“Nothing Hurts Less Than Being Dead”: Psychological Pain in Case Descriptions of Psychiatric Euthanasia and Assisted Suicide from the Netherlands: « Rien ne fait moins mal qu’être mort »: La douleur psychologique dans les descriptions de cas d’euthanasie et de suicide assisté psychiatrique aux Pays-Bas

Abstract

Objectives: Euthanasia and assisted suicide (EAS) of individuals with mental disorders is a growing practice in several countries, including the Netherlands. Here, we aimed to identify the most frequent dimensions of and associated factors to psychological pain, which has been associated with suicidality, in individuals undergoing psychiatric EAS. Methods: An exploratory retrospective content analysis of the English translation of 66 digital case records of individuals who died by EAS in the Netherlands between 2011 and 2014 was performed. Nine standard psychological pain dimensions (irreversibility, loss of control, emptiness, emotional flooding, freezing, social distancing, narcissistic wounds, confusion, and self-estrangement), illness, and sociodemographic variables were evaluated by 2 independent raters using a premade data abstraction form (Kohen κ > 0.8 in all cases). Results: The mean number of dimensions was 4.64 ± 1.20 (median = 5), out of 9. The most frequent dimensions were irreversibility, loss of control, emptiness, and emotional flooding, in decreasing order. Past treatment refusal and the mention of social connections in case descriptions were related to the higher number of psychological pain dimensions (4.89 ± 1.24 vs. 4.31 ± 1.07, P = 0.03 and 5.05 ± 1.17 vs. 4.43 ± 1.17, P = 0.03, respectively). Emotional flooding was the only dimension specifically associated with specific psychiatric conditions, namely posttraumatic phenomena and personality disorders. Conclusions: Numerous psychological pain dimensions were detected in case descriptions of individuals who underwent EAS before the procedure. Subjective nature of the study precludes definite conclusions but suggest that future studies should explore psychological pain and the role of interventions targeting it in patients requesting EAS.

Psychological pain in depressive disorder: A concept analysis

“…When individuals are in a depressed mood and perceive that the depressive symptom is increasing or difficult to relieve, it can cause great psychological pain. Low adherence and poor treatment outcome are also disease-related factors affecting the psychological pain of patients with depression, mainly due to poor adherence to medication and recurrent episodes of disease, thus superimposing negative emotions (Lengvenyte et al, 2020).…”

Eutanasia y enfermedad mental:el problema del sufrimiento.

“…son variados e incluyen cuadros que no se identifican habitualmente como graves, lo que de nuevo remite a que lo determinante es el sufrimiento alegado por la persona (8). Este sufrimiento, al que Lengvenyte y colabores identifica como "dolor psicológico", tendría las siguientes dimensiones: impresión de irreversibilidad de la situación, vivencia de pérdida de control, sensación de vacío, desbordamiento emocional, pérdida de actividad o motivación, aislamiento social, heridas narcisísticas, dificultades cognitivas en el día a día, e impresión de cambio radical en la propia personalidad (8).…”

Assisted Suicide and Euthanasia in Mental Disorders: Ethical Positions in the Debate between Proportionality, Dignity, and the Right to Die

“…Furthermore, the legislative limits that restricted access to assisted dying have been progressively challenged by requests of E/PAS by people suffering from mental disorders other than "severe mental illness" (SMI) (e.g., prolonged grief, alexithymia, factitious disorder, dissociative disorder, reactive attachment disorder, kleptomania); where SMI, according to the Dutch consensus definition, should be represented by a long-lasting psychiatric disorder which "requires psychiatric treatment" and is "accompanied by serious restrictions in the social and societal functioning" [11]. In this sense, psychic pain, a transdiagnostic dimension, seems to have an important role [12], encompassing different types of suffering (e.g., psychological, existential, spiritual) [13].…”