Do Doctors Differentiate Between Suicide and Physician-Assisted Death? A Qualitative Study into the Views of Psychiatrists and General Practitioners

Rosalie Pronk,Suzanne Van De Vathorst,Dick L Willems

doi:10.1007/s11013-020-09686-2

Abstract

Physician-assisted death for patients suffering from psychiatric disorders is allowed in the Netherlands under certain circumstances. One of the central problems that arise with regard to this practice is the question of whether it is possible to distinguish between suicidality and a request for physician-assisted death. We set up this study to gain insight into how psychiatrists and general practitioners distinguish between suicidality and physician-assisted death. The data for this study were collected through qualitative interviews with 20 general practitioners and 17 psychiatrists in the Netherlands. From the interviews, we conclude that physicians distinguish three types of death wishes among patients suffering from psychiatric disorders: ‘impulsive suicidality,’ ‘chronic suicidality,’ and ‘rational death wishes.’ To discern between them they evaluate whether the death wish is seen as part of the psychopathology, whether it is consistent over time, and whether they consider it treatable. Some considered physician-assisted death an alternative to a ‘rational suicide,’ as this was perceived to be a more humane manner of death for the patient and their relatives. We argue that physician-assisted death can be justified also in some cases in which the death wish is part of the psychopathology, as the patient’s suffering can be unbearable and irremediable. Physician-assisted death in these cases may remain the only option left to relieve the suffering.

Highlights

In the Netherlands, patients who suffer from psychiatric illnesses are not excluded from the practice of euthanasia and physician-assisted suicide (EAS) (the term ‘Medical Aid in Dying’ (MAID) is used, in both Canada and the US
Concerning patients who suffer from psychiatric disorders, most physicians distinguished between different types of death wishes, namely (a) impulsive suicidality, (b) chronic suicidality, and (c) a well-considered and persistent wish to die
The fact that someone is suicidal, is something completely different than a euthanasia request (GP - R8) That was one of the clients who was treated here, who had a persistent death wish that differed from the chronic suicidality that we often see with personality disorders

Summary

Introduction

In the Netherlands, patients who suffer from psychiatric illnesses are not excluded from the practice of euthanasia and physician-assisted suicide (EAS) (the term ‘Medical Aid in Dying’ (MAID) is used, in both Canada and the US. In the Netherlands, a physician is allowed to provide assistance in dying if he or she meets the legal criteria of due care. These criteria hold that there should be a voluntary and well-considered request, the patient’s suffering should be unbearable and without the prospect of improvement, the patient should be informed about his or her situation, there are no reasonable alternatives to relieve suffering, an independent physician should be consulted, and the method used should be medically and technically appropriate (Regionale Toetsingscommissie Euthanasie 2018). Evenblij et al showed that of the general public 53% though that people with psychiatric disorders should be eligible for EAS, 15% was opposed to this, and 32% remained neutral (Evenblij et al 2019)

Methods

Results

Conclusion