‘A new study in the journal JAMA Psychiatry has presented an alarming picture of physician evaluation of euthanasia requests in the Netherlands. The article, lead authored by National Institutes of Health (NIH) psychiatrist Dr. Scott Y. H. Kim, examined 66 psychiatric euthansia and assisted suicide (EAS) case summaries made available online by the Dutch regional euthanasia review committees.
The authors found that 56% of patients reported having refused at least one kind of treatment, and of those, almost half refused because of ‘lack of motivation’.
The study also confirmed the findings of previous surveys that loneliness is a key driver behind requests by those suffering from mental illness. Of the 66 patients surveyed, 37 identified loneliness or social isolation as a motivation behind their request. One elderly patient – both mentally and physically healthy –gave no other reason for euthanasia other than loneliness after her husband had passed away. Many of the patients used what the study called a “mobile-end-of life clinic” – a doctor and nurse funded by a local euthanasia advocacy group.
Dutch women with a psychiatric illness were more than twice as likely to be euthanased than men. Of the 66, 70% were women; 32% were 70 or older; 44% were between 50 and 70; and 24% were between 30 and 50. However, information about the patients in the reports was scanty. They contained little social history, not even their family structures. Marital status, occupation, education level, race/ethnicity, and nationality were rarely mentioned.
There was a total of 110 psychiatric EAS cases between 2011 and 2014, but the regional review committees uncovered only one patient for whom due care criteria were not met. This was a woman in her 80s with chronic depression who sought help from a mobile end-of-life clinic which sends a doctor to patients whose own doctor has refused to euthanase them.
“The clinic physician met with her 2 times (the first time was 3 weeks before her death), and the patient was not alone on both occasions, with family members present. The physician was not a psychiatrist, did not consult psychiatrists, was unaware of the Dutch Psychiatric Association Guidelines, and yet ‘had not a single doubt’ about the patient’s prognosis.”
In another case, the regional review committee was merely critical. “The patient had attempted suicide, which led to a broken thigh. The patient refused all treatments and requested EAS. The RTE was ‘puzzled’ by the fact that this physician ‘complied with the patient’s [EAS] wish almost at once”.
The statistics suggest that patients “shop” for compliant doctors. Among them, 32% had been refused EAS at some point but physicians later changed their mind about three of them and performed EAS, while 27% had physicians who were new to them perform the EAS. In 14 of the 66 cases studied, the new physician was affiliated with the mobile euthanasia practice.
The authors hint that regulation may be lax. "The retrospective oversight system in the Netherlands generally defers to the judgments of the physicians who perform and report EAS. Whether the system provides sufficient regulatory oversight remains an open question that will require further study," they conclude.
American specialists expressed strong reservations about the way that the Dutch handle psychiatric patients who want to die.
“The criteria in the Netherlands essentially require that the person’s disorder be intractable and untreatable, and this study shows that evaluating each of those elements turns out to be problematic,” said Dr. Paul S. Appelbaum, a professor of psychiatry, medicine and law at Columbia University, told the New York Times.
Dr. Appelbaum continued, “the idea that people are leaving their treating physician and going to a clinic that exists solely for this purpose, and being evaluated not by a psychiatrist but by someone else who has to make these very difficult decisions about levels of suffering and disease — it seems to me like the worst possible way of implementing this process.”
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