Doctor assisted suicide for MH conditions

[cara susanna]

Hi all,

Apparently Belgium allows doctor-assisted suicide for psychiatric conditions. Although I personally struggle with the philosophical question of whether people have the right to suicide, I had strong reactions to the idea of, as a mental health professional, being asked to assist with it. What do you all think? Would you feel comfortable with something like that being implemented in the USA?



I'm posting in the Psychiatry forum because I assume that you guys would be more involved than psychologists (although my fellow psychologists that read this board can feel free to chime in)

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[deleted480308]

I do not believe anyone has the "right" to a doctor assisted suicide

 

[WisNeuro]

I believe that the "right" in this particular case is that it is not illegal. My assumption is that physicians are not forced to participate if they do not wish to, just that an individual can opt for a method that is likely less messy and more of a sure thing than most options that are commonly used.

 

[wolfvgang22]

I believe it is a strong taboo for people who work in mental healthcare to even discuss it in the U. S.

 

[WisNeuro]

We've had didactics around the assisted suicide issues for our trainees here and there, with some of our palliative and hospice providers. Though, these didactic and discussions were confined to the realm of terminal illnesses.

 

[Armadillos]

I haven’t looked into this in awhile, but from some older news articles I read MH related physician assisted suicide in Europe is even worse in practice than the concept sounds on paper. Literally there have been folks in 20s/30s either nearly killed or killed via this method with little to no input from the medical professionals who have actually treated the patient.

Sounds like there are couple providers there who do the evals and at least a couple of them are quite liberal in approving them due to odd moral reasonings I don’t remember.

 

[clausewitz2]

I haven’t looked into this in awhile, but from some older news articles I read MH related physician assisted suicide in Europe is even worse in practice than the concept sounds on paper. Literally there have been folks in 20s/30s either nearly killed or killed via this method with little to no input from the medical professionals who have actually treated the patient.

Sounds like there are couple providers there who do the evals and at least a couple of them are quite liberal in approving them due to odd moral reasonings I don’t remember.

Simply not true in the Dutch case. The final eval process is specialized in a handful of clinics but for euthanasia on psychiatric grounds there has to be a demonstration that the patient has failed all available treatments. It takes on average about two years to be approved and 90% of applications on psychiatric grounds are turned down.

 

[WisNeuro]

Simply not true in the Dutch case. The final eval process is specialized in a handful of clinics but for euthanasia on psychiatric grounds there has to be a demonstration that the patient has failed all available treatments. It takes on average about two years to be approved and 90% of applications on psychiatric grounds are turned down.

As a MH professional, I'd say we all tend towards reducing suicide in any way that we can. But, if an individual has truly tried many treatments with little to no benefit, has capacity for medical decision making, and has made a clear and consistent expression of choice over a good length of time (how long is definitely hotly debatable), I'd have to say I don't think we should stand in the way of them making this choice to do so on their own terms, in a way that minimizes pain and mess. That being said, I would choose to not be a participant in the healthcare process for such things.

 

[Sushirolls]

Several years ago I looked into the laws with WA and OR state that have need for mental health rule outs on the request for assisted suicide in terminal illnesses on the state approved list with 6 months left to live. However, I believe some of the states show that none of them actually saw a psychologist or psychiatrist in the process. Peripherally this is my understanding of how far the overlap in the US goes with assisted suicide for Psychiatry.

 

[Armadillos]

Simply not true in the Dutch case. The final eval process is specialized in a handful of clinics but for euthanasia on psychiatric grounds there has to be a demonstration that the patient has failed all available treatments. It takes on average about two years to be approved and 90% of applications on psychiatric grounds are turned down.

I think it was Belgium that had issues, this article talks just about one case but there was a different one that was more like a case series if I remember

Belgium investigates doctors who euthanized autistic woman

LONDON (AP) — Belgian officials are investigating whether doctors improperly euthanized a woman with autism, the first criminal investigation in a euthanasia case since the practice was legalized in 2002 in the European nation.

www.apnews.com

 

[Crayola227]

Several years ago I looked into the laws with WA and OR state that have need for mental health rule outs on the request for assisted suicide in terminal illnesses on the state approved list with 6 months left to live. However, I believe some of the states show that none of them actually saw a psychologist or psychiatrist in the process. Peripherally this is my understanding of how far the overlap in the US goes with assisted suicide for Psychiatry.

I don't know that in many of those cases, it's medically necessary to have a psychologist or psychiatrist rule out mental health as a factor. I mean, I think PCPs can often do a decent job of dx'ing the presence, or at least one would hope, the absence, of depression or psychosis, etc.

 

[Armadillos]

I don't know that in many of those cases, it's medically necessary to have a psychologist or psychiatrist rule out mental health as a factor. I mean, I think PCPs can often do a decent job of dx'ing the presence, or at least one would hope, the absence, of depression or psychosis, etc.

To be fair we are talking about doctors taking steps to actively kill someone, so hopefully the standard is a little higher than “a decent job”.

 

[Sushirolls]

I don't know that in many of those cases, it's medically necessary to have a psychologist or psychiatrist rule out mental health as a factor. I mean, I think PCPs can often do a decent job of dx'ing the presence, or at least one would hope, the absence, of depression or psychosis, etc.

Not really looking to pass judgement, in this context, on other doctors capacity for mental health diagnosis/ rule out abilities. But for general education here's the link to WA state:

Death with Dignity Act - Forms for Patients & Providers :: Washington State Department of Health

On one of the primary doctors forms here are the two mental health options that doctor has to chose from:
Check one of the following (required):
I have determined that the patient is not suffering from a psychiatric or psychological disorder, or depression, causing impaired judgment, in accordance with chapter 70.245 RCW.

I have referred the patient to the provider listed below for evaluation and counseling for a possible psychiatric or psychological disorder, or depression causing impaired judgment, and attached the consultant’s form.

 

[Crayola227]

Not really looking to pass judgement, in this context, on other doctors capacity for mental health diagnosis/ rule out abilities. But for general education here's the link to WA state:

Death with Dignity Act - Forms for Patients & Providers :: Washington State Department of Health

On one of the primary doctors forms here are the two mental health options that doctor has to chose from:
Check one of the following (required):
I have determined that the patient is not suffering from a psychiatric or psychological disorder, or depression, causing impaired judgment, in accordance with chapter 70.245 RCW.

I have referred the patient to the provider listed below for evaluation and counseling for a possible psychiatric or psychological disorder, or depression causing impaired judgment, and attached the consultant’s form.

Fair enough, if that's what the form and law requires.

 

[Crayola227]

To be fair we are talking about doctors taking steps to actively kill someone, so hopefully the standard is a little higher than “a decent job”.

I'm being a bit facetious in using the word "decent." I think a standard can be high, and should be high, but I still don't think that means that diagnosis of certain mental health conditions is outside the purview of non-psychologists and non-psychiatrists. To be clear, the stakes are high in diagnosing any condition that can predispose to suicide, whether or not the patient is terminal and seeking medically assisted suicide or not.

I've had some first hand exposure to assisted suicide. I realize how that sentence could read. I am Crayola the Friendly Ghost Writer.

 

[Armadillos]

My other issue (based on understanding from limited reading) is that in Belgium patients can refuse other treatments thereby making their condition “untreatable” and qualifying for physician suicide. So they could be euthanizing folks with personality disorders who never got DBT or a fair shot at psychodynamic therapy or whatever. Or someone who is depressed who never got ECT/TMS/ketamine/etc

 

[Mass Effect]

Though, these didactic and discussions were confined to the realm of terminal illnesses.

And there's the rub -- the implication that some psychiatric illnesses aren't terminal.