Scott Y H Kim1, Raymond G De Vries2, John R Peteet3. 1. Department of Bioethics, National Institutes of Health, Bethesda, Maryland. 2. Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor3CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands. 3. Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Abstract
IMPORTANCE: Euthanasia or assisted suicide (EAS) of psychiatric patients is increasing in some jurisdictions such as Belgium and the Netherlands. However, little is known about the practice, and it remains controversial. OBJECTIVES: To describe the characteristics of patients receiving EAS for psychiatric conditions and how the practice is regulated in the Netherlands. DESIGN, SETTING, AND PARTICIPANTS: This investigation reviewed psychiatric EAS case summaries made available online by the Dutch regional euthanasia review committees as of June 1, 2015. Two senior psychiatrists used directed content analysis to review and code the reports. In total, 66 cases from 2011 to 2014 were reviewed. MAIN OUTCOMES AND MEASURES: Clinical and social characteristics of patients, physician review process of the patients' requests, and the euthanasia review committees' assessments of the physicians' actions. RESULTS: Of the 66 cases reviewed, 70% (n = 46) were women. In total, 32% (n = 21) were 70 years or older, 44% (n = 29) were 50 to 70 years old, and 24% (n = 16) were 30 to 50 years old. Most had chronic, severe conditions, with histories of attempted suicides and psychiatric hospitalizations. Most had personality disorders and were described as socially isolated or lonely. Depressive disorders were the primary psychiatric issue in 55% (n = 36) of cases. Other conditions represented were psychotic, posttraumatic stress or anxiety, somatoform, neurocognitive, and eating disorders, as well as prolonged grief and autism. Comorbidities with functional impairments were common. Forty-one percent (n = 27) of physicians performing EAS were psychiatrists. Twenty-seven percent (n = 18) of patients received the procedure from physicians new to them, 14 of whom were physicians from the End-of-Life Clinic, a mobile euthanasia clinic. Consultation with other physicians was extensive, but 11% (n = 7) of cases had no independent psychiatric input, and 24% (n = 16) of cases involved disagreement among consultants. The euthanasia review committees found that one case failed to meet legal due care criteria. CONCLUSIONS AND RELEVANCE: Persons receiving EAS for psychiatric disorders in the Netherlands are mostly women and of diverse ages, with complex and chronic psychiatric, medical, and psychosocial histories. The granting of their EAS requests appears to involve considerable physician judgment, usually involving multiple physicians who do not always agree (sometimes without independent psychiatric input), but the euthanasia review committees generally defer to the judgments of the physicians performing the EAS.
IMPORTANCE: Euthanasia or assisted suicide (EAS) of psychiatricpatients is increasing in some jurisdictions such as Belgium and the Netherlands. However, little is known about the practice, and it remains controversial. OBJECTIVES: To describe the characteristics of patients receiving EAS for psychiatric conditions and how the practice is regulated in the Netherlands. DESIGN, SETTING, AND PARTICIPANTS: This investigation reviewed psychiatric EAS case summaries made available online by the Dutch regional euthanasia review committees as of June 1, 2015. Two senior psychiatrists used directed content analysis to review and code the reports. In total, 66 cases from 2011 to 2014 were reviewed. MAIN OUTCOMES AND MEASURES: Clinical and social characteristics of patients, physician review process of the patients' requests, and the euthanasia review committees' assessments of the physicians' actions. RESULTS: Of the 66 cases reviewed, 70% (n = 46) were women. In total, 32% (n = 21) were 70 years or older, 44% (n = 29) were 50 to 70 years old, and 24% (n = 16) were 30 to 50 years old. Most had chronic, severe conditions, with histories of attempted suicides and psychiatric hospitalizations. Most had personality disorders and were described as socially isolated or lonely. Depressive disorders were the primary psychiatric issue in 55% (n = 36) of cases. Other conditions represented were psychotic, posttraumatic stress or anxiety, somatoform, neurocognitive, and eating disorders, as well as prolonged grief and autism. Comorbidities with functional impairments were common. Forty-one percent (n = 27) of physicians performing EAS were psychiatrists. Twenty-seven percent (n = 18) of patients received the procedure from physicians new to them, 14 of whom were physicians from the End-of-Life Clinic, a mobile euthanasia clinic. Consultation with other physicians was extensive, but 11% (n = 7) of cases had no independent psychiatric input, and 24% (n = 16) of cases involved disagreement among consultants. The euthanasia review committees found that one case failed to meet legal due care criteria. CONCLUSIONS AND RELEVANCE: Persons receiving EAS for psychiatric disorders in the Netherlands are mostly women and of diverse ages, with complex and chronic psychiatric, medical, and psychosocial histories. The granting of their EAS requests appears to involve considerable physician judgment, usually involving multiple physicians who do not always agree (sometimes without independent psychiatric input), but the euthanasia review committees generally defer to the judgments of the physicians performing the EAS.
Authors: Marijke Catharina Jansen-van der Weide; Bregje Dorien Onwuteaka-Philipsen; Gerrit van der Wal Journal: Health Policy Date: 2006-04-18 Impact factor: 2.980
Authors: J H Groenewoud; P J van der Maas; G van der Wal; M W Hengeveld; A J Tholen; W J Schudel; A van der Heide Journal: N Engl J Med Date: 1997-06-19 Impact factor: 91.245
Authors: Pauline S C Kouwenhoven; Natasja J H Raijmakers; Johannes J M van Delden; Judith A C Rietjens; Maartje H N Schermer; Ghislaine J M W van Thiel; Margo J Trappenburg; Suzanne van de Vathorst; Bea J van der Vegt; Cristiano Vezzoni; Heleen Weyers; Donald G van Tol; Agnes van der Heide Journal: Palliat Med Date: 2012-06-13 Impact factor: 4.762
Authors: M Bernal; J M Haro; S Bernert; T Brugha; R de Graaf; R Bruffaerts; J P Lépine; G de Girolamo; G Vilagut; I Gasquet; J V Torres; V Kovess; D Heider; J Neeleman; R Kessler; J Alonso Journal: J Affect Disord Date: 2006-10-30 Impact factor: 4.839
Authors: Lieve Thienpont; Monica Verhofstadt; Tony Van Loon; Wim Distelmans; Kurt Audenaert; Peter P De Deyn Journal: BMJ Open Date: 2015-07-27 Impact factor: 2.692