa and accordingly no treatments have been developed, tested, and approved that specifically target the underlying biology. Genetic factors? Nothing. The Times Article also does not address recent research indicating prolonged starvation damages the gastro system and impoverishes the microbial ecology making recovery more painful and more difficult.

The Times Article did not address alternative and evolving medical measures being utilized to treat anorexia.  For example, Ketamine, Psilocybin, ECT: (electroconvulsive therapy), TMS: (transcranial magnetic stimulation), tACS: (transcranial alternating current stimulation) DBS: (deep brain stimulation). After all, don’t our medical and mental health professionals have the duty to explore all viable treatment options before beginning that journey which leads to the end of life? The article failed to explore this issue.

The Times Article unfairly portrayed Dr. Joel Yager in an unflattering light. Dr. Yager virtually attended the November 17, 2023, summit. He heard inspirational stories of heartache and resiliency from Linda and Jack Mazur and heartfelt apologies from Dr. Gaudiani to those who may have been hurt. He not only heard from but collaborated with some of the leading eating disorder experts in attendance that day. He heard the term “Terminal Anorexia” is being abandoned. He heard the commitment from all in attendance to preserve, to work together, to address this volatile topic in a compassionate, intelligent collaborative manner. As such, we are certainly justified in questioning why Dr. Yager was portrayed in such a cynical manner. Was the Times Article accurate in asserting Dr. Yager questioned the ethics and competency of other psychiatrists?  Whether they had become “zealots for the model.” Whether Dr. Yager was ambivalent and equally accepting whether Naomi lived or died. Whether Dr. Yager stated, “Yager told me that he does not regret what he wrote. ‘The main point is that some people die from the disease,’ he explained.” I believe that type of cynicism could not be generated from the Dr. Yager who participated in the November 17, 2023, summit.

The Times Article did not include information about the plenary panel session to be conducted at the International Conference of Eating Disorders in mid-March in New York City. This panel includes Dr. Gaudiani, Dr. Westmoreland, and others, with all sides of this topic to be discussed in a professional, open forum. This highly volatile, emotional, potentially divisive issue which touches our very existence deserves our highest compassion, intelligence and collaborative work. The Article failed in addressing this.

The New York Times is sometimes referred to as the “Gray Lady,” or the “Old Gray Lady.” Initially, the Gray Lady was a term of affection, meaning that the Times was deserving of respect, of measured intelligent thought. This article was the antithesis of the Times past standard.

With at least one of its photos in the article deserving of both a “trigger warning” or inclusion in the National Enquirer, this article was not worthy of being called investigative journalism. The Article took a complex, emotional issue … life or death, and relegated it to a lurid standard that makes “yellow journalism” appear erudite. Even the birds in my birdcage would be offended if I used this Article to line their dwelling.

Perhaps showing that the Old Gray Lady just ain’t what she used to be … many long years ago.