End of life decision-making, euthanasia, and physician assisted suicide in persons with neuropsychiatric conditions

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Abstract

In the past year, we have conducted the following projects. 1. We have completed an analysis of the relationship between suicide, gender and psychiatric EAS, using modern theories of suicide (generally known as as ideation-to-action theories) to explore the ethical, clinical, and policy implications of overrepresentation of women in psychiatric EAS. The MS was published in BJPsychiatry. 3. Treatment resistant depression (TRD), psychiatric EAS, and the criterion of irremediability. One of the key criteria for psychiatric euthanasia in countries that allow it is irremediability and medical futility of the condition and the suffering arising from it. However, the current practice (as reflected in published reports that our group has studied extensively) relies on clinician judgments which may or may not reflect practices based on current evidence base. This project uses TRD as the paradigm condition and will provide a rigorous evidence-based review and analysis to answer the question: How reliable and valid is a clinician's judgment in making a prediction about a patients future clinical status and course? This project's main manuscript is now under review. 4. Using our analysis of concurrent request EAS (i.e., persons with dementia who received EAS while they were still deemed competent, rather than based on advance directives after they reach state of incapacity), we analyzed in depth the current practice in the Netherlands and the standards currently endorsed by the RTE (Dutch euthanasia review committees). We argued that contrary to the published guidelines, the Dutch practice for concurrent request dementia EAS does not seem to use a functional model of capacity and is more like an implementation of oral advance directive based EAS (which is technically not legal). This was published in J Medical Ethics. 5. We have recently completed a national survey of US population on whether they think advance request EAS for dementia should be legalized. The experimental survey design examined the impact of 6 specific ethical and practical challenges in the implementation of advance request EAS. This was published in Am J of Geriatric Psychiatry. 6. I recently published an analysis which argued that EAS should not be debated as a matter of a basic human right; if it is to be debated, it should be as a matter for social policy-making. Answering this question does not settle whether psychiatric EAS should be legal. But it will help us to see more clearly what it is that we are debating, and the implications of the different ways in which we debate it. This study covered areas in law, philosophy, and bioethics, and was published in Perspectives in Biology and Medicine. 7. Switzerland is one of the countries that allow physician-assisted deaths. In collaboration with Professor Rafael Cohen-Almagor from University of Hull, we continue our study of the Swiss practice through the eyes of the organizational and medical experts in that country.