Do Patients Without a Terminal Illness Have the Right to Die?
'I'm not very good at it,' Paula said. 'Obviously.' Then she started to cry. She said that everything was getting worse. She said she didn't want to suffer anymore. 'This is a more dignified way to go than suicide.'
Paula was lying in the big bed that she had pulled into the center of the living room, facing an old TV and a window that looked out on a row of garbage bins. The room's brown linoleum floors were stained, and its walls were mostly unadorned. On a bookshelf, there was a small figurine of an angel, her arm raised in offering. At 52, Paula had a pale, unblemished face and a tangle of dark hair that fell around her waist. The day before the appointment, in January this year, she washed her hair for the first time in weeks, but then she was not able to lift herself out of the bathtub. When, after hours, she managed to get out, her pain and dizziness was so bad that she had to crawl across the floor.
Dr. Matt Wonnacott sat in a folding chair at the foot of the bed. He was there as Paula's 'primary assessor': one of two independent physicians, along with Dr. Elspeth MacEwan, a psychiatrist, who drove through the snow to Smiths Falls, Ontario, to evaluate Paula's eligibility for Canada's Medical Assistance in Dying (MAID) program — what critics call physician-assisted suicide.
'You're a difficult case,' Wonnacott admitted. Another clinician had already assessed Paula and determined that she was ineligible — but there was no limit to how many assessments a patient could undergo, and Paula had called the region's MAID coordination service every day, sometimes every hour, demanding to be assessed again, until the nurse on the other line had practically begged Wonnacott and his colleagues to take Paula off her roster.
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Forbes
30 minutes ago
- Forbes
Nevada Enacts New Law To Shut Down The Use Of AI For Mental Health But Sizzling Loopholes Might Exist
In today's column, I examine the recently enacted law by Nevada that seemingly aims to shut down the use of AI for mental health therapy in the glitzy Silver State. Here's the deal. Several states have been quickly pushing through new legislation to try and restrict or outrightly ban the use of AI to perform therapy. The idea is that only human therapists, psychologists, psychiatrists, and mental health professionals are allowed to perform mental health services. It is presumably an act reserved for human-to-human exclusivity. I recently analyzed the latest such AI-restricting law that was passed in Illinois, see the link here, which in many ways is akin to the Nevada law. I will discuss the mainstay similarities and differences herein. All in all, a looming spread of these laws, including potentially having federal enactments too, puts AI makers in potential trouble and will inexorably squash the use of AI as a mental health tool. Let's talk about it. This analysis of AI breakthroughs is part of my ongoing Forbes column coverage on the latest in AI, including identifying and explaining various impactful AI complexities (see the link here). AI And Mental Health Therapy As a quick background, I've been extensively covering and analyzing a myriad of facets regarding the advent of modern-era AI that produces mental health advice and performs AI-driven therapy. This rising use of AI has principally been spurred by the evolving advances and widespread adoption of generative AI. For a quick summary of some of my posted columns on this evolving topic, see the link here, which briefly recaps about forty of the over one hundred column postings that I've made on the subject. There is little doubt that this is a rapidly developing field and that there are tremendous upsides to be had, but at the same time, regrettably, hidden risks and outright gotchas come into these endeavors too. I frequently speak up about these pressing matters, including in an appearance last year on an episode of CBS's 60 Minutes, see the link here. Background On AI For Mental Health First, I'd like to set the stage on how generative AI and LLMs are typically used in an ad hoc way for mental health guidance. Millions upon millions of people are using generative AI as their ongoing advisor on mental health considerations. The top-ranked use of contemporary generative AI and LLMs is to consult with the AI on mental health facets, see my coverage at the link here. This popular usage makes abundant sense. You can access most of the major generative AI systems for nearly free or at a super low cost, doing so anywhere and at any time. Thus, if you have any mental health qualms that you want to chat about, all you need to do is log in to AI and proceed forthwith on a 24/7 basis. Compared to using a human therapist, the AI usage is a breeze and readily undertaken. When I say that I am referring to generative AI and LLMs, please know that there are generic versions versus non-generic versions of such AI. Generic AI is used for all kinds of everyday tasks, and just so happens to also encompass providing a semblance of mental health advice. On the other hand, there are customized AIs specifically for performing therapy; see my discussion at the link here. I'm going to primarily be discussing generic generative AI, though many of these points can involve the specialized marketplace, too. Therapists Adopting AI Therapists are realizing that they, too, must consider adopting the use of AI. The reason is straightforward. Potential clients and patients are walking in the door with claimed-to-be cognitive diagnoses that AI has generated for them. Some therapists tell their clients and patients to simply ignore the AI. But that doesn't usually do much good, since people will indubitably go behind the back of their therapist and access AI anyway. For more on the ins and outs of therapists using AI for mental health, see my analysis at the link here. An emerging strategy for therapists is to avidly adopt the use of AI into their practices. It's the proverbial if you can't beat them, join them refrain. The march toward AI is unstoppable. They generally do