Mapping the ethical aspects in end-of-life care for persons with a severe and persistent mental illness: A scoping review of the literature (original) (raw)
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Euthanasia and physician-assisted suicide are a contentious issue globally. Usually, the argument focuses on assisted dying for people with a terminal physical illness. However, the Netherlands, Luxembourg, and Belgium have legalised assisted dying for a variety of circumstances including disabling psychiatric conditions and mental distress. This essay explores the ethics of such legislation from a human rights perspective.
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This essay considers sources of opposition to allowing access to medical assistance in dying for individuals with mental illness. It originated with an observation by members of the University of Toronto Joint Centre for Bioethics that in mainstream Canadian culture—as well as in political, academic, and professional circles—such opposition remains widespread (and often reflexive) even in light of broad support for access to assisted dying for individuals with illness manifesting in physical suffering. Most Canadians treat the prospect of assisted dying for those with mental illness with suspicion, and it is worth exploring why this opposition persists, what arguments can be leveled to support it, and whether those arguments can be sustained. To that end, I identify five sources of opposition to assisted dying for the mentally ill that seem to characterize the public debate, and argue that none succeed. They either rely on false premises or otherwise fail to secure the conclusion th...
Shaffer, C. S., Cook, A. N., & Connolly, D. A. (2016). Should medical assistance in dying extend to persons with a mental disorder? Introducing a framework for discussion. [Special Issue]. Psynopsis, 38, 18-19. Psynopsis is Canada’s Psychology Magazine. Each of its quarterly issues focuses on a particular area of psychological research and/or practice with relevance, not only to the discipline and profession, but also to the range of stakeholders who may rely on or benefit from the work of Canada’s psychologists. In our article, we discuss issues and dilemmas that arise from the extension of medical assistance in dying to persons with a mental disorder, and introduce a recent publication that provides a guide for discussion.
Ethics, psychiatry and end-of-life issues
At the end of life, psychiatrists are often asked to assess a patient’s capacity to refuse treatment, but the role of the psychiatrist in this situation is much broader. Even when a person’s mental capacity is not at issue, subtle and not-so-subtle psychological forces can weigh heavily on life-and-death decisions that may be elucidated with a psychiatric assessment. In an ideal world envisaged by supporters of physician-assisted death, patients ask for assistance to die because they have weighed the pros and cons of continued existence; finding the option of prolonging life unsatisfactory, they opt for death at a time of their own choosing—an exit with dignity and grace. Although this scenario may happen, it is far from universal. Often, a request for physician-assisted dying or for withdrawal of life-sustaining treatment results more from a fear of the unknown, a need to maintain control, or a misunderstanding of what the future may bring.
2016
Shaffer, C. S., Cook, A. N., & Connolly, D. A. (2016). A conceptual framework for thinking about physician-assisted death for persons with a mental disorder. Psychology, Public, Policy and Law, 22, 141-157. Physician-assisted death (PAD) has been enacted in a number of international jurisdictions, with several extending access to PAD for persons whose condition is not terminal, including those with a mental disorder. We argue that based on the state of the literature, it is too early to make well-defined recommendations on how relevant fields can proceed legally, ethically, and clinically, particularly in regard to PAD for persons with a mental disorder. The aim of this paper is to introduce a framework for further discussions on PAD for persons with a mental disorder to stimulate thoughtful and considered debate in our field. We provide a brief discussion of the principles that guide regulatory frameworks on PAD practices worldwide, including a discussion of jurisdictions in Europe and North America that allow PAD for those suffering from an incurable non-terminal disease, illness, or disability. Next, we present a conceptual framework as a series of questions that address legal, ethical, and clinical dilemmas arising from this trend. We conclude with a summary of guidelines on the practice of PAD from international jurisdictions in order to assist in the development of potential legal and professional regulations.
Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders
Current Psychiatry Reports
Purpose of Review Over the last 30 years, medical assistance in dying (MAiD) including euthanasia (EU) and physician-assisted death (or suicide, PAS) has become the center of a large debate, particularly when these practices have involved people with psychiatric illness, including resistant depression, schizophrenia, personality, or other severe psychiatric disorders. We performed a review utilizing several databases, and by including the most relevant studies in full journal articles investigating the problem of MAiD in patients with psychiatric disorders but not in physical terminal conditions (non-terminal, MAiD-NT). Recent Findings Literature has shown that a small percentage of people with psychiatric disorders died by MAiD-NT in comparison with patients with somatic diseases in terminal clinical conditions (e.g., cancer, AIDS). However, the problem in the field is complex and not solved yet as confirmed by the fact that only a few countries (e.g., the Netherlands, Belgium, Lux...
Medical Assistance in Dying and Mental Health: A Legal, Ethical, and Clinical Analysis
The Canadian Journal of Psychiatry
Medical assistance in dying (MAiD) legislation is now over a year old in Canada, and consideration is turning to whether MAiD should be extended to include serious mental illness as the sole qualifying condition for being eligible for MAiD. This article considers this question from ethical and clinical perspectives. It argues that extending the eligibility for MAiD to include those with a serious mental illness as the sole eligibility criterion is not ethical, necessary, or supported current psychiatric practice or opinion.
O-16 Improving end of life care for adults with severe mental illness and life-limiting conditions
BMJ Supportive & Palliative Care, 2017
Background People with mental illness experience higher rates of many life-limiting conditions and die on average twenty years earlier than the general population. A literature review was carried out which revealed limited understanding of the end of life needs of this patient group. The role of clinical staff was highlighted as a key factor, yet their views were not reflected in the published research. Aims The aim of this research was to conduct an exploratory study to develop further understanding of how to improve end of life care for people with severe mental illness through exploring the views and experiences of clinical staff working in both mental health and end of life services. Methods Four focus groups with clinicians were conducted, using the CUbe method (Magee, Fielden, & Moody, 2015), across a large Mental Health Trust and a hospice. 23 participants from a range of professional backgrounds attended and shared their experiences and perceptions of the barriers to deliver...