Physician Assisted Death for Those with Mental Disorders
Legal developments surrounding physician assisted death (PAD) are considered more frequently now that 4 US states, 4 European nations, and Canada have legalized PAD in some scenarios. Despite this consideration, people with mental disorders are most commonly excluded from the possibility of accessing PAD under the pretense that their request may be symptomatic or their mental competence is to be questioned. A recently published article in the journal Psychology, Public Policy, and Law suggests that more discussion is needed to ensure that exclusions from PAD are rightfully deserved by those with a mental disability and that in cases where mental illness is tied to a PAD request the request is treated in a fair and ethical manner. This paper calls on a range of viewpoints from the fields of philosophy, psychology, medicine, and law and uses them in an attempt to generate discussion.
In its consideration of the legal landscape currently surrounding PAD, this paper deals with the way mental illness is considered in the context of a court of law . It highlights the belief that because social factors may be involved in the experience of mental illness, the experience of illness may be viewed with more skepticism or its permanence or suffering may be more difficult to assess. Despite evidence of biological roots for mental disorders, the concept that mental disorders may be more plastic in nature than other chronic illnesses gives many pause when considering PAD as a possibility for those suffering mental anguish. The magnitude of this anguish is also called into question as the suffering associated with mental disorders is, by its nature, essentially unquantifiable and personal. The argument that the desire to seek death could be seen as a symptom of disorder is also featured in this publication. This is an interesting argument as it considers the desire for death as a direct symptom rather than a second order desire rooting from some other symptom or symptoms (e.g. pain).
At its root, this paper examines mental competence and how a diagnosed mental disorder does not equate to a lack of the ability to adeptly describe a desire for PAD and make a request. In an illustrative manner, caffeine withdrawal is discussed as a diagnosable mental condition and seen to be potentially treated as a condition that would justify the removal of access to PAD in many jurisdictions. The assessment of a person’s competence is briefly discussed and the idea of levels of competence is also put forward. Should a greater level of competence be displayed by those requesting access to PAD or should the level of competence necessary for PAD access be the same as for any other medical decision? The idea of transient competence and complications that may arise surrounding formal PAD directives or someone changing their mind about PAD has called up further points for consideration.
A concept that calls into question the value of autonomy in order to acknowledge current research is also discussed. As relationships and interaction with others has been shown to have profound effects on the symptoms and persistence of mental illness, it is important to consider the possibility of required family consults surrounding a PAD request. This certainly constitutes a violation of patient autonomy and could potentially open the doors to coercion, a risk that also requires greater consideration in cases where mental disorders may be impacting a patient. It also asks us to weigh the autonomy of all persons against the just treatment of patients as equals by causing us to consider that requests for PAD by individuals with mental illness may be treated differently than those made by undiagnosed individuals.
One line of questions stands out above all others in this discussion of PAD. How much treatment is enough? Is it necessary for doctors to do all that is possible before allowing a PAD request to be honored? All this remains to be seen.
Appelbaum, Paul S. "Physician-Assisted Death for Patients With Mental Disorders—Reasons for Concern." JAMA Psychiatry 73.4 (2016): 325. Web.
Shaffer, Catherine S., Alana N. Cook, and Deborah A. Connolly. "A Conceptual Framework for Thinking about Physician-assisted Death for Persons with a Mental Disorder." Psychology, Public Policy, and Law 22.2 (2016): 141-57. Web.