so in these two major ways: An administrative use of AI by a therapist is generally less concerning than when using AI for therapeutic purposes. Assuming that the administrative use of AI is done with proper security and rigor, most clients or patients won't especially care that the therapist is using AI in that manner. The assumption is that the AI streamlines the business side and hopefully reduces The controversial angle is the use of AI as an arm of the therapist. Some therapists say that choosing to use AI is a big mistake and that the cherished therapist-client dyad bond should remain untouched and unchanged. Others, such as my advocacy, assert that we are heading into an era of a new triad, consisting of a therapist-AI-client relationship. It is inevitable and unavoidable. See my coverage at the link here. The Law Gap Is Closing Fast Consider then that we have two potential overarching issues brewing: It would be possible to establish regulations that could be a means of dealing with one or both of those brewing concerns. Lawmakers could opt to formalize legal conditions associated with how therapists lean into AI. That could be a consideration all by itself. Likewise, a circumstance all by itself could be the matter of regulating AI makers about allowing their AI to wantonly provide mental health advice. A double whammy would be to tackle both tough topics in one fell swoop. The recently passed and signed Nevada law tries to tackle both topics at the same time. Indeed, the Nevada law goes further and has a veritable potpourri of other aspects. In contrast, the Illinois law tended to focus primarily on the two above-noted considerations. These state laws not only have to do with the respective states, but they are also a bellwether of how AI for mental health is possibly going to be regulated. Often, regulations of one kind or another start in one state and then are reused or recast when other states opt to do something similar. They might take the language used in the already passed law and use that as a draft for their own proposed law. Some language gets changed, new language is added, and so on. The first law to get approved often serves as a template or model. Besides the various states enacting their own laws, there is often a dynamic that gets the federal government to also pursue the same or similar regulation. Once again, the initial state law might be an illuminating example. Questions naturally arise on how to best reshape a state-specific law into a law that might be suitable across the board as a federal law. Impacts Are Plenty Let's go ahead and take a quick peek at the Nevada law and see what we can make of it. I will share just some mindfully chosen snippets and give you a taste of what the law contains. Please know that the law has numerous twists and turns. Also, my commentary is merely a layman's viewpoint. Make sure to consult with your attorney to garner the legal ramifications of whatever your own situation entails. The law that was passed is known as Assembly Bill 406, abbreviated as AB406, and was signed into law by the governor of Nevada on June 5, 2025. You will see the nomenclature of 'NRS' throughout the passages -- NRS means Nevada Revised Statutes, referring to the various codified laws of Nevada. Here is the official description of AB406 at a 30,000-foot level: A significant difference between the Nevada law versus the Illinois law is the added element of AI usage in schools. The background is that there is a lot of controversy these days about deploying AI in schools, and that AI could be used in undesirable ways. This law tries to provide conditions and restrictions on the educational use of AI in the public schools of Nevada. I am not going to address that topic in this discussion and will be covering the debate regarding school uses of AI in a future posting. Be on the watch for that coverage. AI Use By The Public I had mentioned earlier that the Nevada law and the Illinois law entail two major AI-powered mental health capacities. One aspect is the use of AI for mental health as undertaken by the general public of their own volition. The other capacity is the use of AI by mental health professionals via their services and professional practice. Let's start with the perhaps biggest kicker, the use of AI for mental health by the public at large. That portion is contained in Section 7 of AB406. In Section 7 of AB406, the legal indication amends an existing statute known as Chapter 433, and here is the core language (excerpt): There are three bulleted points labeled as 'a', 'b', and 'c'. Read those points carefully. You will keenly observe that the crux is that AI available for use in Nevada is not supposed to provide professional mental or behavioral health care. This includes that the AI is not to simulate human conversation in that same vein. Nor can the provider of the AI, nor the AI itself, appear to suggest or outrightly state that it is a kind of professional mental health specialist, such as a human therapist. I am paraphrasing the language shown, so realize that the actual language is paramount, not my paraphrasing. Emphasis On Professional And Of Programmed The next portion of that Section 7 adds a further twist to this: The language once again hammers away at the notion that the AI isn't supposed to be doing the job of a living-breathing mental health therapist. There are some key wording aspects in this Section 7 that are worth pondering. One aspect is the conspicuous use of the word 'professional'. A legal beagle that represents an AI maker would undoubtedly argue that if the AI isn't performing professional-caliber mental health guidance, the AI doesn't come under these provisions. Only AI that is acting in a seemingly professional manner, or that the AI maker claims is functioning professionally, ends up under this umbrella. In short, if the AI is, shall we say, feeble, in contrast to professional mental health guidance, the AI maker might insist they are off the hook. Hey, our AI is just playing around and perchance dips its toe into mental health therapy. It isn't the real thing. Period, end of story. In