Marie E Nicolini1,2, John R Peteet3, G Kevin Donovan4, Scott Y H Kim2. 1. Interfaculty Center for Biomedical Ethics and Law, KU Leuven, Kapucijnenvoer 35 - Box 7001, 3000 Leuven, Belgium. 2. Department of Bioethics, National Institutes of Health, 10 Center Drive, Room 1C118, Bethesda, Maryland20892, USA. 3. Department of Psychiatry, Harvard Medical School and Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts02115, USA. 4. Center for Clinical Bioethics, Georgetown University, Bldg. D., Suite 236, 4000 Reservoir Road, Washington D.C. 20007, USA.
Abstract
BACKGROUND: Euthanasia or assisted suicide (EAS) for psychiatric disorders, legal in some countries, remains controversial. Personality disorders are common in psychiatric EAS. They often cause a sense of irremediable suffering and engender complex patient-clinician interactions, both of which could complicate EAS evaluations. METHODS: We conducted a directed-content analysis of all psychiatric EAS cases involving personality and related disorders published by the Dutch regional euthanasia review committees (N = 74, from 2011 to October 2017). RESULTS: Most patients were women (76%, n = 52), often with long, complex clinical histories: 62% had physical comorbidities, 97% had at least one, and 70% had two or more psychiatric comorbidities. They often had a history of suicide attempts (47%), self-harming behavior (27%), and trauma (36%). In 46%, a previous EAS request had been refused. Past psychiatric treatments varied: e.g. hospitalization and psychotherapy were not tried in 27% and 28%, respectively. In 50%, the physician managing their EAS were new to them, a third (36%) did not have a treating psychiatrist at the time of EAS request, and most physicians performing EAS were non-psychiatrists (70%) relying on cross-sectional psychiatric evaluations focusing on EAS eligibility, not treatment. Physicians evaluating such patients appear to be especially emotionally affected compared with when personality disorders are not present. CONCLUSIONS: The EAS evaluation of persons with personality disorders may be challenging and emotionally complex for their evaluators who are often non-psychiatrists. These factors could influence the interpretation of EAS requirements of irremediability, raising issues that merit further discussion and research.
BACKGROUND: Euthanasia or assisted suicide (EAS) for psychiatric disorders, legal in some countries, remains controversial. Personality disorders are common in psychiatric EAS. They often cause a sense of irremediable suffering and engender complex patient-clinician interactions, both of which could complicate EAS evaluations. METHODS: We conducted a directed-content analysis of all psychiatric EAS cases involving personality and related disorders published by the Dutch regional euthanasia review committees (N = 74, from 2011 to October 2017). RESULTS: Most patients were women (76%, n = 52), often with long, complex clinical histories: 62% had physical comorbidities, 97% had at least one, and 70% had two or more psychiatric comorbidities. They often had a history of suicide attempts (47%), self-harming behavior (27%), and trauma (36%). In 46%, a previous EAS request had been refused. Past psychiatric treatments varied: e.g. hospitalization and psychotherapy were not tried in 27% and 28%, respectively. In 50%, the physician managing their EAS were new to them, a third (36%) did not have a treating psychiatrist at the time of EAS request, and most physicians performing EAS were non-psychiatrists (70%) relying on cross-sectional psychiatric evaluations focusing on EAS eligibility, not treatment. Physicians evaluating such patients appear to be especially emotionally affected compared with when personality disorders are not present. CONCLUSIONS: The EAS evaluation of persons with personality disorders may be challenging and emotionally complex for their evaluators who are often non-psychiatrists. These factors could influence the interpretation of EAS requirements of irremediability, raising issues that merit further discussion and research.
Authors: Lars Mehlum; Christian Schmahl; Ann Berens; Stephan Doering; Joost Hutsebaut; Andres Kaera; Ueli Kramer; Paul Anthony Moran; Babette Renneberg; Joaquim Soler Ribaudi; Sebastian Simonsen; Michaela Swales; Svenja Taubner; Ester di Giacomo Journal: Borderline Personal Disord Emot Dysregul Date: 2020-07-30
Authors: Benjamin Vyssoki; Michaela Stich; Elisabeth Eder-Pissarek; Ingrid Jez; Stefan Dobias; Annemarie Unger; Alexander Kautzky; Georg Psota Journal: Neuropsychiatr Date: 2021-09-27