Citation

Schneeberger AR, Hoff P, Seifritz E, Lang UE, Graf M, Franke I, Huber CG. Front. Psychiatry 2020; 11: e58.

Affiliation

Universitäre Psychiatrische Kliniken Basel (UPK), Klinik für Erwachsene, Universität Basel, Basel, Switzerland.

Copyright

(Copyright © 2020, Frontiers Media)

DOI

10.3389/fpsyt.2020.00058

PMID

32132939

PMCID

PMC7040838

Abstract

In the September issue of the American Journal of Bioethics, Kious and Battin (1) present their arguments on why physician aid-in-dying (PAD) due to severe suffering should also be allowed in non-terminal psychiatric diseases. The authors argue that a crucial aspect of PAD is the assessment of the decision-making capacity. Furthermore, they elaborate on the incompatibility of current PAD regulations and compulsory treatment because of suicidality, emphasizing differences between European, Canadian, and US-American policies. They differentiate between possible pathways the discussion about laws and policies concerning medically assisted dying could lead to. Firstly, keep the status quo, requiring a terminal illness, without considering the suffering caused by mental illness. Secondly, a change toward a partial opening of PAD for people with mental illness if their decision-making capacity is intact. This approach would require a change in policies regarding assisted dying while at the same time changing the involuntary civil commitment practices. The third approach devises a metric to measure suffering. While allowing patients who reach the threshold of unbearable suffering to access PAD, people with lower scores of suffering would fall under the policies of involuntary civil commitment and treatment. This third approach poses difficult questions concerning the nature of an instrument to determine suffering, the definition of suffering and its thresholds, and about the authority of the gatekeeper determining whether a person qualifies for PAD.

We congratulate the authors for their balanced and differentiated argumentation on a highly important and still critically discussed topic in psychiatry. The line of thought they present focuses on the situation in the United States of America and resembles the current discussion in Switzerland ...

Language: en

Keywords

bioethics; physician-assisted dying; psychiatry; suffering; suicide prevention