Physician assistance to help people end their lives—by prescribing or directly administering medication—is now legal in some form in 4 American states, Canada, and 4 European countries.1 In the United States, laws permitting physicians to write prescriptions for medications intended to end patients’ lives are limited to patients with terminal conditions and preclude physician administration of the medication. However, other countries, including the Netherlands, allow direct physician involvement and have expanded the criteria to include patients with irremediable suffering, whatever the cause. Therefore, the door has been opened for people whose suffering is primarily due to mental disorders to seek assistance in dying.
Data from Belgium and the Netherlands make clear that such requests occur and are often approved. Approximately 3% of patients receiving physician assistance to die in Belgium2 and almost 1% in the Netherlands3 requested assisted death because of suffering due to intractable psychiatric disorders. However, particular concerns attend physician-assisted death for psychiatric indications. The practice of helping patients to die began with patients having terminal illness, often with metastatic cancer, who have a limited life span and are experiencing severe pain. For those patients, the application of the criteria for assistance—including a terminal diagnosis, competent decision, and intense suffering—while not easy in every case, is relatively straightforward. For psychiatric patients, however, for whom a desire to die is often part of the disorder and whose response to additional treatment is less certain, the competence of their decision and the intractability of their suffering are much more difficult to assess.
A very controversial subject. I notice no mention of people with schizophrenia. Perhaps seen as incapable of making a “rational” decision.
I know that requests can be made by patients with mental illness to end their lives. It’s not happening on a big scale though. Contrary to what is written here, nearly all of requests in these circumstances are denied. GP’s or psychiatrists can do this, but almost never would agree to assist in the case of psychological suffering. There is a special end-of-life-clinic for people with such a wish, who are sent away by their own doctor. They get loads of more complex requests by people with mental illness, hundreds each year. There’s a waiting list.
In 2014 17 requents were fulfillled. I don’t know if they would help people with schizophrenia, they don’t say explicitly.
They give two case studies of requests that they …(how do you call that?) fulfilled. One is a 64 year old male who had had severe treatment resistent depression all his life, has to quit working now, has no social contacts and suffers from extreme selfhatred. Every treatment has been tried and he does not respond to anything. The other is a woman with several severe mental illnesses from childhood on. She too has got no social contacts or possibility to get them, because of her extreme obsession with cleanliness. Both patients were seen for a long period (months, almost a year) by the end-of-life clinic and they sought for other solutions with them, before the decision was made. Some government institution has to judge whether the procedure was done in a good, careful way and a right decision was made.
I used to think only God decides about life or death. Now…being really sick, I can actually imagine that people would end their lives and have thought about that myself.
I don’t know what to think… in these cases it’s much more difficult to make a careful decision…but if someone is ill for 45 years and everything has been tried…it might be more humane to hand over some meds than to have them jump in front of a train or off some building.
I see the controversy and danger, and am on the fence on this subject, but tend to think that euthanasia should be possible in cases of extreme mental suffering. I know I’m influenced by the debate/liberal attitude in my own country though…
From the article: “Will psychiatrists conclude from the legalization of assisted death that it is acceptable to give up on treating some patients? If so, how far will the influence of that belief spread? There is also understandable anxiety about the secondary consequences of an assisted death option for people with mental disorders, including inducing hopelessness among other individuals with similar conditions and removing pressure for an improvement in psychiatric and social services.”
Suffering is part of every life. There are depths of suffering from mental illness that cannot be measured, and every life is still irreplaceable.
Seems like palliative care and all other end of life decision making should be reserved for people who are actually dying of accurately and unquestionably diagnosed illnesses whose courses are scientifically proven. We all know that months or a year might not be enough time for recovery from MI.
As long as someone is competent and of age, I think euthanasia should be allowed regardless of a person’s physical condition. At the end of the day, it’s their life.