Euthanasia for psychiatric reasons uncommon in Belgium, Netherlands

Key takeaways:

• In Belgium and the Netherlands, psychiatric disorders accounted for 4% or less of physician-assisted suicides.
• The findings may guide the establishment of euthanasia in the United States.

SAN FRANCISCO — From 2018 to 2021, psychiatric disorders were the primary reason for a small portion of physician-assisted suicides in the Netherlands and Belgium, according to a poster presented here.

Although legal in Belgium and the Netherlands, physician-assisted suicide for psychiatric disorders is not legal in the United States, according to the poster.

“While this is not an explicit debate we are having in the U.S., it is a debate that is happening in other parts of the world,” Christian S. Monsalve, MD, MS, a second-year psychiatry resident at the University of Texas Southwestern Medical Center in Dallas, told Healio at the American Psychiatric Association annual meeting. “I thought it would be prudent to share some of this information with my colleagues so that when this debate does more formally come, over the course of our practice and our careers, to the U.S., we can be more informed and prudent about how we go about our laws and recommendations as a professional society.”

Monsalve and colleagues analyzed annual reports from the Regional Euthanasia Review Committees on Euthanasia from the Netherlands and the Reports to the Legislative Chamber by the Federal Control and Evaluation Committee for Euthanasia in Belgium from 2018 to 2021.

In Belgium, rates of euthanasia for psychiatric disorders were highest in 2018 (n = 34; 1.4%) and lowest in 2019 (n = 23; 0.8%). The rates were highest for dementia-related euthanasia in 2019 and 2021 (both n = 26; 1%) and lowest in 2018 and 2020 (both n = 22; 0.9%).

Analyses by specific psychiatric conditions revealed that mood disorders and personality and behavioral disorders accounted for most of the assisted suicides for psychiatric disorders in Belgium. Additionally, psychological suffering was reported by 3.5% of decedents in 2018, 4.3% of decedents in 2019, 1.9% of decedents in 2020 and 2.1% of decedents in 2021.

In the Netherlands, rates of euthanasia for psychiatric disorders were highest in 2021 (n = 115; 1.6%) and lowest in 2018 (n = 67; 1.1%) and 2019 (n = 68; 1.1%). For dementia-related euthanasia, rates were highest in 2021 (n = 215; 2.8%) and lowest in 2018 (n = 146; 2.4%).

Across all study years in the Netherlands, cancer was the reason for the largest proportion of these physician-assisted suicides among decedents aged 18 to 40 years and accounted for 61% of physician-assisted suicides in 2021. However, psychiatric disorder as a reason for euthanasia increased across the study period.

Monsalve said U.S. clinicians should remain aware of the debates surrounding this topic across the world so that they are informed once it is brought up for discussion in the U.S.

“Another thing that would be interesting is the issue of conscience protection,” Monsalve told Healio. “That is to say, if you’re a hospital or if you're a physician that does not wish to participate in this practice, what would that look like? Would you be protected? Would there potentially be retaliation from the employer if you didn't wish to prescribe these medications, but also if you didn't wish to refer because you would feel implicit in the practice perhaps violating your understanding of the Hippocratic Oath?”

Monsalve said the answers to these questions may inform legislation in the future.