Abstract
ObjectiveAlthough euthanasia in the context of adult psychiatry is legalized in Belgium, it poses major ethical and clinical challenges for the health care professionals and volunteers involved. This study aimed to address these members' concrete experiences and support needs.MethodsA qualitative semi-structured interview study was conducted with 16 physicians and 14 other health care professionals and volunteers, with at least one concrete experience with euthanasia requests and procedures concerning adults with psychiatric conditions.FindingsConcrete experiences concerned the following 8 domains: (1) the impact of euthanasia on the clinical trajectory and (2) on the therapeutic relationship, (3) internal and (4) external collaborative partnerships, (5) patients' social inner circle (non-)involvement, (6) the use of recently published guidelines and, (7) the first criminal trials on this topic, and (8) the act of euthanasia. The following 8 main support needs emerged; (1) protocols addressing specific sub-populations and pathologies, (2) protocols specifically drawn up for non-medics, (3) guidance on how to adequately implement the two-track approach, (4) (after)care for patients, (5) (after)care for the health care team, (6) guidance on the patient's social inner circle involvement, (7) enhanced education measures, and (8) enhanced financial measures, including incentives for holistic, palliative care approaches.ConclusionThe health care professionals and volunteers reported many positive and negative experiences in dealing with euthanasia requests in adult psychiatry. They reported several support needs across the extensive euthanasia trajectory, pertaining to concrete management of thorny issues that guidelines do not (yet) touch on. Important implications of our study relate to tackling these existing issues, and to paying sufficient attention to the impact of a euthanasia trajectory on all actors, including the patients and their social inner circle, involved.
Highlights
Medical assistance in dying, defined as the act to end life by providing, prescribing or administering lethal medication at the competent patient’s explicit request, is—under certain conditions—legal in an increasing number of countries around the globe (1)
Adults with psychiatric conditions can be potentially eligible for euthanasia, it remains a highly controversial and extremely complex end-of-life practice in terms of whether and when these patients can meet all legal criteria (8)
Physicians have to deal with a higher level of uncertainty in psychiatry and the tension between suicide prevention and euthanasia (8, 9)
Summary
Medical assistance in dying, defined as the act to end life by providing, prescribing or administering lethal medication at the competent patient’s explicit request, is—under certain conditions—legal in an increasing number of countries around the globe (1). The Belgian central requirements include having the necessary mental competence to express a voluntary, well-considered and repeated euthanasia request, experiencing unbearable suffering that cannot be alleviated and that is based on an incurable medical condition (see Box 1 in OSF for all legal criteria). Adults with psychiatric conditions can be potentially eligible for euthanasia (i.e., the act of a physician administering the lethal medication to a patient), it remains a highly controversial and extremely complex end-of-life practice in terms of whether and when these patients can meet all legal criteria (8). Euthanasia assessment procedures concerning this patient group, may take an emotional toll, as a recent survey study revealed that physicians may feel e.g., pressured by the patient, the patient’s social inner circle, colleague-physicians and/or the affiliated institution to (dis)approve the euthanasia request (10)
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