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Should euthanasia and assisted suicide for psychiatric disorders be permitted? A systematic review of reasons

Published online by Cambridge University Press:  02 June 2020

Marie E. Nicolini Open the ORCID record for Marie E. Nicolini [Opens in a new window] ,
Scott Y. H. Kim Open the ORCID record for Scott Y. H. Kim [Opens in a new window] ,
Madison E. Churchill  and
Chris Gastmans Open the ORCID record for Chris Gastmans [Opens in a new window]
Marie E. Nicolini*
Affiliation:
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
Scott Y. H. Kim
Affiliation:
Department of Bioethics, National Institutes of Health, 10 Center Drive, Room 1C118, Bethesda, Maryland20892, USA
Madison E. Churchill
Affiliation:
Department of Bioethics, National Institutes of Health, 10 Center Drive, Room 1C118, Bethesda, Maryland20892, USA
Chris Gastmans
Affiliation:
Center for Biomedical Ethics and Law, KU Leuven, Kapucijnenvoer 35 – Box 7001 3000 Leuven, Belgium
*
Author for correspondence: Marie E. Nicolini, E-mail: [email protected]
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Abstract

Background

Euthanasia and assisted suicide (EAS) based on a psychiatric disorder (psychiatric EAS) continue to pose ethical and policy challenges, even in countries where the practice has been allowed for years. We conducted a systematic review of reasons, a specific type of review for bioethical questions designed to inform rational policy-making. Our aims were twofold: (1) to systematically identify all published reasons for and against the practice (2) to identify current gaps in the debate and areas for future research.

Methods

Following the PRISMA guidelines, we performed a search across seven electronic databases to include publications focusing on psychiatric EAS and providing ethical reasons. Reasons were grouped into domains by qualitative content analysis.

Results

We included 42 articles, most of which were written after 2013. Articles in favor and against were evenly distributed. Articles in favor were mostly full-length pieces written by non-clinicians, with articles against mostly reactive, commentary-type pieces written by clinicians. Reasons were categorized into eight domains: (1) mental and physical illness and suffering (2) decisional capacity (3) irremediability (4) goals of medicine and psychiatry (5) consequences for mental health care (6) psychiatric EAS and suicide (7) self-determination and authenticity (8) psychiatric EAS and refusal of life-sustaining treatment. Parity- (or discrimination-) based reasons were dominant across domains, mostly argued for by non-clinicians, while policy reasons were mostly pointed to by clinicians.

Conclusions

The ethical debate about psychiatric EAS is relatively young, with prominent reasons of parity. More direct engagement is needed to address ethical and policy considerations.

Keywords

Ethicseuthanasianon-terminal illnessphysician aid-in-dyingphysician-assisted suicidepsychiatrysystematic review of reasons
Type
Review Article
Information
Psychological Medicine , Volume 50 , Issue 8 , June 2020 , pp. 1241 - 1256
Copyright
Copyright © National Institutes of Health, USA, 2020. This is a work of the US Government and is not subject to copyright protection within the United States. Published by Cambridge University Press

