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Depression, personality disorder most common diagnoses among patients who request euthanasia

The most common diagnoses among Belgian individuals who requested euthanasia for psychological suffering associated with psychiatric disorders were depression and personality disorder, according to study findings in BMJ Open.

“The Belgian Euthanasia Law (2002) defines euthanasia as the physician’s ‘act of deliberately ending a patient’s life at the latter’s request,’ by administering life-ending drugs. In Europe, psychological suffering stemming from either a somatic or mental disorder is acknowledged as a valid legal basis for euthanasia only in Belgium, the Netherlands and Luxembourg,” study researcher Lieve Thienpont, PhD, of the University Hospital Brussels in Belgium, and colleagues wrote. “The Belgian Euthanasia Law indicates explicitly that requests for euthanasia from non-terminally ill adults or ‘emancipated minors’ (ie, minors who are legally independent from their parents) suffering from ‘unbearable and untreatable’ somatic and psychiatric disorders can be granted, as well as those from terminally ill patients.”

Researchers conducted a retrospective case note review of 100 consecutive patients who requested euthanasia for psychological suffering associated with psychiatric disorders between October 2007 and December 2011. Study participants included 23 men and 77 women with ages ranging from 21 to 80 years.

Most patients were referred for psychiatric counseling by their physician (n = 55) or by Life End Information Forum, a service that refers people to qualified health care professionals for assistance with end-of-life matters (n = 36).

Ninety patients had more than one psychiatric disorder. The most common diagnoses were depression (n = 58) and personality disorder (n = 50).

Overall, 48 euthanasia requests were accepted and 35 were carried out.

Of the 13 remaining patients whose requests were accepted, eight postponed or cancelled the procedure “because simply having this option gave them enough peace of mind to continue living,” according to researchers.

By December 2012, 43 study participants died, including 35 by euthanasia, six by suicide, one by palliative sedation and one by anorexia nervosa.

“A literature review made clear that the concept of ‘unbearable suffering’ has not yet been defined adequately, and that views on this concept are in a state of flux. It is generally accepted that this concept is considered to be subjective, dependent on personal values, and that it must be determined in the first place by the patient. Nevertheless, a psychiatrist should carefully evaluate this in the context of each patient’s psychopathology,” Thienpont and colleagues wrote. “Unfortunately, there are no guidelines for the management of euthanasia requests on grounds of mental suffering in Belgium. Taking into account the ongoing fierce ethical debates, it is essential to develop such guidelines, and translate them into clear and detailed protocols that can be applied in practice.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.