Medically Assisted Death in the Context of Mental Health Challenges

According to van Veen et al. (2020), Medically Assisted Death (MAiD) is among the controversial topics among ethicists and physicians. Overall, assisted death has been a heavily debated topic globally. However, there is an increasing focus on MAiD among psychiatric patients. Physician-assisted death is acceptable in a growing number of countries. A key argument in favor of this option is that doctors should be permitted to help mentally competent patients dying to end their excruciating, unrelievable suffering. Only in the Netherlands, Belgium, Luxembourg, and Switzerland are psychiatric patients permitted to get physician assistance in dying (van Veen et al., 2020). Few countries embraced medically assisted death to help patients suffering from terminal illnesses, such as cancer, to have a decent death and alleviate their pain and suffering. However, other countries have extended assisted death to patients with non-terminal conditions, such as psychiatric disorders. This paper will discuss the problems associated with MAiD among psychiatric patients and the pros and cons of potential solutions. Also, I will share my opinion on the topic.

Problem Statement

Countries have different criteria to determine whether a patient is eligible for Medically Assisted Suicide. However, some criteria for non-terminal conditions are standard in almost all jurisdictions, including that the condition should be untreatable, making the patient’s quality of life poor, refractory, and causing unbearable pain (Grassi et al., 2020). Most researchers agree that the fundamental practices and criteria applied to somatic illnesses are inapplicable to non-terminal diseases, such as mental health conditions, leading to various arguments against and for MAiD among psychiatric patients. Critical challenges associated with the criteria for MAiD eligibility among psychiatric patients include:

• Patients may suffer from impaired decisional competence due to psychiatric disorders.
• Pressure from family and relatives makes psychiatric patients opt for assisted dying.
• The possibility of spontaneous recovery makes it difficult to determine with certainty that there are no prospects for improvement.
• The availability of many treatment alternatives makes it difficult for physicians to agree that there are no reasonable alternatives, leading to MAiD.

Pros and Cons of Medically Assisted Death Among Mental Health Patients

The table below shows the arguments for and against MAiD among patients with mental health conditions.

Table 1 Pros and Cons of MAD in Psychiatric Patients

Critics of MAiD among psychiatric patients argue that doctors should not assist their patients in taking away their lives since they would be breaking the Hippocratic oath (Evenblij et al., 2019). They say doctors should use medicine to preserve life instead of facilitating suicide. Further arguments propose that even though patients may refuse treatment, doctors do not have the right to take away their lives. Doctors do not have the duty to kill. Other critics argue that it is difficult to determine an accurate prognosis for mental health disorders like somatic illnesses. As a result, it is challenging to determine if a psychiatric illness is irremediable, making it risky to practice medically assisted suicide among mental health patients. Critics have also raised risks associated with the “slippery slope” phenomenon; extending MAiD to non-terminal conditions may lead to losing its control (Evenblij et al., 2019). For instance, unethical doctors may use MAiD as an excuse to get rid of patients who require significant resources to get well, reducing healthcare costs. Also, others may mask their unprofessional actions under MAiD to contribute to organ donation by utilizing the vulnerability of psychiatric patients and minors.

On the other hand, some groups and individuals consider MAiD among psychiatric patients to be permissible and moral. They argue that individuals have the right to decide their lives, including when and how to die. According to them, it is better to facilitate MAiD and give an individual a decent death than to leave them to live a life of agony. Also, the proposers argue that not all psychiatric patients can make decisions affecting their lives. As a result, physicians should respect their decisions.

Pronk et al. (2022) conducted a study to examine the views of patients who have mental illness on accessing MAD in the Netherlands. Medically Assisted death among mental illness patients is legal in the Netherlands. However, it is a controversial topic. The study revealed that psychiatric patients associate access to MAiD with four themes. First, the patients associated access to MAiD with autonomy and self-determination (Pronk et al., 2022). They felt that the possibility of accessing MAiD allowed them to decide about their end of life. According to the study, some patients felt they did not have control over their lives and wanted to decide when and how they should die. Second, the patients’ associated access to MAiD with the theme of ending their suffering (Pronk et al., 2022). Some patients admitted that they did not want to die for the sake of dying but to escape their constant battle with mental illness. Others associated the possibility of MAiD with recognition. They believed that the possibility of requesting MAiD would show the severity of their conditions, leading to better interventions. The final theme of the study was a dignified end of life (Pronk et al., 2022). The respondents believed that the possibility of MAiD would ensure they get a dignified end-of-life experience.

