Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders

Abstract

Purpose of Review Over the last 30 years, medical assistance in dying (MAiD) including euthanasia (EU) and physician-assisted death (or suicide, PAS) has become the center of a large debate, particularly when these practices have involved people with psychiatric illness, including resistant depression, schizophrenia, personality, or other severe psychiatric disorders. We performed a review utilizing several databases, and by including the most relevant studies in full journal articles investigating the problem of MAiD in patients with psychiatric disorders but not in physical terminal conditions (non-terminal, MAiD-NT). Recent Findings Literature has shown that a small percentage of people with psychiatric disorders died by MAiD-NT in comparison with patients with somatic diseases in terminal clinical conditions (e.g., cancer, AIDS). However, the problem in the field is complex and not solved yet as confirmed by the fact that only a few countries (e.g., the Netherlands, Belgium, Luxemburg) have legalized MAiD-NT for patients with psychiatric disorders, while most have maintained the practices accessible only to people with somatic disease in a terminal phase. Also, how to make objective the criterion of irremediability of a mental disorder; how to balance suicide prevention with assisted suicide; how to avoid the risk of progressively including in requests for MAiD-NT vulnerable segments of the population, such as minors, elderly, or people with dementia, in a productive-oriented society, are some of the critical points to be discussed. Summary The application of MAiD-NT in people with psychiatric disorders should be further explored to prevent end-of-life rights from contradicting the principles of recovery-oriented care.

Lifetime Suicide Attempts in Otherwise Psychiatrically Healthy Individuals

“…In such cases, self-inflicted death could be viewed as a rational “exit plan” (D. Sisti, PhD, University of Pennsylvania, email, August 15, 2023). However, some Benelux countries have laws supportive of MAID for individuals for whom the only medical condition is psychiatric, and Canada is slated to implement such a law soon . In those cases, consideration about whether self-inflicted death is pathological is more complex.…”

Identifying practical clinical problems in active euthanasia: A systematic literature review of the findings in countries where euthanasia is legal

“…This is because euthanasia due to psychological pain is often caused by conditions such as dementia, and as the disease progresses, the ability to make decisions deteriorates (Groenewoud et al 2022). Moreover, in some cases, the ability to make decisions is insufficient when the patient is experiencing so-called unbearable pain (Grassi et al 2022). The effectiveness of ADEs has been recognized to prevent patients from not being relieved from pain for this reason; however, the implementation of these ADEs may be problematic in some cases.…”

Euthanasia and physician-assisted suicide in people with intellectual disabilities and/or autism spectrum disorders: investigation of 39 Dutch case reports (2012–2021)

“…Our concerns echo those raised internationally about whether the necessarily broad criteria for legal EAS provide sufficient safeguards for vulnerable patient groups, such as those with psychiatric conditions. [21][22][23] We also share concerns about the level of disagreement between physicians and the level of regulatory oversight. 24 The cases in this study were highly complex, requiring careful consideration of the reasons behind both the EAS request and the granting of that requests.…”