the portion above, you might also have noted that the phrase 'specifically programmed' was utilized. This provides perhaps another escape route. An AI maker might stridently claim that they didn't devise the AI to be professional. And, for sure, it isn't rising to any iota of a professional level or caliber. Voila, on both elements, we don't have to worry about this law and can proceed scot-free. It will be interesting to see how that plays out in reality and whether legal cases will be launched in Nevada that deal with the semantics or interpretation of this law. Due to space limitations here and wanting to be succinct, I'll note that there is a Section 7c that provides a definition of 'Professional mental or behavioral health care' that dovetails into the semantics considerations. I am not going to dive into that passage here but bring it to your attention for the sake of completeness. Self-Help Exclusion A provision in Section 6 brings forth another possible wiggle-room pathway: You might have caught the notable wording that if the AI is providing self-help in the mental health context, and assuming the AI and nor is the AI maker proclaiming that the AI is of professional quality, the AI maker might be given a free pass. Do you think that generative AI could be construed as providing a self-help style of interaction? If so, an additional avenue opens for AI makers who are trying to avoid getting ensnared in this new law. AI Provided Via Therapists Shifting gears, let's explore the side of things involving human therapists who opt to make use of AI in their services and practice. That comes up in Section 8: This smacks of a similar approach used in the Illinois law. The idea is that therapists can use AI for administrative purposes, such as scheduling and billing, but they dare not use AI for therapeutic purposes. I find this trend to be unfortunate, short-minded, and dismal. A therapist could legitimately have AI interacting with clients while the client is at home or elsewhere, doing some follow-up homework under the overall guidance of the therapist. These laws are an overreach, a clumsy catch-all. It will utterly chase therapists away from using AI in a manner that can be highly productive, merely because the wording is like a sword dangling over their heads. Society ought to want mental health professionals to use AI in sound ways, especially so on the therapy side of things. Thus, don't ban the AI. Instead, provide provisions associated with sensible and tangible guardrails and stipulations. Setting sensible boundaries would be useful. Squashing or heavily stifling innovation in mental health is not the way we should be headed. Thoughtful and guarded adoption of AI is warranted and saluted. I vote that any laws related to therapists' use of AI for therapy ought to be of a balanced nature. So far, they are lopsided, egregiously so. Key Takeaways For AI Makers For the AI makers, they should take this as a clarion call and closely scrutinize these laws and take immediate and mindful actions to protect themselves from undue legal vulnerabilities and reputational risks. Allow me to clarify that this does not imply they should dodge these laws. They should abide by these laws and figure out where their AI sits in the emerging wanton mosaic that is being formulated. In the case of Nevada law, it would seem likely that the legal counsel of an AI maker would urge their client to take overt action to refrain from suggesting or stating that their AI is performing professional mental health care. Don't say that your generic generative AI instantiates professional quality therapy, such as brazenly blabbing so in your marketing materials. The top executives should not be giving speeches proclaiming that their generic generative AI is an ace at mental health. The AI itself should not be telling users that it is professional quality. That could easily happen. Depending on how the LLM has been data-trained and subsequently tuned, there is a chance that on some occasions, it might emit that kind of claim. AI makers would be wise to institute specialized add-on filters and computational double-checks that catch the AI from making those emboldened assertions. Other considerations include aligning the online licensing agreement and terms of service so that there isn't any wording that leans toward professional-stating claims. Another angle is whether the AI maker has users perform some form of consent when using the AI in a mental health capacity. That would be a ripe spot to declare that the AI isn't of professional quality and make darned sure to remove any wording that suggests otherwise. Getting Over Our Skis A crucial distinction that some of these laws are astutely making, while others are not, consists of separating unregulated AI that does therapy from regulated AI. Think of it this way. Suppose a highly customized AI app for therapy is carefully devised, tested, and then fielded. It has gone through the gauntlet of getting certification or regulated approval. These laws that toss everything into the same kitchen sink are equating generic generative AI to those mindfully devised AIs. No distinction is acknowledged. It is one thing to go after generic generative AI, and yet an entirely different consideration involving AI that has been dutifully crafted with evidence-based rigor for mental health. Like the old saying goes, to some degree, we might be tossing out the baby with the bathwater. A final thought for now. The famous line that what happens in Vegas, stays in Vegas, provides ample fodder associated with this Nevada law. Any AI maker that has their AI available to anyone in Nevada has now gained a new high risk. Whether the AI maker knows it or not, and many AI makers seem not to be cognizant of these laws, what happens in Nevada doesn't per se stay in Nevada. An AI maker in New York, California, or wherever else is a high roller in Nevada, assuming their AI is accessible in that state. Your stake is sitting on the table, with both legal and financial penalties cozying up, so open your eyes, make sure you have a safe hand, else you could lose your shirt.
