Dr. Colin Brewer has a long clinical and academic career in adult psychiatry and addiction medicine, and is well-known for his advocacy for voluntary euthanasia and medically-assisted, rational suicide.
Dr. Brewer has assisted many who wish to choose their own death by evaluating their mental faculties, so they qualify for medically assisted dying services in countries, like Switzerland, which allow a person to choose to die without a terminal illness.
One must provide proof of sound mind and autonomy, which is what Dr. Brewer analyzes over a series of three visits before he makes a recommendation.
One of the clients he assisted was Catherine Kassenoff, who he evaluated in April 2023.
He judged her competent to end her life through medically assisted suicide (MAS).
He said he saw “no sign of guilt, low self-esteem, retardation, delusions or other classic features of a severe depressive illness.” His report did not mention a recurrence of cancer.
He did note an email from Allan Kassenoff, which Catherine said: “strongly indicated the unlikelihood of any agreed access to her children, which is one of the major factors in her request for MAS.”
In an email to Frank Report, Dr. Brewer stated:
I’ve been actively and publicly involved with the assisted dying movement for over half of my 80-odd years, so it’s not being identified as such that worries me and there’s clearly a lot of information already in the public domain, but I can see that the debate about the [Kassenoff] case in the US is getting very toxic.
I don’t do social media, but I really don’t want my inbox filling up with the sort of uninformed and vicious comments that your very factual articles are evidently provoking, along with more measured ones. On that understanding, I’m willing to consider further questions but if you want to know my considered views on assisted dying, you can find them in my books.
In January 2015, he published “I’ll See Myself Out, Thank You” – a book of essays that he co-edited with Dr. Michael Irwin.
His latest publication is: “O, Let Me Not Get Alzheimer’s Sweet Heaven!: Why many people prefer death or active deliverance to living with dementia” .
He provides descriptions of what Alzheimer’s looks and feels like, with chapters names like, “Will You Still Need Me, Will You Tube-Feed Me, When I’m Ninety-Four?” and “What Do We Want? Euthanasia! When Do We Want It? As Soon As We Need 24-Hour Care!!”
An excerpt from Dr. Brewer’s book:
CHAPTER 9: SLIPPERY SLOPES.
Opponents of deliverance typically invoke at least two separate slippery slopes.
One criticism focuses on the observation that when deliverance is permitted, the number of people who want it increases.
Let us immediately remind ourselves, though, that by legal definition and in all the relevant jurisdictions, these people must have the Mental Capacity to make decisions about the current and future management of their conditions. As a rule, their views about deliverance have developed over several years, and they are not under any pressure from others to choose deliverance.
With very few exceptions, they are not suffering from anything that could be called a mental illness, even by the most zealous defender of DSM-5’s diagnostic free-fire zone. Even those exceptions must have been confirmed to have Capacity and are therefore rational enough to make decisions about their treatment.
Deliverance, for most users, simply means that after much thought, they have exercised their right to choose an alternative end-of-life scenario to the one that is becoming increasingly and unacceptably unpleasant – or looks as if it will do so before much longer.
Why is it either surprising or undesirable if it attracts more than a very few followers?
Critics of this kind may not oppose deliverance on principle and might even use it themselves if the need arose, but often it seems that they do not fully accept the argument from autonomy as it affects the relationship between doctor and patient – an argument that accepts the basic, presumptive right of adults (and of younger people with sufficient knowledge and understanding) to make their own decisions about accepting or not accepting medical interventions, even against medical advice.
In my experience, critics of autonomy tend to be at least somewhat religious (the religious attitude studies cited above bear that out) and though not necessarily as doctrinaire as those who think rational suicide is a sin, the concept still disturbs them at some fundamental level. They also tend to argue that current British (or English) law and the Swiss Option are a satisfactory compromise because the law acts as a deterrent and the DPP can be relied on to be merciful.
The other slippery slope is the one onto which, it is alleged, large numbers of people with physical and mental disabilities, who have never expressed any desire for deliverance from their conditions, will be encouraged to enter by family members, stigma and social pressure, or by the State that spends so much money on their care and is always looking for economies.
In this scenario, the disabled will not so much walk or crawl reluctantly onto the slope but will be pushed onto it willy-nilly in their wheelchairs, reaching out in vain for ethical and legal handholds as they accelerate down towards the final ski-jump.
This scenario is invoked by both religious critics and non-religious ones like the right-of-centre, atheist, gay, libertarian journalist Douglas Murray – a man I greatly admire for his brave defence of our hard-won freedom to criticize all religions, including Islam.
For Murray, the ‘slippery slope’ is evidently a daily concern. “I think continually about this” he writes. “Perhaps this will become the dominant vision of life in Britain…. But I cannot wish for it. There’s the slippery slope, the uncertain old who may feel pressured, the pathetic cases of depressed teenagers choosing death, and the shift in meaning it brings to life as well as death.”…
However, Murray also worries about the slow but steady increase in Dutch and Belgian deaths by voluntary euthanasia (our opponents often leave out that crucial adjective) and their equivalents in states where deliverance is legal. I will deal with that objection first.
One explanation for the increase is surely the same one that accounts for the gradual – even hesitant – adoption of many other new ideas, technologies and freedoms: including, I suppose, the relatively recent freedom to come out as a gay journalist without any serious legal or professional consequences….
Is it surprising if more and more patients suffering from unpleasant and intractable or terminal conditions, in jurisdictions from the Netherlands to Oregon and Australia, have taken advantage of the freedom the law allows them to choose the time and manner of their deaths in the way that many doctors are able to do?
There are obvious advantages to be had from dying peacefully, predictably and without anxiety about frightening terminal symptoms such as fighting for breath and palpitations; without being confused, hallucinating and barely conscious for several days because of high doses of morphine and sedatives; or of diminishing the dignity of the final farewell and the carefully chosen last words by becoming confused or by an all-too-noticeable attack of vomiting or faecal incontinence.
Those who, for whatever reasons, prefer the natural, drawn-out but often unpredictable version are free to choose it. Palliative care and hospices exist in part to cater for their tastes. Not everyone wants a planned and medicalised death and far more people evidently prefer not to think too much – or at all – about death…
Dr. Brewer told Frank Report:
I think Catherine’s death would not have been possible in any other jurisdiction that permits assisted dying. Only Switzerland allows AD for what I would categorize as ‘existential’ reasons, with no significant medical or psychiatric factors.
I was told the law originated around 1919 and was originally designed to protect Swiss officers who provided the traditional bottle of whisky and revolver to a colleague who had disgraced his regiment and wanted to do the traditional penance. It’s an interesting claim but I’ve never been able to find chapter and verse.
Sincerely, Colin Brewer.
