Psychiatric patients requesting euthanasia: Guidelines for sound clinical and ethical decision making

Verhofstadt, Monica; Assche, Kristof Van; Sterckx, Sigrid; Audenaert, Kurt; Chambaere, Kenneth

doi:10.1016/j.ijlp.2019.04.004

Cited by 46 publications

(37 citation statements)

References 28 publications

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“…As these guidelines are not binding, they might have the undesirable consequence that an APC patient’s euthanasia request is handled differently according to individual differences in physicians’ approaches towards euthanasia assessment and decision-making (whether or not the physician involved also takes the more stringent criteria of the guidelines into account). As a result, this may have an additional undesirable consequence: the patient might immediately search for physicians who presumably hold more permissive stances and approaches regarding euthanasia instead of discussing their euthanasia request with the treating psychiatrist, under the assumption that the latter is inclined to take a more restrictive stance [ 28 ]. Therefore, more in-depth research on what kind of additional support and specific training psychiatrists need regarding the adequate and proper handling of a euthanasia request is recommended.…”

Section: Discussionmentioning

confidence: 99%

The engagement of psychiatrists in the assessment of euthanasia requests from psychiatric patients in Belgium: a survey study

et al. 2020

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Background: Since its legalisation in 2002, the number of times euthanasia has been carried out in response to requests from adults with psychiatric conditions (APC) has continued to increase. However, little is known about why and how psychiatrists become engaged in the assessment of such euthanasia requests. Methods: A cross-sectional survey study was conducted between November 2018 and April 2019 of 499 psychiatrists affiliated with the Flemish Psychiatry Association. Chi square/Fisher's exact tests were performed to examine if, and to what extent, psychiatrists' backgrounds relate to their concrete experiences. The answers to the open question regarding motives for (non-) engagement were thematically coded. Results: Two hundred one psychiatrists participated, a response rate of 40%. During their careers, 80% of those responding have been confronted with at least one euthanasia request from an APC patient and 73% have become involved in the assessment procedure. Their engagement was limited to the roles of: referring physician (in 44% of the psychiatrists), attending physician (30%), legally required 'advising physician' (22%), and physician participating in the actual administration of the lethal drugs (5%). Within the most recent 12 months of practice, 61% of the respondents have been actively engaged in a euthanasia assessment procedure and 9% have refused at least once to be actively engaged due to their own conscientious objections and/or the complexity of the assessment. The main motive for psychiatrists to engage in euthanasia is the patient's fundamental right in Belgian law to ask for euthanasia and the psychiatrist's duty to respect that. The perception that they were sufficiently competent to engage in a euthanasia procedure was greater in psychiatrists who have already had concrete experience in the procedure.

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Section: Discussionmentioning

confidence: 99%

The engagement of psychiatrists in the assessment of euthanasia requests from psychiatric patients in Belgium: a survey study

et al. 2020

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“…Public media have reported on controversial euthanasia cases based on psychiatric conditionsthree of which were referred to Belgian or European Courts [7][8][9] and some observers have expressed concerns about potentially overly-permissive approaches in some instances, in terms of the assessment of eligibility [10]. Therefore, health care institutions and ethical and professional organisations have recently developed and published guidelines on the assessment of euthanasia requests in APC emphasizing the need for careful scrutiny in euthanasia decision-making procedures [11].…”

Section: Introductionmentioning

confidence: 99%

Belgian psychiatrists’ attitudes towards, and readiness to engage in, euthanasia assessment procedures with adults with psychiatric conditions: a survey

et al. 2020

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Background: Although the Belgian assessment pathway for legal euthanasia requires the engagement of at least one psychiatrist, little is known about psychiatrists' attitudes towards euthanasia for adults with psychiatric conditions (APC). This study aims to gauge psychiatrists' attitudes towards and readiness to engage in euthanasia assessment and/or performance procedures in APC. Methods: This cross-sectional survey study was performed between November 2018 and April 2019. The survey was sent to a sample of 499 eligible psychiatrists affiliated to the Flemish Association for Psychiatry, a professional association that aims to unite and represent all psychiatrists working in Flanders, the Dutch-speaking, northern part of Belgium. The Association's members comprise an estimated 80-90% of all psychiatrists active in Flanders. Only psychiatrists working with APC (83% of the association's total membership) were included. Factorial Anova and Chi Square tests were performed to examine if and to what extent psychiatrists' backgrounds were associated with, respectively, their attitudes and their readiness to play a role in euthanasia procedures concerning APC. Results: One hundred eighty-four psychiatrists completed the questionnaire (response rate 40.2%); 74.5% agree that euthanasia should remain permissible for APC. However, 68.9% question some of the approaches taken by other physicians during the euthanasia assessment and only half consider euthanasia assessment procedures compatible with the psychiatric care relationship. Where active engagement is concerned, an informal referral (68%) or preliminary advisory role (43.8%) is preferred to a formal role as a legally required advising physician (30.3%), let alone as performing physician (< 10%). Conclusion: Although three quarters agree with maintaining the legal option of euthanasia for APC, their readiness to take a formal role in euthanasia procedures appears to be limited. More insight is required into the barriers preventing engagement and what psychiatrists need, be it education or clarification of the legal requirements, to ensure that patients can have their euthanasia requests assessed adequately.

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“…The legal situations and specific clinical challenges for psychiatry associated with medical assistance in dying have been the topic of a recent review (13). Notably, guidelines for clinical and ethical decision-making specifically in psychiatric patients requesting euthanasia in Belgium were also recently published (14).…”

Section: Discussionmentioning

confidence: 99%

Compulsory Psychiatric Admission in a Patient With Metastatic Breast Cancer: From Palliative Care to Assisted Suicide

2020

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The provision of palliative care in psychiatry and the use of coercion in palliative care are underexplored areas. We report the case of a 65-year-old woman with cerebral metastatic breast cancer who was compulsorily admitted from a specialized palliative care ward to a psychiatric inpatient ward in Zurich, Switzerland. While in specialized inpatient palliative care, the patient had resisted palliative care but was found to lack decision-making capacity for her treatment due to disordered thought process and paranoid delusions. Under our care, which involved coercive treatment in the form of concealed administration of an antipsychotic, the patient's psychiatric symptoms improved. She regained decisionmaking capacity, was granted discharge from hospital, and ended her life by assisted suicide on the day of discharge.

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Psychiatric patients requesting euthanasia: Guidelines for sound clinical and ethical decision making

Cited by 46 publications

References 28 publications

The engagement of psychiatrists in the assessment of euthanasia requests from psychiatric patients in Belgium: a survey study

The engagement of psychiatrists in the assessment of euthanasia requests from psychiatric patients in Belgium: a survey study

Belgian psychiatrists’ attitudes towards, and readiness to engage in, euthanasia assessment procedures with adults with psychiatric conditions: a survey

Compulsory Psychiatric Admission in a Patient With Metastatic Breast Cancer: From Palliative Care to Assisted Suicide

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