Should the mentally ill have the right to end their own lives?
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Assisted Suicide Requests Up In Patients With Mental Illness, Dementia

Physician assisted suicide is now legal in at least 5 US states and may soon be legal in at least as many more. It does, however, remain a controversial topic with people on both sides of the debate pointing to assisted suicide data from Europe as proof that their side holds the moral high ground.

But even among people who fully endorse the rights of terminally ill patients to avoid the suffering that often accompanies diseases like cancer, the rights of the mentally ill or cognitively disabled to end their lives can remain ethically troublesome. As more mentally ill people seek the right to die, medicine is grappling for answers.

A study published this morning at the website for the journal BMC Psychiatry finds that the number of mentally ill or dementia patients undergoing physician assisted suicide in Belgium, where the practice has been legal for 15 years, has jumped from 0.5% to 3% of all medically assisted suicides reported since 2008.

Women are over-represented in these cases. More than 58% of dementia patients seeking assisted suicide are female; more than 77% of suicide-seeking patients with mood disorders are women.

Now, none of these cases represents what most of us would consider euthanasia. These were all cases in which the patient himself/herself requested the procedure after being deemed competent to make such a decision.

Can A Mentally Ill Patient Make An Informed Choice?

While nations that officially allow doctor assisted suicides have procedures in place to protect vulnerable patients from making such a decision in a moment of pain or confusion, many critics will point out that a desire to die can be a symptom of some psychiatric illnesses.

And a 2008 UK study, for example, found that 97% of patients with mania-involved conditions were incapable of making any informed choice about their care.

Is Dementia A Special Case?

The researchers behind the Belgian study did not explain why they chose to lump dementia and other cognitively impaired patients in with people suffering from conditions like major depression or schizoaffective disorder.  With the National Academies of Sciences, Engineering and Medicine announcing only this week that there was still only “inconclusive evidence” that any intervention could prevent dementia, some may ask if patients with conditions like Alzheimer’s or Parkinson’s should be treated differently, especially given that these conditions are both progressive and irreversible.

What The Belgium Researchers Say

The researchers behind the Belgian study are calling on the medical community to look more closely at–as they put it–“these highly delicate requests” and develop guidelines for physicians who treat these vulnerable patients.

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