Personal Opinion

I believe medically assisted death among psychiatric patients should not get legalized. Most mental health conditions are associated with depression and anxiety, which lead to feelings of hopelessness and an increased desire to die. Legalizing medically assisted death among mental health patients may encourage them to take the “shortcut” to avoid the pain and suffering associated with mental illnesses without seeking alternative treatment options to get better. There is a possibility of spontaneous recovery among mental health patients, which raises ethical questions about medically assisted death. For instance, physicians may conduct MAiD on a psychiatric patient who would have otherwise gotten better upon the administration of a different treatment option. Van Veen et al. (2020) present a real-life case of a patient who sought medically assisted suicide from the Expert Centre of Euthanasia (ECE) after struggling with various mental health issues for over ten years. The center assessed him for one year and recommended that he goes to an academic hospital for a second opinion about his mental health problems. The experts revealed that the patient had been misdiagnosed and proposed a new treatment. Surprisingly, the patient’s symptoms improved within three weeks, and within a few more weeks, he reached remission, canceling the request for MAiD (van Veen, 2020).

Physicians should focus on treatment options instead of facilitating medically assisted deaths among psychiatric patients. Also, they need to get several expert opinions about the patients’ conditions to ensure they treat the right conditions for better outcomes. Patient recovery is not a linear path. As a result, physicians should be persistent in seeking the appropriate treatment options and involve the patients and their families in a collaborative experience.

Also, doctors should investigate the social determinants of mental health and their impacts on mental health. One’s physical, economic, and social environments have a significant impact on their mental health. Social inequalities increase the chances of one suffering from mental disorders. As a result, relevant institutions and governments should focus on working on the social determinants of mental health from birth to death to reduce the risks of suffering from mental health disorders. Social inequality is a significant risk factor for many common mental diseases, with the risk of each disorder increasing with the level of inequality. Action must be taken to enhance living conditions from conception through early childhood, older childhood, adolescence, starting a family and entering the workforce, and into old age. Action at these phases of life would present chances for both population mental health improvement and a decrease in the likelihood of mental diseases linked to social inequality.

Also, governments should promote mental health education. Education about mental health offers people and their loved ones the resources and awareness they need to navigate the diagnostic and treatment phases. It aids in eradicating the stigma related to mental health and can also support initiatives for therapy and recovery, reducing the demand for medically assisted death among psychiatric patients.

Conclusion

For a sizeable percentage of the population, including—to a certain extent—people with a mental condition, the desire for medically assisted death has become a social reality. Living with a mental health disorder is difficult due to constant depressive thoughts, hopelessness, and anxiety. However, legalizing medically assisted deaths for patients with mental health issues may prevent doctors and patients from seeking appropriate treatment options and consider the “shortcut.” Governments and relevant authorities need to consider several factors, such as the criterion of irremediability of a mental disorder, balancing suicide prevention with assisted death, and how to avoid going down the “slippery slope” before legalizing medically assisted deaths among patients with mental health conditions.

References

Evenblij, K., Pasman, H. R. W., Pronk, R., & Onwuteaka-Philipsen, B. D. (2019). Euthanasia and physician-assisted suicide in patients suffering from psychiatric disorders: a cross-sectional study exploring the experiences of Dutch psychiatrists. BMC Psychiatry, 19(1), 1-10.

Grassi, L., Folesani, F., Marella, M., Tiberto, E., Riba, M. B., Bortolotti, L., … & Caruso, R. (2022). Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders. Current Psychiatry Reports, 1-11.

Pronk, R., Willems, D. L., & van de Vathorst, S. (2022). Feeling seen, being heard: perspectives of patients suffering from mental illness on the possibility of physician-assisted death in the Netherlands. Culture, Medicine, and Psychiatry, 46(2), 475-489.

van Veen, S. M. P., Scheurleer, W. F. J., Ruijsch, M. L., Röder, C. H., Widdershoven, G. A. M., & Batalla, A. (2020). Last-minute recovery of a psychiatric patient requesting physician-assisted death. Psychiatric Services, 71(6), 621-623.