Assisted dying in liberalised jurisdictions and the role of psychiatry: A clinician’s view

Abstract

There remain significant concerns about the accuracy of psychiatric assessment in the terminally ill. Mental processes are more relevant influences on a hastened wish to die than are the physical symptoms of terminal malignant disease. Psychiatric review of persons requesting euthanasia is relevant. It is not obligatory or emphasised in those legislations allowing assisted dying. Psychiatry needs to play a greater role in the assessment processes of euthanasia and PAS.

Implementation of Medical Assistance in Dying: A Scoping Review of Health Care Providers' Perspectives

“…45 Ensuring Safeguards Are in Place. Thirty-three percent (11/33) of articles, spanning physicians, 13,25,27,44,45 mental health providers, 29,37 pharmacists, 32,39,40 and social workers, 34 recognized the unresolved clinical issue of ensuring that necessary safeguards were in place for MAiD to protect patients from harm. While all these articles discussed the necessity of procedural safeguards to ensure requests were of the patient's free will, within the capacity to consent and met eligibility requirements for MAiD, implementing and overseeing these processes was subject to practical barriers.…”

“…24,27 Similarly, several authors maintained concerns of the ''slippery slope'' argument, whereby subjective medical impressions of suffering and capacity to consent were difficult to determine with objective certainty. 26,37,38 In the absence of a predefined clinical and/or legal test for mental capacity, six articles explored the inclusion of mental health providers to improve assessment processes. 29,30,35e38 While mental health providers, such as psychologists and psychiatrists, are perceived to be equipped to assess a patient's decisional capacity due to the potential presence of psychopathy (such as depression and cognitive impairments), concerns remained about how providers' personal characteristics, training, and experience may influence decisions about MAiD.…”

“…Lack of Knowledge and/or Training. Twenty-four percent (eight of 33) of included sources explicitly discussed the lack of knowledge and/or training about end-of-life matters and MAiD among nurses, 17,19 physicians, 24,25,28 mental health providers, 29,37 social workers, 19 and medical examiners. 42 For instance, surveys of 306 nurses and 85 social workers within hospices in Oregon, U.S., revealed that almost onequarter of respondents were not comfortable in discussing assisted suicide with a patient.…”

Brokering trust: estimating the cost of physician-assisted death

“…This is evident in the practical implementation of physicianassisted suicide and euthanasia in other countries. 2 Existential suffering and fears of losing control, being a burden, experiencing pain, and grappling with the unknown are real fears that cause tangible suffering, but we need to ask if there are better ways for physicians and communities to address this suffering.…”

“…Cette distinction est évidente dans l'application concrète de l'aide médicale au suicide et de l'euthanasie dans d'autres pays. 2 La tradition hippocratique n'est pas immuable, mais il est essentiel de réfléchir sérieusement à toute évolution des objectifs ou de l'ethos de la médecine qui sape la confiance entre le médecin et son patient. Des délais artificiels, décidés par autrui, nous forcent à écourter ce qui aurait dû être un dialogue empreint de réflexion parmi les médecins et entre les médecins et la communauté de patients dans son intégralité.…”