Euthanasia for mental illness

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Euthanasia for mental illness involves a physician intentionally ending the life of a patient who has requested euthanasia due to a psychiatric condition. The practice is legal in Belgium, [1] the Netherlands, [2] Luxembourg, [3] Spain [4] and Colombia. [5] In Canada, legislation authorizing the procedure was passed, but has since been repeatedly postponed. [6]

Contents

The practice is considered controversial as unlike with other types of euthanasia, a patient euthanized for mental illness alone is usually not terminally ill, and may have their decisional capacity impeded by their condition. [7] [8] [9] It is also considered more difficult with psychological conditions to determine an objective prognosis, or whether a disorder is irremediable. [10] [11]

By country

Belgium

In Belgium, euthanasia for mental illness is legal if the patient is mentally competent to make the decision; the patient requests euthanasia on two separate occasions in writing; the patient is suffering from an incurable disease or mental illness, and all treatment options have been exhausted; and the patient is experiencing "unbearable suffering" from the illness, either physically or psychologically. [12] Three doctors must agree to grant euthanasia in psychiatric cases. [13] [14] Euthanasia for mental suffering is not available for children. [15]

As of 2017, approximately 40 patients per year received euthanasia due to mental illness, out of approximately 2,000 total yearly euthanasia deaths. [15]

In 2020, a Belgium court acquitted three doctors who had euthanized Tine Nys, a physically healthy 38-year-old woman with autism, of manslaughter charges. [16] Nys' sister Sophie Nys had filed a lawsuit alleging that the doctors did not properly attempt to treat her condition, and that Nys had not been incurably ill as the law required. [16]

Netherlands

Euthanasia for mental illness has been legal since 2002 in the Netherlands provided the patient has "unbearable suffering with no prospect of improvement" and has requested to die in a way that is "voluntary, well considered and with full conviction", among other criteria. [17] [18] In 2020, the Supreme Court of the Netherlands ruled that physicians could euthanize patients with dementia if they had expressed a wish to die before the onset of their condition. [19]

In 2023, 138 people in the Netherlands received euthanasia due to psychiatric conditions, a 20% increase from 2022. [20] The first minor euthanized for a psychiatric condition was in 2023. [20]

Related Research Articles

Euthanasia is the practice of intentionally ending life to eliminate pain and suffering.

Involuntary commitment, civil commitment, or involuntary hospitalization/hospitalisation is a legal process through which an individual who is deemed by a qualified person to have symptoms of severe mental disorder is detained in a psychiatric hospital (inpatient) where they can be treated involuntarily. This treatment may involve the administration of psychoactive drugs, including involuntary administration. In many jurisdictions, people diagnosed with mental health disorders can also be forced to undergo treatment while in the community; this is sometimes referred to as outpatient commitment and shares legal processes with commitment.

A psychiatrist is a physician who specializes in psychiatry. Psychiatrists are physicians and evaluate patients to determine whether their symptoms are the result of a physical illness, a combination of physical and mental ailments or strictly mental issues. Sometimes a psychiatrist works within a multi-disciplinary team, which may comprise clinical psychologists, social workers, occupational therapists, and nursing staff. Psychiatrists have broad training in a biopsychosocial approach to the assessment and management of mental illness.

<span class="mw-page-title-main">Psychiatric hospital</span> Hospital specializing in the treatment of serious mental disorders

Psychiatric hospitals, also known as mental health hospitals, or behavioral health hospitals are hospitals or wards specializing in the treatment of severe mental disorders, including schizophrenia, bipolar disorder, eating disorders, dissociative identity disorder, major depressive disorder, and others.

Anti-psychiatry, sometimes spelled antipsychiatry without the hyphen, is a movement based on the view that psychiatric treatment is often more damaging than helpful to patients, highlighting controversies about psychiatry. Objections include the reliability of psychiatric diagnosis, the questionable effectiveness and harm associated with psychiatric medications, the failure of psychiatry to demonstrate any disease treatment mechanism for psychiatric medication effects, and legal concerns about equal human rights and civil freedom being nullified by the presence of diagnosis. Historical critiques of psychiatry came to light after focus on the extreme harms associated with electroconvulsive therapy or insulin shock therapy. The term "anti-psychiatry" is in dispute and often used to dismiss all critics of psychiatry, many of whom agree that a specialized role of helper for people in emotional distress may at times be appropriate, and allow for individual choice around treatment decisions.

A psychiatric or psychotropic medication is a psychoactive drug taken to exert an effect on the chemical makeup of the brain and nervous system. Thus, these medications are used to treat mental illnesses. These medications are typically made of synthetic chemical compounds and are usually prescribed in psychiatric settings, potentially involuntarily during commitment. Since the mid-20th century, such medications have been leading treatments for a broad range of mental disorders and have decreased the need for long-term hospitalization, thereby lowering the cost of mental health care. The recidivism or rehospitalization of the mentally ill is at a high rate in many countries, and the reasons for the relapses are under research.

