Bioethicists have for several decades discussed whether Physician Assisted Death (PAD) can be distinguished from other forms of suicide. The question is of critical importance for suicide prevention initiatives in countries where PAD is legal, as it may be the case that the practice of PAD is undermining the work of organisations committed to reducing suicide rates.
A major intervention into the debate was made late last year by the American Society for Suicidology (ASS) -- the peak association in the United States that advocates for suicide prevention -- when the organisation released a statement declaring that “suicide is not the same as “physician aid in dying””. In that statement, the organisation suggested that certain features of “traditional” suicide -- such as the lack of competency of the suicider; the loss of meaning in one’s life; and the sense of hopelessness experienced by the individual -- make it a distinct sociological, medical and legal phenomenon from state sanctioned forms of PAD. The statement describes PAD as a relatively peaceful means to end one’s life, and suggests that it is closely scrutinised in all jurisdictions where it is legal (both in the US and abroad). The statement concluded with a bold assertion that a commitment to suicide prevention has “no bearing” on one’s attitude to PAD, and, furthermore, that the term “physician assisted suicide” should be deleted from use.
Yet three US psychiatrists have just published scathing critique of the statement in the journal JAMA Psychiatry, arguing in particular that the practice of PAD for psychiatric disorders is in many cases very difficult to distinguish from other forms of suicide. The authors of the paper -- Drs Scott Kim (NIH), Yeats Conwell (Rochester) and Eric D. Caine (Rochester) -- argue that the features of “traditional” suicide may indeed be present in cases of euthanasia for psychiatric disorders. The authors write:
“persons who receive psychiatric PAD share these characteristics [with persons who die by suicide]: they all have some form of mental illness; most also have personality disorders, have attempted suicide, and are socially isolated or lonely”.
The cite a series of papers published on PAD for psychiatric disorders in the Netherlands and Belgium, indicating a gross lack of oversight and concern for patient autonomy. One case cited in the article includes a man in the Netherlands who “jumped off a building, survived the fall with broken thighs, and then received PAD during the ensuing hospitalization”.
Importantly, the authors note that, even in cases where euthanasia is requested on the grounds of a terminal illness, patients often report psychological pain and despair and a fundamental loss of meaning.
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