Bloomberg
2 hours ago
- Bloomberg
Swedish Startup Mindler Agrees to Buy Ieso Digital Health UK
Swedish startup Mindler AB has acquired Ieso Digital Health UK for an undisclosed sum as it seeks to build out its footprint in the online therapy market. The acquisition will give Mindler access to existing contracts with the National Health Service in England and Scotland, according to emailed comments. The company says it's seeking to benefit from increased demand for mental health services in the UK at a time of relatively high vacancy rates for doctors in the NHS mental health services.
Yahoo
5 hours ago
- Yahoo
Breastfeeding could help prevent early puberty in girls and boys, South Korean study finds
Girls and boys who were exclusively breastfed during their first four to six months showed a reduced risk of early puberty, according to a large new study from South Korea that Canadian doctors say could apply here. The study, published in Monday's issue of JAMA Network Open, looked back at the diets and development of more than 300,000 children from 2007 to 2020, based on data from checkups at four to six months of age and before six years. Worldwide, puberty has increasingly begun earlier in kids. Called "central precocious puberty," it's linked to an increased risk of health problems in adulthood, like heart disease, cancer and diabetes, as well as mental health issues like depression and anxiety. The researchers believe that kids who are exclusively breastfed are less likely to develop childhood obesity, a major predisposing factor of early puberty. However, experts note that many mothers face challenges in breastfeeding, which they say should be addressed on a structural level. "The take-home message should be, for parents or to-be parents, that breastfeeding has multiple beneficial health effects for their children," said Dr. Sonia Anand, associate vice-president of global health at McMaster University, who was not involved in the study. "And the second message is it is not always easy to do." Long-term benefits of breastfeeding About 46 per cent of the babies in the South Korean study were exclusively breastfed, more than a third had formula and nearly 20 per cent had both. "The idea is that breastfed kids are less likely to have extra weight and that's the mechanism whereby they're more protected from developing early puberty," said Dr. Kaberi Dasgupta, a professor of medicine and physician scientist at the McGill University Health Centre, who also was not involved in the study. Boys who were fed just formula had a 16 per cent increased risk of early puberty compared with their peers who were only fed breast milk, the researchers found. For exclusively formula-fed girls, the association jumped to 60 per cent. For mixed-fed boys, it was 14 per cent higher, compared with 45 per cent for girls. The researchers noted some caveats to their study. The participants self-reported how long they breastfed their children, for example. It also couldn't include genetic factors like maternal age of puberty. The early part of life is a key time, as that's when a lot of disease risk is set, wrote doctors Lin Yang and Shengxu Li. Though they weren't involved in the study, they wrote an accompanying journal commentary. "Disease starts early, so should its prevention," they said. Dasgupta says there's no reason to think the findings would be different in Canada. Preventing early puberty can also help kids in other ways, she adds. "The earlier your puberty, the shorter you may become," she said. "There's also the stigma around having early signs of being an adult when you're still a kid. Other kids may tease you." Supporting mothers instead of shaming Yang and the researchers say that instead of putting pressure on new moms, a society-wide approach is important. That includes stronger parental leave policies, workplace accommodations like a private space to breastfeed and lactation support services. "I think policy support, raised awareness, as well as creating the environment for women to be able to [breastfeed] is very important," Yang told CBC News. Sleep patterns, physical activity levels and screen time could also be increasing childhood obesity and early puberty rates, Yang and Li wrote in their commentary, as well as environmental pollutants like endocrine disruptors, though she acknowledged there isn't good data on that. In Canada, about 91 per cent of parents start out breastfeeding. About 38 per cent of parents breastfed exclusively for at least six months, Statistics Canada reported in 2024. Of those who stopped before six months, reasons included not having enough breast milk, finding breastfeeding difficult and the child weaning themself off of it. "I think the wrong takeaway and the wrong approach is to shame mothers who try to breastfeed but can't continue," Anand said. Breastfeeding is one factor among many that can influence weight gain in kids. Lifestyle choices like limiting fast food and cooking with more vegetables and lean proteins can also help prevent childhood obesity, doctors say. While the South Korean study doesn't prove that formula feeding causes early puberty, the researchers had a robust data set and the associations are plausible, she said. Anand's own research demonstrated early breastfeeding and for at least six months was associated with lower levels of excess body fat in children at age three. She says she'd like to see other large studies show similar findings to the South Korean to nail down cause and effect. Studies looking at how genes are tied to precocious puberty could also help, she said.
