When should a life of suffering be ended? Clinical, Legal and Ethical Perspectives on Euthanasia in Psychiatry

When suffering becomes unbearable for psychiatric patients with no prospect of improvement, euthanasia or ‘assisted dying’ offers psychiatric patients the possibility to end their life in a dignified way. In Switzerland, Belgium and the Netherlands assisted dying is not restricted to terminally ill patients but is also legally permitted for those whose unbearable suffering is due to non-terminal but severe, persistent and untreatable mental illness. Psychological suffering can be equally unbearable and debilitating as somatic suffering. This much seems obvious from the high proportion of people attempting suicide that are diagnosed with mental illnesses such as major depression, substance addiction and personality disorders.

Although the moral case for assisted death for psychiatric illness is strong, there are difficult medical and ethical dilemmas that confront physicians when a psychiatric patient requests to die. Physicians must be able to reach a well-considered judgement that the patient has a treatment refractory condition and is therefore without prospect of further improvement. Yet there is currently no objective, scientific way to determine whether a mental illness is untreatable; when the patient’s suffering is too much for them to bear; and when a request for assisted dying is well-considered rather than a symptom of the patient’s illness to be treated alongside their other symptoms. Under what conditions can it be concluded that the life of an adolescent is without prospects of improvement? When can the life of an elderly person be considered to be completed, and no longer worth living?

We will seek to address these and other questions surrounding the practice of euthanasia in psychiatry from legal, clinical, and ethical perspectives. This is the second in a series of workshops organized by the Lemon Tree Interdisciplinary Center for Psychiatry, Psychotherapy and Philosophy, and kindly hosted by the University of Amsterdam’s Institute for Advanced Studies.