Assisted dying requests from people in detention: Psychiatric, ethical, and legal considerations–A literature review

Abstract

The principle of equivalence of care states that prisoners must have access to the same standard of health care as the general population. If, as recent court decisions suggest, assisted dying is not limited to people with a terminal physical illness or irremediable suffering, it might also be requested by people with severe mental illness in detention. Some of the countries with legal regulations on assisted dying also have recommendations on how to handle requests from prisoners. However, detention itself can lead to psychological distress and suicidality, so we must consider whether and how people in such settings can make autonomous decisions. Ethical conflicts arise with regard to an individual's free will, right to life, and physical and personal integrity and to the right of a state to inflict punishment. Furthermore, people in prison often receive insufficient mental health care. In this review, we compare different practices for dealing with requests for assisted dying from people in prison and forensic psychiatric facilities and discuss the current ethical and psychiatric issues concerning assisted dying in such settings.

Caring for people in prison with palliative and end-of-life care needs

“…The legality of such actions differs between countries and states. However, recent years have seen a shift towards liberalisation in several countries 27▪▪ .…”

“…Franke and colleagues 27 provide a comprehensive review of the psychiatric, ethical and legal dimensions of assisted dying for people who are incarcerated. The care of people in prison should be equitable with that of the general population, and in jurisdictions where assisted dying is legally permitted, there are no laws explicitly denying this right to the incarcerated population 28 .…”

“…Both reviews discuss these dilemmas to a depth beyond that which can be summarised here, but a key distinction is that there is a difference between requests for assisted dying made on the grounds of terminal illness and those made because of psychological suffering due to incarceration. Franke and colleagues 27 emphasise the need for prisons to support rehabilitation and reintegration, cautioning against the use of assisted dying in all but exceptional cases.…”