Euthanasia and physician-assisted suicide in patients suffering from psychiatric disorders: a cross-sectional study exploring the experiences of Dutch psychiatrists

Rosalie Pronk,H. Roeline W. Pasman,Bregje D. Onwuteaka-Philipsen,Kirsten Evenblij

doi:10.1186/s12888-019-2053-3

Abstract

BackgroundThe medical-ethical dilemmas related to euthanasia and physician-assisted suicide (EAS) in psychiatric patients are highly relevant in an international context. EAS in psychiatric patients appears to become more frequent in the Netherlands. However, little is known about the experiences of psychiatrists with this practice. This study aims to estimate the incidence of EAS (requests) in psychiatric practice in The Netherlands and to describe the characteristics of psychiatric patients requesting EAS, the decision-making process and outcomes of these requests.MethodsIn the context of the third evaluation of the Dutch Euthanasia Act, a cross-sectional study was performed between May and September 2016. A questionnaire was sent to a random sample of 500 Dutch psychiatrists. Of the 425 eligible psychiatrists 49% responded. Frequencies of EAS and EAS requests were estimated. Detailed information was asked about the most recent case in which psychiatrists granted and/or refused an EAS request, if any.ResultsThe total number of psychiatric patients explicitly requesting for EAS was estimated to be between 1100 and 1150 for all psychiatrists in a one year period from 2015 to 2016. An estimated 60 to 70 patients received EAS in this period. Nine psychiatrists described a case in which they granted an EAS request from a psychiatric patient. Five of these nine patients had a mood disorder. Three patients had somatic comorbidity. Main reasons to request EAS were ‘depressive feelings’ and ‘suffering without prospect of improvement’. Sixty-six psychiatrists described a case in which they refused an EAS request. 59% of these patients had a personality disorder and 19% had somatic comorbidity. Main reasons to request EAS were ‘depressive feelings’ and ‘desperate situations in several areas of life’. Most requests were refused because the due care criteria were not met.ConclusionsAlthough the incidence of EAS in psychiatric patients increased over the past two decades, this practice remains relatively rare. This is probably due to the complexity of assessing the due care criteria in case of psychiatric suffering. Training and support may enable psychiatrists to address this sensitive issue in their work better.

Highlights

The medical-ethical dilemmas related to euthanasia and physician-assisted suicide (EAS) in psychiatric patients are highly relevant in an international context
No psychiatrists reported to have turned down a request due to lack of familiarity with the process or law
Of the 207 responding psychiatrists, 72.8% worked in a private practice, 29.6% in a mental health facility, 11.1% on a psychiatric ward in a general hospital, and 12.3% in another place

Summary

Introduction

The medical-ethical dilemmas related to euthanasia and physician-assisted suicide (EAS) in psychiatric patients are highly relevant in an international context. EAS in psychiatric patients appears to become more frequent in the Netherlands. In the Benelux countries and Canada people who request EAS because of suffering from psychiatric disorders can be eligible for EAS [1,2,3]. EAS is rarely performed in people with psychiatric disorders. In the Netherlands, 1 % of all 6585 reported EAS cases in 2017 concerned people with psychiatric disorders [4]. The assessment of the statutory due criteria can be complicated when the suffering is caused by a psychiatric disorder [5, 6]. The possibility of spontaneous recovery and the large variety of treatment alternatives make meeting the criteria of ‘no prospect of improvement’ and ‘a lack of reasonable alternatives’ a precarious matter [5, 6]

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