Deep Uncertainties in the Criteria for Physician Aid-in-Dying for Psychiatric Patients (original) (raw)

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This commentary explores the complexities surrounding physician aid in dying (PAD) for psychiatric patients, highlighting the deep uncertainties associated with diagnostic, motivational, and existential factors. The authors critique prior work by Kious and Battin, arguing that due to the nuanced nature of mental illness, establishing objective criteria for suffering and assessing when PAD is appropriate is significantly more challenging than suggested. The commentary emphasizes that the limitations inherent in psychiatric diagnoses, characterized by a reliance on subjective assessments, complicate the decision-making process regarding PAD.

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Deep Uncertainties in the Criteria for Physician Aid in Dying for Psychiatric Patients - American Journal of Bioethics 19 (10) 2019

American Journal of Bioethics , 2019

In their insightful article, Brent Kious and Margaret Battin (2019) correctly identify an inconsistency between an involuntary psychiatric commitment for suicide prevention and physician aid in dying (PAD). They declare that it may be possible to resolve the problem by articulating “objective standards for evaluating the severity of others’ suffering,” but ultimately they admit that this task is beyond the scope of their article since the solution depends on “a deep and difficult” question about comparing the worseness of two possible scenarios: letting someone die (who could have been helped) with not letting someone die (whose suffering could only be alleviated by death). In our commentary, we argue that creating such standards is more difficult than the authors assume because of the many types of deep uncertainties we have to deal with: (1) diagnostic, (2) motivational, and (3) existential.

How does the Psychiatrist Know?

2024

How do clinical psychiatrists arrive at their diagnostic conclusions? Little attention has been directed to this question by philosophers of psychiatry. Adrian Kind presents a systematic, in-depth philosophical investigation into this question and argues that psychiatric diagnostic reasoning can be understood as a model-based reasoning procedure analogous to scientific model-based reasoning. To support this, he draws on ideas from the philosophy of science, psychiatry, cognitive science, and artificial intelligence. This study is an invaluable resource for practicing psychiatrists, philosophers interested in psychiatry, and researchers in artificial intelligence or cognitive science interested in medical cognition.

Ethical Decisions in the Classification of Mental Conditions as Mental Illness

Since the early 1990s, the philosophical debate over broad accounts of mental illness has stalled. Although there remains unresolved tension between mixed and medical models of mental illness, bioethics seems to be moving from a naturalistic account of mental illness to one in which illness is determined by applying an evaluative notion of function. Nonetheless, existing models often underestimate the role of social norms in defining illness. Most important, such models have paid inadequate attention to the relevance of wider philosophical assumptions about the objectivity of ethics and the concept of personhood to our understanding of illness. I attempt to demonstrate that these concepts are integral for differentiating mental illnesses from the vast array of irrational and pre-rational drives and personality traits for which we usually wish to hold the bearer morally responsible. In emphasizing the normative component in accounts of mental illness, I am not attacking psychiatric expertise, but rather endeavoring to bring philosophical discussion closer to the actual, informal decisions that psychiatrists (in particular forensic psychiatrists) regularly make when asked to determine someone's moral responsibility for a mental condition.

Making a good mental health diagnosis: Science, art and ethics

Australian Journal of General Practice

Background There are limitations to psychiatric classification, which affects the utility of diagnosis in general practice. Objective The aim of this article is to explore the principles of science, art and ethics to create clinically useful psychiatric diagnoses in general practice. Discussion Psychiatric classification systems provide useful constructs for clinical practice and research. Evidence-based treatments are based on the classification of mental illnesses. However, while classification is necessary, it is not sufficient to provide a full understanding of ‘what is going on’. A good psychiatric diagnosis will also include a formulation, which provides an understanding of the psychosocial factors that provide a context for illness. Experiences such as trauma and marginalisation will change the illness experience but also provide other forms of evidence that shape therapy. Diagnoses also carry ethical implications, including stigma and changes in self‑concept. The science, ar...

Un-diagnosing mental illness in the process of helping

A medical diagnosis of a mental illness is a powerful symbol of both the presumed nature of the person’s experience and the authority of the person making the diagnosis. RICHARD LAKEMAN and MARY EMELEUS consider the meaning of diagnosis, its place in the ritual of health care, and the practical problems associated with not diagnosing and un-diagnosing. The traditional approach of western medical practice is to undertake an assessment and arrive at the correct diagnosis, which in turn determines the right treatment. Service users present frequently to helping agencies with a diagnosis of mental illness conferred already. This colours the therapeutic encounter and raises expectations of what needs to be done. The therapeutic potential and practical problems of deferring psychiatric diagnosis or ‘un-diagnosing’ mental illness in the context of providing care to people with complex presentations is critically considered. Un-diagnosing mental illness can be an important part of the care ...

Irremediable Psychiatric Suffering in the Context of Physician-assisted Death: A Scoping Review of Arguments: La souffrance psychiatrique irrémédiable dans le contexte du suicide assisté : Une revue étendue des arguments

The Canadian Journal of Psychiatry, 2020

Objectives: Physician-assisted death (PAD), also known as medical assistance in dying, of patients with a psychiatric disorder (PPD) is a global issue of debate. In most jurisdictions that allow PAD, irremediable suffering is a legal requirement, how to apply the concept of irremediability to PPD remains challenging. The aim of this article is to identify the main arguments concerning irremediability in the debate about PAD of PPD and give directions for further moral deliberation and empirical research. Methods: Systematic searches in MEDLINE, Embase, and PsycINFO were combined with 4 additional search strategies. All conceptual-ethical articles, quantitative and qualitative empirical studies, guidelines, case reports, and commentaries that met the inclusion criteria were included, and a qualitative data synthesis was used to identify recurring themes within the literature. The study protocol was preregistered at the Open Science Framework under registration code: thjg8. Results: A...

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