How Do the Mental Health Issues Differ in the Withholding/Withdrawing of Treatment versus Assisted Death?

Abstract

This article reviews ten of the most common mental health-related arguments against assisted death and applies them to the withholding/withdrawal of treatment to determine if the concerns expressed are truly unique to assisted death. After this analysis it is suggested that the mandatory involvement of a mental health professional can alleviate many of the concerns specifically associated with assisted death and that a mental health professional may also be helpful in situations involving the withholding/withdrawal of treatment.

Concerns About Decisions Related to Withholding/ Withdrawing Life-Sustaining Treatment and Futility for Persons With Disabilities

“…The caveat I offer to Batavia's (2002) point is that I believe such a policy statement should include persons with disabilities in its drafting and the policy should have a provision for involvement of a patient advocate. In terms of other pieces of a policy, I concur with those who have advised that policies regarding withholding and withdrawing treatment should include safeguards similar to those that are part of assisted suicide proposals and that are designed to put the power in the hands of the patient (or his or her surrogates for someone unable to make his or her own decisions), given that these measures would provide important protection for persons with disabilities (e.g., Mayo & Gunderson, 2002;Quill et al, 1997;Werth, 2000; see also Rosenblatt & Block, 2001).…”

“…The main point in this section is that virtually all of the arguments made by Coleman (2002), Gill and colleagues (Gill, 1992(Gill, , 1999(Gill, , 2000Kirschner et al, 1997), and others regarding the potential dangers associated with assisted suicide are also applicable to wh/wd tx (see also Orentlicher, 1996Orentlicher, , 2000Quill, Lo, & Brock, 1997;Werth, 2000). I am not the only one to have made this extension, for even disability-rights advocates have done so.…”

“…Specifically, less discussion has been given to the psychological or social components of the dying process, even though research and experience have demonstrated that psychosocial issues are important determinants of quality of life and end-of-life decision making (Werth, Gordon, & Johnson, 2002). Also, little work has been done examining the potentially problematic psychosocial issues associated with decisions such as withholding and withdrawing treatment (Werth, 2000), even though a much higher percentage of people will die through these means than through assisted suicide (perhaps 70% or more [In re L.W., 1992] vs. 1/10 of 1% [Bascom & Tolle, 2002]), and issues that are potential problems with assisted suicide, such as clinical depression, are also problems for withholding or withdrawing treatment (see, e.g., Rosenblatt & Block, 2001).…”

Using Rational Suicide as an Intervention to Prevent Irrational Suicide

“…Many people distinguish between the withdrawal or withholding of treatment and suicide. However, regardless of the semantics, Mr. A has made a decision to take an action that will lead to his death (Werth, in press b). Whether or not one calls this a “suicide” there is the opportunity to use the criteria for rational suicide to structure the ensuing discussions and consultations.…”