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Euthanasia and assisted suicide of persons with psychiatric disorders: the challenge of personality disorders

Published online by Cambridge University Press:  04 March 2019

Marie E. Nicolini Open the ORCID record for Marie E. Nicolini [Opens in a new window] ,
John R. Peteet ,
G. Kevin Donovan  and
Scott Y. H. Kim
Marie E. Nicolini*
Affiliation:
Interfaculty Center for Biomedical Ethics and Law, KU Leuven, Kapucijnenvoer 35 – Box 7001, 3000 Leuven, Belgium Department of Bioethics, National Institutes of Health, 10 Center Drive, Room 1C118, Bethesda, Maryland20892, USA
John R. Peteet
Affiliation:
Department of Psychiatry, Harvard Medical School and Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts02115, USA
G. Kevin Donovan
Affiliation:
Center for Clinical Bioethics, Georgetown University, Bldg. D., Suite 236, 4000 Reservoir Road, Washington D.C. 20007, USA
Scott Y. H. Kim
Affiliation:
Department of Bioethics, National Institutes of Health, 10 Center Drive, Room 1C118, Bethesda, Maryland20892, USA
*
Author for correspondence: Marie E. Nicolini, E-mail: [email protected]
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Abstract

Background

Euthanasia or assisted suicide (EAS) for psychiatric disorders, legal in some countries, remains controversial. Personality disorders are common in psychiatric EAS. They often cause a sense of irremediable suffering and engender complex patient–clinician interactions, both of which could complicate EAS evaluations.

Methods

We conducted a directed-content analysis of all psychiatric EAS cases involving personality and related disorders published by the Dutch regional euthanasia review committees (N = 74, from 2011 to October 2017).

Results

Most patients were women (76%, n = 52), often with long, complex clinical histories: 62% had physical comorbidities, 97% had at least one, and 70% had two or more psychiatric comorbidities. They often had a history of suicide attempts (47%), self-harming behavior (27%), and trauma (36%). In 46%, a previous EAS request had been refused. Past psychiatric treatments varied: e.g. hospitalization and psychotherapy were not tried in 27% and 28%, respectively. In 50%, the physician managing their EAS were new to them, a third (36%) did not have a treating psychiatrist at the time of EAS request, and most physicians performing EAS were non-psychiatrists (70%) relying on cross-sectional psychiatric evaluations focusing on EAS eligibility, not treatment. Physicians evaluating such patients appear to be especially emotionally affected compared with when personality disorders are not present.

Conclusions

The EAS evaluation of persons with personality disorders may be challenging and emotionally complex for their evaluators who are often non-psychiatrists. These factors could influence the interpretation of EAS requirements of irremediability, raising issues that merit further discussion and research.

Keywords

Assisted suicideeuthanasiaclinical ethicspsychiatrypersonality disorders
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 4 , March 2020 , pp. 575 - 582
Copyright
Copyright © Cambridge University Press 2019

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