Assessment of decision-making capacity in patients requesting assisted suicide

Abstract

SummaryIn this editorial, we argue that current attitudes toward terminally ill patients are generally too paternalistic, and that it is wrong to assume that patients suffering from mental health issues (including depression) cannot consent to assisted suicide. Declaration of interestNone. Copyright and usage

The advocates of euthanasia in patients with mental illness are going in the wrong direction

“…The advocates of euthanasia in patients with mental illness are going in the wrong direction Shaw et al argue that 'it is wrong to assume that patients suffering from mental health issues (including depression) cannot consent to assisted suicide'. 1 But being depressed is the strongest correlate of decision instability, of changing from acceptance of euthanasia to rejecting it at follow-up. 2 As a matter of fact, the rate of psychiatric patients who, after seeking euthanasia or assisted suicide (EAS), no longer wished to die and/or withdrew their requests is quite high.…”

“…The editorial by Shaw et al in the July edition discussing decisionmaking capacity to request assisted suicide follows on from a previous report from Belgium also published in the journal entitled 'When unbearable suffering incites psychiatric patients to request euthanasia: qualitative study.' 1,2 There seem to have been no balancing editorials or reports on the merits of effective palliative care in individuals who are terminally ill or in those suffering unbearably. This must be the hand of the editor because it definitely is not the hand of God!…”

My response to ‘Assessment of decision-making capacity in patients requesting assisted suicide’

“…Although I congratulate the authors for addressing a controversial and neglected subject, I fear that in their efforts to soften their views they also 'muddy the waters'. 1 Specifically, they refer to the enhanced evaluation and a higher standard of competence for those patients seeking assisted suicide who are not terminally ill. However, capacity as assessed through the tests laid down in the Mental Capacity Act 2005 is issue-specific, time-specific and obviously also patient-specific.…”

An odd choice for an editorial!

“…It is puzzling that this article by Shaw et al received the mantle of an editorial! 1 The authors express opposition to psychiatric interview and psychological questionnaires in the assessment of individuals seeking assisted suicide. In my opinion the article should have been published for debate, with a contrary view presented.…”

“…In their editorial, Shaw et al argue that current medical practice is overly paternalistic towards patients who are mentally competent and who have a terminal illness (including those with psychiatric illness) who request assisted suicide. 1 They base their general argument on the four principles of bioethics with a special emphasis on patient autonomy and end by asserting that, 'any doctor who attempts to prevent a patient who is mentally competent from accessing assisted suicide is adopting an over-paternalistic stance'. 1 The authors' implicit argument against dissuading a patient from assisted suicide appears to rest on the premise that death is a lesser evil (or a lesser suffering) compared with being alive and suffering.…”