Attitudes toward assisted suicide requests in the context of severe and persistent mental illness: A survey of psychiatrists in Switzerland

Abstract

ObjectiveSwitzerland is among the few countries worldwide where a request for assisted suicide (AS) can be granted on the basis of a primary psychiatric diagnosis. Psychiatrists play an increasingly important role in this regard, especially when the request for AS arises in the context of suffering caused by severe and persistent mental illness (SPMI). The objective of the survey was to assess general attitudes among psychiatrists in Switzerland regarding AS requests from patients with SPMI.MethodIn a cross-sectional survey of 1,311 German-speaking psychiatrists in Switzerland, participants were asked about their attitude to AS for patients with SPMI, based on three case vignettes of patients diagnosed with anorexia nervosa, treatment-refractory depression, or severe persistent schizophrenia.ResultFrom a final sample of 457 psychiatrists (a response rate of 34.9%) whose mean age was 57.8 years, 48.6% of respondents did not support access to AS for persons diagnosed with SPMI, 21.2% were neutral, and 29.3% indicated some degree of support for access. In relation to the case vignettes, a slightly higher percentage of respondents supported the patient's wish to seek AS: 35.4% for those diagnosed with anorexia nervosa, 32.1% for those diagnosed with depression, and 31.4% for those diagnosed with schizophrenia.Significance of resultsAlthough a majority of the responding psychiatrists did not support AS for SPMI patients, about one-third would have supported the wishes of patients in the case vignettes. In light of the increasing number of psychiatric patients seeking AS and the continuing liberalization of AS practices, it is important to understand and take account of psychiatrists’ perspectives.

Belgian psychiatrists’ attitudes towards, and readiness to engage in, euthanasia assessment procedures with adults with psychiatric conditions: a survey

“…Contrary to Canadian and Swiss findings [ 17 , 18 ] but in line with Dutch findings [ 15 ], the majority of psychiatrists were in favour of continuing to allow APC to die by means of euthanasia. Most Dutch-speaking psychiatrists agreed that APC can effectively meet the substantive legal criteria, although this mainly concerns the criteria that can be attributed directly to the patient (e.g.…”

“…Currently, only the Netherlands provides information from periodic evaluation and survey studies on euthanasia practice involving APC from a psychiatrist’s perspective and results show that although the number of euthanasia cases performed has increased over time, the Dutch professional body of psychiatrists has become more reluctant to engage in or grant euthanasia requests from APC over the years [ 15 , 16 ]. Recent cross-sectional studies gauging Canadian and Swiss psychiatrists’ attitudes to such cases also show this reluctance [ 17 , 18 ]. This is commonly attributed to the complexity and difficulty of adequately assessing all legal substantive criteria in APC [ 15 , 19 ].…”

Compulsory Psychiatric Admission in a Patient With Metastatic Breast Cancer: From Palliative Care to Assisted Suicide

“…Furthermore, prevention of suicide due to mental illness is a core task of psychiatry and deeply engrained in the professional identity of psychiatrists. In line with this, about half of the psychiatrists in a recent Swiss survey did not support access to assisted suicide in cases of severe and persistent mental illness-even when decision-making capacity was maintained (12). The legal situations and specific clinical challenges for psychiatry associated with medical assistance in dying have been the topic of a recent review (13).…”

Perceived Burdensomeness and the Wish for Hastened Death in Persons With Severe and Persistent Mental Illness

“…This perspective is particularly important when considering whether patients with SPMI should be allowed to access MAID although possibly perceiving themselves as a burden to others. Psychiatrists are trained to focus on suicide prevention, and this may conflict with acceptance of MAID for patients with mental illness ( 6 , 7 , 9 , 17 , 20 , 45 – 47 ). For that reason, it seems necessary to question the appropriateness of conflating arguments for suicide prevention with arguments about MAID, as recently discussed in relation to psychiatric disorders ( 47 ).…”

“…Psychiatrists are trained to focus on suicide prevention, and this may conflict with acceptance of MAID for patients with mental illness ( 6 , 7 , 9 , 17 , 20 , 45 – 47 ). For that reason, it seems necessary to question the appropriateness of conflating arguments for suicide prevention with arguments about MAID, as recently discussed in relation to psychiatric disorders ( 47 ). Because of certain “ shared characteristics ” ( 47 , 48 ), one might struggle to distinguish suicide “ in the conventional sense ” ( 48 ) from MAID, and emergent expressions like “ rational suicide ” ( 45 , 46 ) highlight this struggle.…”