Guidelines for assessments: Reactions to the commentators.

Abstract

In this short article, the authors respond to the critiques of the four commentators on the original "Guidelines" article. They highlight areas of agreement and disagreement with the other authors in an effort to move the discussion forward.We appreciate the thorough review of our proposed guidelines by the panel of commentators. We were impressed with how carefully they scrutinized our review of the literature and the guidelines themselves. Their essays have added much to the philosophical, legal, and psychological discussion of this topic. Because of their prominence and experience, we were especially heartened with what we perceived to be an overall belief that the guidelines were both thorough and comprehensive.Although we agree with much of what the panel had to say about the issue of capacity assessment in general and our guidelines in particular, we want to take this opportunity to explore some of their assertions. We first review Youngner's commentary, "Bureaucratizing Suicide," as he is the only psychiatrist, and then address the views of the law professors in alphabetical order.

A conceptual framework for thinking about physician-assisted death for persons with a mental disorder.

“…The Special Issue comprised 24 articles from various experts in the field who provided reviews and commentary on practice, policies, and empirical evidence on PAD (for a summary of the special issue see Benjamin, 2000). PAD for persons with a mental disorder as a sole diagnosis was not thoroughly debated in this special issue, perhaps because it was not permissible under Oregon law and there was an apparent consensus at that time that PAD is not appropriate for persons with a mental disorder (Baron, 2000; Burt, 2000; Illingworth & Bursztajn, 2000; Jamison, 2000; Kerkhof, 2000; King, Kim, & Conwell, 2000; Martyn & Bourguignon, 2000; Rosenfeld, 2000a, 2000b; Werth, Benjamin, & Farrenkopf, 2000; Werth, Farrenkopf, & Benjamin, 2000; Youngner, 2000). Things have changed.…”

“…17For a response to these commentators by the authors’ of the guidelines see Werth, Farrenkopf, et al (2000).…”

Observations on the first year of Oregon's Death with Dignity Act.

“…65 Patients generally understand and are supportive of precautions related to assessing mental competence, nonimpaired judgment, and whether the request is enduring and rational. 66 They have willingly accepted encouragement toward hospice care and the consideration of other alternatives such as intense comfort care, terminal sedation, and stopping eating and drinking. 67 In fact, 27 were enrolled in hospice when they died.…”