Do Doctors Differentiate Between Suicide and Physician-Assisted Death? A Qualitative Study into the Views of Psychiatris
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Do Doctors Differentiate Between Suicide and Physician-Assisted Death? A Qualitative Study into the Views of Psychiatrists and General Practitioners Rosalie Pronk1,3 • Dick L. Willems1 Suzanne van de Vathorst1,2
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The Author(s) 2020
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.
& Rosalie Pronk [email protected] 1
Department of General Practice, Medical Ethics Section, Academic Medical Centre, Amsterdam UMC, Amsterdam, The Netherlands
2
Department of Medical Ethics and Philosophy, Erasmus Medical Centre, Rotterdam, The Netherlands
3
Department of General Practice, Medical Ethics Section, Academic Medical Centre, Amsterdam UMC, Room J2-219, PO Box 22660, Amsterdam, The Netherlands
123
Cult Med Psychiatry
Keywords Suicide Physician-assisted death Psychiatry Psychiatric patients Euthanasia Netherlands
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 also used, in both Canada and the US. However, we will make use of the term ‘EAS,’ as this is how it is used in the Netherlands). The Dutch Supreme Court ruled in the Chabot case (in 1994) that the unbearableness of the suffering should be leading, regardless of the source of this suffering (Pans 2006). Physician-assisted death for patients suffering from psychiatric illnesses solely is also permitted under strict criteria in Belgium, Luxembourg, and Canada (Emanuel et al. 2016; Downie and Dembo 2016). In the Netherlands, a physician is allowed to provide assistance in dying
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