<span class="mw-page-title-main">Thomas Szasz</span> Hungarian-American psychiatrist and activist (1920–2012)

Thomas Stephen Szasz was a Hungarian-American academic and psychiatrist. He served for most of his career as professor of psychiatry at the State University of New York Upstate Medical University in Syracuse, New York. A distinguished lifetime fellow of the American Psychiatric Association and a life member of the American Psychoanalytic Association, he was best known as a social critic of the moral and scientific foundations of psychiatry, as what he saw as the social control aims of medicine in modern society, as well as scientism.

<span class="mw-page-title-main">Hypochondriasis</span> Medical condition

Hypochondriasis or hypochondria is a condition in which a person is excessively and unduly worried about having a serious illness. Hypochondria is an old concept whose meaning has repeatedly changed over its lifespan. It has been claimed that this debilitating condition results from an inaccurate perception of the condition of body or mind despite the absence of an actual medical diagnosis. An individual with hypochondriasis is known as a hypochondriac. Hypochondriacs become unduly alarmed about any physical or psychological symptoms they detect, no matter how minor the symptom may be, and are convinced that they have, or are about to be diagnosed with, a serious illness.

<span class="mw-page-title-main">Assisted suicide</span> Suicide undertaken with aid from another person

Assisted suicide – sometimes referred to as medical aid in dying – means a procedure in which people take medications to end their own lives with the help of others, usually medical professionals. The term usually refers to physician-assisted suicide (PAS), which is an end of life measure for a person suffering a painful, terminal illness. Once it is determined that the person's situation qualifies under the physician-assisted suicide laws for that location, the physician's assistance is usually limited to writing a prescription for a lethal dose of drugs.

<span class="mw-page-title-main">Advance healthcare directive</span> Legal document

An advance healthcare directive, also known as living will, personal directive, advance directive, medical directive or advance decision, is a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity. In the U.S. it has a legal status in itself, whereas in some countries it is legally persuasive without being a legal document.

The right to die is a concept based on the opinion that human beings are entitled to end their life or undergo voluntary euthanasia. Possession of the right to die is often bestowed with the understanding that a person with a terminal illness, incurable pain, or without the will to continue living should be allowed to end their own life, use assisted suicide, or decline life-prolonging treatment. The question of who, if anyone, may be empowered to make this decision is often the subject of debate.

Voluntary euthanasia is the ending of a person's life at their request in order to relieve them of suffering. Voluntary euthanasia and physician-assisted suicide (PAS) have been the focus of intense debate in recent years. Some forms of voluntary euthanasia are legal in Australia, Belgium, Canada, Colombia, Luxembourg, the Netherlands, New Zealand, and Spain.

Involuntary treatment refers to medical treatment undertaken without the consent of the person being treated. Involuntary treatment is permitted by law in some countries when overseen by the judiciary through court orders; other countries defer directly to the medical opinions of doctors.

Medical model is the term coined by psychiatrist R. D. Laing in his The Politics of the Family and Other Essays (1971), for the "set of procedures in which all doctors are trained". It includes complaint, history, physical examination, ancillary tests if needed, diagnosis, treatment, and prognosis with and without treatment.

Euthanasia in the Netherlands is regulated by the "Termination of Life on Request and Assisted Suicide Act" which was passed in 2001 and took effect in 2002. It states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These criteria concern the patient's request, the patient's suffering, the information provided to the patient, the absence of reasonable alternatives, consultation of another physician and the applied method of ending life. To demonstrate their compliance, the Act requires physicians to report euthanasia to a review committee.

<span class="mw-page-title-main">Legality of euthanasia</span>

The legality of euthanasia varies between countries and territories. Efforts to change government policies on euthanasia of humans in the 20th and 21st centuries have met with limited success in Western countries. Human euthanasia policies have also been developed by a variety of NGOs, most advocacy organisations although medical associations express a range of perspectives, and supporters of palliative care broadly oppose euthanasia.

<span class="mw-page-title-main">Psychiatry</span> Branch of medicine devoted to mental disorders

Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of deleterious mental conditions. These include various matters related to mood, behaviour, cognition, perceptions, and emotions.

Child euthanasia is a form of euthanasia that is applied to children who are gravely ill or have significant birth defects. In 2005, the Netherlands became the first country since the end of Nazi Germany to decriminalize euthanasia for infants with hopeless prognosis and intractable pain. Nine years later, Belgium amended its 2002 Euthanasia Act to extend the rights of euthanasia to minors. Like euthanasia, there is world-wide public controversy and ethical debate over the moral, philosophical and religious issues of child euthanasia.

<span class="mw-page-title-main">Euthanasia in Canada</span> Legal history of euthanasia in Canada

Euthanasia in Canada in its legal voluntary form is called Medical Assistance in Dying and it first became legal along with assisted suicide in June 2016 for those whose death was reasonably foreseeable. In March 2021, the law was further amended by Bill C-7 which to include those suffering from a grievous and irremediable condition whose death was not reasonably foreseeable. According to the Fourth Annual Report on MAID, there were 13,241 MAID deaths reported in Canada in 2022.

