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Wednesday, August 24, 2016

The Controversial Issue of Euthanasia in Patients With Psychiatric Illness

Emilie Olie & Philippe Courtet
JAMA. 2016;316(6):656-657

A main objective of legalization of euthanasia or physician-assisted suicide (EAS) is to ease suffering (ie, physical pain and loss of autonomy elicited by an irreversible serious disease), when a terminally ill patient's pain is overwhelming despite palliative care. It implies that there is no reasonable alternative in the patient's situation, with no prospect of improvement of a painful condition or global functioning. Because mental disorders are among the most disabling illnesses, requests for EAS based on unbearable mental suffering caused by severe psychiatric disease may possibly increase. EAS may be differentiated from suicide because EAS results in death without self-inflicted behavior, yet both are driven by a desire to end life. This raises the question: Should the management of patients with psychiatric disorders requesting EAS be considered for suicide prevention?

Mental illness increases suicidal risk and requires treatment. Nevertheless, evidence-based medical and psychosocial treatments currently are not provided to the majority of patients with psychiatric diseases who would benefit. Even if these therapies were prescribed, about 30% of depressed patients are treatment resistant. Patients may have undergone treatments destined to fail or they may have refused potential effective therapeutics. Nevertheless, the probability of disease remission increases with number of different treatments attempted. Given these uncertainties and that there are no valid indicators to predict the response to treatment, there is no reliable mechanism to define incurable disease and determine medical futility for psychiatric care. Considering euthanasia for psychiatric patients may reinforce poor expectations of the medical community for mental illness treatment and contribute to a relative lack of progress in developing more effective therapeutic strategies.

The article is here.