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Should euthanasia and assisted suicide for psychiatric disorders be permitted? A systematic review of reasons

Published online by Cambridge University Press:  02 June 2020

Marie E. Nicolini Open the ORCID record for Marie E. Nicolini [Opens in a new window] ,
Scott Y. H. Kim Open the ORCID record for Scott Y. H. Kim [Opens in a new window] ,
Madison E. Churchill  and
Chris Gastmans Open the ORCID record for Chris Gastmans [Opens in a new window]
Marie E. Nicolini*
Affiliation:
Center for Biomedical Ethics and Law, KU Leuven, Kapucijnenvoer 35 – Box 7001 3000 Leuven, Belgium Department of Bioethics, National Institutes of Health, 10 Center Drive, Room 1C118, Bethesda, Maryland20892, USA
Scott Y. H. Kim
Affiliation:
Department of Bioethics, National Institutes of Health, 10 Center Drive, Room 1C118, Bethesda, Maryland20892, USA
Madison E. Churchill
Affiliation:
Department of Bioethics, National Institutes of Health, 10 Center Drive, Room 1C118, Bethesda, Maryland20892, USA
Chris Gastmans
Affiliation:
Center for Biomedical Ethics and Law, KU Leuven, Kapucijnenvoer 35 – Box 7001 3000 Leuven, Belgium
*
Author for correspondence: Marie E. Nicolini, E-mail: [email protected]
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Abstract

Background

Euthanasia and assisted suicide (EAS) based on a psychiatric disorder (psychiatric EAS) continue to pose ethical and policy challenges, even in countries where the practice has been allowed for years. We conducted a systematic review of reasons, a specific type of review for bioethical questions designed to inform rational policy-making. Our aims were twofold: (1) to systematically identify all published reasons for and against the practice (2) to identify current gaps in the debate and areas for future research.

Methods

Following the PRISMA guidelines, we performed a search across seven electronic databases to include publications focusing on psychiatric EAS and providing ethical reasons. Reasons were grouped into domains by qualitative content analysis.

Results

We included 42 articles, most of which were written after 2013. Articles in favor and against were evenly distributed. Articles in favor were mostly full-length pieces written by non-clinicians, with articles against mostly reactive, commentary-type pieces written by clinicians. Reasons were categorized into eight domains: (1) mental and physical illness and suffering (2) decisional capacity (3) irremediability (4) goals of medicine and psychiatry (5) consequences for mental health care (6) psychiatric EAS and suicide (7) self-determination and authenticity (8) psychiatric EAS and refusal of life-sustaining treatment. Parity- (or discrimination-) based reasons were dominant across domains, mostly argued for by non-clinicians, while policy reasons were mostly pointed to by clinicians.

Conclusions

The ethical debate about psychiatric EAS is relatively young, with prominent reasons of parity. More direct engagement is needed to address ethical and policy considerations.

Keywords

Ethicseuthanasianon-terminal illnessphysician aid-in-dyingphysician-assisted suicidepsychiatrysystematic review of reasons
Type
Review Article
Information
Psychological Medicine , Volume 50 , Issue 8 , June 2020 , pp. 1241 - 1256
Copyright
Copyright © National Institutes of Health, USA, 2020. This is a work of the US Government and is not subject to copyright protection within the United States. Published by Cambridge University Press

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