Somatic symptom disorder, also known as somatoform disorder, is defined by one or more chronic physical symptoms that coincide with excessive and maladaptive thoughts, emotions, and behaviors connected to those symptoms. The symptoms are not deliberately produced or feigned, and they may or may not coexist with a known medical ailment.

References

  1. ↑ De Hert, Marc; Loos, Sien; Van Assche, Kristof (2023). "The Belgian euthanasia law under scrutiny of the highest courts". The Lancet Regional Health - Europe. 24. Elsevier BV: 100549. doi:10.1016/j.lanepe.2022.100549. hdl: 10067/1925430151162165141 . ISSN   2666-7762.
  2. ↑ van Veen, SMP; Widdershoven, GAM; Beekman, ATF; Evans, N. (2022-06-20). "Physician Assisted Death for Psychiatric Suffering: Experiences in the Netherlands". Frontiers in Psychiatry. 13. Frontiers Media SA. doi: 10.3389/fpsyt.2022.895387 . ISSN   1664-0640. PMC   9251055 .
  3. ↑ "Information on requesting euthanasia or assisted suicide". Guichet.lu. 2023-12-08. Retrieved 2024-04-21.
  4. ↑ Ramos-Pozón, Sergio; Terribas-Sala, Núria; Falcó-Pegueroles, Anna; Román-Maestre, Begoña (2023). "Persons with mental disorders and assisted dying practices in Spain: An overview". International Journal of Law and Psychiatry. 87. Elsevier BV. doi:10.1016/j.ijlp.2023.101871. hdl: 2445/195880 . ISSN   0160-2527.
  5. ↑ Kuntz, Leah (2022-01-10). "First Colombian With Nonterminal Illness Legally Dies via Euthanasia". Psychiatric Times. Retrieved 2024-04-21.
  6. ↑ McCulloch, Craig (2024-02-09). "Canada Postpones Plan to Allow Euthanasia for Mentally Ill". Voice of America. Retrieved 2024-04-21.
  7. ↑ Yasgur, Batya Swift (2023-08-03). "Clinicians Talking: Euthanasia for SMI -- Right or Wrong?". Medscape. Retrieved 2024-04-21.
  8. ↑ Olié, Emilie; Courtet, Philippe (2016-08-09). "The Controversial Issue of Euthanasia in Patients With Psychiatric Illness". JAMA. 316 (6). American Medical Association (AMA): 656. doi:10.1001/jama.2016.9883. ISSN   0098-7484.
  9. ↑ Lane, Charles (2016-10-19). "Europe's morality crisis: Euthanizing the mentally ill". Washington Post. Archived from the original on 2016-12-02. Retrieved 2024-04-21.
  10. ↑ Nicolini, Marie E.; Jardas, EJ; Zarate, Carlos A.; Gastmans, Chris; Kim, Scott Y. H. (2022-10-28). "Irremediability in psychiatric euthanasia: examining the objective standard". Psychological Medicine. 53 (12). Cambridge University Press (CUP): 5729–5747. doi:10.1017/s0033291722002951. ISSN   0033-2917. PMC   10482705 .
  11. ↑ Grassi, Luigi; Folesani, Federica; Marella, Marco; Tiberto, Elisa; Riba, Michelle B.; Bortolotti, Lisa; Toffanin, Tommaso; Palagini, Laura; Belvederi Murri, Martino; Biancosino, Bruno; Ferrara, Maria; Caruso, Rosangela (2022). "Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders". Current Psychiatry Reports. 24 (6). Springer Science and Business Media LLC: 325–335. doi:10.1007/s11920-022-01339-y. hdl: 11392/2493393 . ISSN   1523-3812.
  12. ↑ "Dying with dignity: The story of euthanasia in Belgium". The Bulletin. 2021-01-02. Retrieved 2024-04-21.
  13. ↑ "it may have saved my life'". Sky News. 2020-08-24. Retrieved 2024-04-21.
  14. ↑ Aviv, Rachel (2015-06-15). "Who Has the Right to Die?". The New Yorker. Retrieved 2024-04-21.
  15. 1 2 "'What could help me to die?' Doctors clash over euthanasia". STAT. 2017-10-26. Retrieved 2024-04-21.
  16. 1 2 Peltier, Elian (2020-01-31). "Belgium Acquits Three Doctors in Landmark Euthanasia Case". The New York Times. Retrieved 2024-04-21.
  17. ↑ "'Dying With Dignity': Dutch Mark 20 Years of Euthanasia". Voice of America. 2022-04-01. Retrieved 2024-04-21.
  18. ↑ "Death on Demand: Has Euthanasia Gone Too Far?". Pulitzer Center. 2019-01-18. Retrieved 2024-04-21.
  19. ↑ "Dutch court approves euthanasia in cases of advanced dementia". the Guardian. 2020-04-21. Retrieved 2024-04-21.
  20. 1 2 Ferrer, Isabel (2024-04-19). "Debate ignites in the Netherlands over rise in euthanasia for mental disorders". EL PAÍS English. Retrieved 2024-04-21.
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