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Review examines euthanasia, assisted suicide practices among patients with psychiatric disorders

Recent findings indicated the majority of individuals who received euthanasia or assisted suicide had chronic, severe conditions, personality disorders, and were described as socially isolated or lonely, with histories of attempted suicides and psychiatric hospitalizations.

“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,” Paul S. Appelbaum, MD, of Columbia University, New York City, wrote in an accompanying editorial. “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.”

To describe characteristics of patients receiving euthanasia or assisted suicide for psychiatric conditions and practice regulations in the Netherlands, Scott Y. H. Kim, MD, PhD, of the NIH, Bethesda, Maryland, and colleagues reviewed psychiatric euthanasia or assisted suicide case summaries available online from the Dutch regional euthanasia review committees. Analysis included 66 cases.

Overall, 70% of cases were women; 32% were aged 70 years or older; 44% were aged 50 to 70 years and 24% were aged 30 to 50 years.

Most had chronic, severe conditions with a history of attempted suicides and psychiatric hospitalizations.

The majority of cases had personality disorders and were described as socially isolated or lonely.

Depressive symptoms were the primary psychiatric issue among 55% of individuals who received euthanasia or assisted suicide. Psychotic, posttraumatic stress or anxiety, somatoform, neurocognitive and eating disorders, prolonged grief and autism were also reported.

Comorbidities and functional impairments were common, according to researchers.

Twenty-seven percent of individuals received euthanasia or assisted suicide from a physician new to them, and 14 of the 18 physicians were from a mobile euthanasia clinic.

Consultation with other physicians was common, though 11% of cases had no independent psychiatric input and 24% involved disagreement among consultants.

One case failed to meet legal due care criteria, according to the euthanasia review committees.

The findings have several limitations, according to Appelbaum. The included reports were filed by physicians most directly involved in cases and accuracy of the reported information is unknown. Data were abstracted from narrative summaries and translated from another language for many variables, according to Appelbaum. The study sample did not include all cases involved psychiatric disorders.

“However, we ought not to lose sight of the need to consider more than just how well a system of physician-assisted death is implemented before reaching a conclusion as to its desirability. In addition to the moral question of whether it is ever acceptable to assist people in ending their lives, the appropriateness of this role for physicians — who traditionally have been dedicated to sustaining life — must be determined,” Appelbaum wrote. “Practical concerns amplify the moral dilemmas. 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.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.