Friday Factoids Catch-Up: Euthanasia for Psychiatric Patients?

At least three countries, the Netherlands, Belgium and Switzerland, allow assisted suicides for people who have severe psychiatric illnesses. Other countries, like Canada, are debating such measures, citing the rights of people with untreatable mental illness. Laws in the United States, passed in five states, restrict doctor-assisted suicide to mentally competent adults with terminal illnesses only, not for psychiatric disorders. In 2002, euthanasia was legalized in the Netherlands for those with “unbearable suffering with no prospect of improvement.” The Netherlands has seen a sharp increase in the number of people choosing to end their own lives due to mental health problems.

Last year 56 people were euthanized in the Netherlands, whereas just two people were euthanized in 2010 due to an “insufferable” mental illness. The criteria for euthanasia in the Netherlands essentially require that the person’s disorder be “intractable” and “untreatable.” Experts worry how these criteria can be measured in patients with dementia or psychiatric illnesses. The most recent controversial case, a woman in her twenties was allowed to go ahead with the procedure as she was suffering from “incurable” posttraumatic stress disorder (PTSD), according to the Dutch Euthanasia Commission. Her conditions included childhood sexual abuse, anorexia, depression, and self-harming behaviors. She was given a lethal injection after doctors and psychiatrists decided that her mental health conditions were incurable. The injection went ahead despite improvements in the woman’s psychological condition after ‘intensive therapy’ two years ago.

Records from cases of doctor-assisted death for psychiatric distress from 2011 to mid-2014 show that 37 of the 66 cases, people had refused a recommended treatment that could have helped. Depression was the most common diagnosis and loneliness was a frequent theme. Most of the patients had a chronic and severe mental illness with histories of suicide attempts and psychiatric hospitalizations. Of the patients included in the study, 70 percent (n = 46) were women; 32 percent (n = 21) were aged 70 years or older, and 44 percent (n = 29) were aged 50 to 70 years. The ratio of women to men was notable in that it is the reverse of the ratio of women to men who commit suicide without assistance in the Netherlands (43 percent women versus 57 percent men). More than half had received a personality disorder diagnosis of Avoidant or Dependent Personality Disorder.

The data also revealed that euthanasia is often granted despite disagreement by treating physicians and psychiatrists over whether cases meet criteria for “unbearable suffering.” Although euthanasia review committees typically defer decisions to the judgment of physicians, that judgment often appears inconclusive. In 24 percent (n = 16) of cases, there was disagreement among consultants; 11 percent (n = 7) of cases were found to have had no independent psychiatric input at all; and one case was found by a review committee to have failed to meet legal due-care criteria. Only 41 percent (n = 27) of physicians administering the assisted suicide were psychiatrists, and among 32 percent (n = 21) of patients, previous assisted suicide requests had been refused. Three of the patients had physicians who later changed their mind, and 18 were granted the assisted suicide from physicians who were new to them. Among those, 14 of the physicians were affiliated with a mobile euthanasia clinic called the End-of-Life Clinic. In 12 percent of cases (n = 8), the researchers found evidence that the psychiatrist involved believed that the criteria for granting a request were not met, but the assisted death took place anyway.

Paulan Stärcke, a Dutch psychiatrist, reported that even children as young as 12-years-old who ask to end their lives should be taken seriously. She stated, “Euthanasia is a good death by the wish of the person who dies and no-one else. It is an execution of the wish of a patient.” Opponents of the law argue that the primary purpose of psychiatric care should be the prevention of suicide, but the opposing argument is that the suffering of some psychiatric patients is as “unbearable” as the suffering of patients with other medical conditions prevailed.

I ask the readers, what’s your view point?

References:
Boztas, S. (2016, May 11). Netherlands Sees Sharp Increase In People Choosing Euthanasia Due To ‘Mental Health Problems.’ The Telegraph. Retrieved from
http://www.telegraph.co.uk/news/2016/05/11/netherlands-sees-sharp-increase-in-people-choosing-euthanasia-du/

Melville, N. A. (2016, February 10). Euthanasia for ‘Untreatable’ Mental Illness: New Data. Retrieved from http://www.medscape.com/viewarticle/858786

Jonathan Torres, M.S.
WKPIC Pre-Doctoral Intern