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References

Allsopp, K., Read, J., Corcoran, R., & Kinderman, P. (2019). Heterogeneity in psychiatric diagnostic classification. Psychiatry Research 279, 15–22.CrossRefGoogle ScholarPubMed
Appelbaum, P. S. (2017). Should mental disorders be a basis for physician-assisted death? Psychiatric Services 68(4), 315–317.CrossRefGoogle ScholarPubMed
Appelbaum, P. S. (2018). Physician-assisted death in psychiatry. World Psychiatry 17(2), 145–146.CrossRefGoogle Scholar
Bazan, A. (2015). Schrap euthanasie op basis van louter psychisch lijden uit de wet (8 December 2015). In DeMorgen.Google Scholar
Berghmans, R., Huisman, J., Legemaate, J., Nolen, W. A., Polak, F., Scherders, M. J. W. T., & Tholen, A. J. (2009). Richtlijn verzoek om hulp bij zelfdoding door patiënten met een psychiatrische stoornis. Nederlandse Vereniging voor Psychiatrie (Dutch Psychiatric Association).Google Scholar
Berghmans, R., Widdershoven, G., & Widdershoven-Heerding, I. (2013). Physician-assisted suicide in psychiatry and loss of hope. International Journal of Law & Psychiatry 36(5/6), 436–443.CrossRefGoogle ScholarPubMed
Black, I. (2012). Suicide assistance for mentally disordered individuals in Switzerland and the state's positive obligation to facilitate dignified suicide. Haas C. Suisse, Cour européenne des droits de l'homme, 1re section (20 janvier 2011). Medical Law Review 20(1), 157–166.CrossRefGoogle Scholar
Blikshavn, T., Husum, T. L., & Magelssen, M. (2017). Four reasons why assisted dying should not be offered for depression. Journal of Bioethical Inquiry 14(1), 151–157.CrossRefGoogle Scholar
Bolt, E. E., Snijdewind, M. C., Willems, D. L., van der Heide, A., & Onwuteaka-Philipsen, B. D. (2015). Can physicians conceive of performing euthanasia in case of psychiatric disease, dementia or being tired of living? Journal of Medical Ethics 41, 592–598.CrossRefGoogle ScholarPubMed
Broome, M. R., & de Cates, A. (2015). Choosing death in depression: A commentary on ‘Treatment-resistant major depressive disorder and assisted dying’. Journal of Medical Ethics 41(8), 586–587.CrossRefGoogle ScholarPubMed
Brothers of Charity (2017). Visie van de groep Broeders van Liefde in Belgie op euthanasie bij psychisch lijden in een niet-terminale situatie. Retrieved from https://www.broedersvanliefde.be/nieuwsberichten/visie-euthanasie-bijgestuurd (Accessed December 2018).Google Scholar
Bruns, F., Blumenthal, S., & Hohendorf, G. (2016). [Assisted suicide in Germany: Medical diagnoses and personal reasons of 117 decedents]. Deutsche Medizinische Wochenschrift 141(4), e32–e37.Google Scholar
CCA Council of Canadian Academies (2018). The State of Knowledge on Medical Assistance in Dying Where a Mental Disorder is the Sole Underlying Medical Condition. Retrieved from https://cca-reports.ca/wp-content/uploads/2018/12/The-State-of-Knowledge-on-Medical-Assistance-in-Dying-Where-a-Mental-Disorder-is-the-Sole-Underlying-Medical-Condition.pdf. Ottawa, Canada (Accessed January 2019).Google Scholar
Chekroud, A. M., Zotti, R. J., Shehzad, Z., Gueorguieva, R., Johnson, M. K., Trivedi, M. H., … Corlett, P. R. (2016). Cross-trial prediction of treatment outcome in depression: A machine learning approach. The Lancet Psychiatry 3, 243–250.CrossRefGoogle ScholarPubMed
Cheng, (2019). Europe's top rights court to hear Belgian euthanasia case: Associated Press News. https://apnews.com/8217108af4f841b3a2d551ca73eecb9c (Accessed Jan 2019).Google Scholar
Cholbi, M. J. (2013). The terminal, the futile, and the psychiatrically disordered. International Journal of Law and Psychiatry 36, 498–505.CrossRefGoogle ScholarPubMed
Claes, S., Van Bouwel, L., An, H., Marc, E., Georges, O., De Lepeleire, J., … Lemmens, W. (2015). Euthanasia for psychiatric patients: Ethical and legal concerns about the Belgian practice. BMJ Open 5(7), e007454.Google Scholar
Cowley, C. (2013). Euthanasia in psychiatry can never be justified. A reply to Wijsbek. Theoretical Medicine and Bioethics 34(3), 227–238.CrossRefGoogle ScholarPubMed
Cowley, C. (2015). Commentary on ‘Treatment-resistant major depressive disorder and assisted dying’. Journal of Medical Ethics 41(8), 585–586.CrossRefGoogle ScholarPubMed
Creighton, C., Cerel, J., & Battin, M. (2017). Statement of the American Association of Suicidology: “Suicide” is not the same as “Physician aid in dying”. Retrieved from https://suicidology.org/wp-content/uploads/2019/07/AAS-PAD-Statement-Approved-10.30.17-ed-10-30-17.pdf. (Accessed December 2018).Google Scholar
Day, M. (2018). Three Belgian doctors are investigated over euthanasia of woman with Asperger's. BMJ 363, k5106.CrossRefGoogle ScholarPubMed
De Hert, M., Van Bos, L., Sweers, K., Wampers, M., De Lepeleire, J., & Correll, C. U. (2015). Attitudes of psychiatric nurses about the request for euthanasia on the basis of Unbearable Mental Suffering (UMS). PLoS One 10(12), e0144749.CrossRefGoogle Scholar
de Kort, S. J. (2015). [Limits to euthanasia]. Nederlands Tijdschrift voor Geneeskunde 159, A8991.Google Scholar
Dembo, J. S. (2010). Addressing treatment futility and assisted suicide in psychiatry. Journal of Ethics in Mental Health 5(1), 1–3.Google Scholar
Dembo, J., Schuklenk, U., & Reggler, J. (2018). “For their own good”: A response to popular arguments against permitting Medical Assistance in Dying (MAID) where mental illness is the sole underlying condition. Canadian Journal of Psychiatry 63, 451–456.CrossRefGoogle ScholarPubMed
den Hartogh, G. (2015). Why extra caution is needed in the case of depressed patients. Journal of Medical Ethics 41, 588–589.CrossRefGoogle ScholarPubMed
Dierickx, S., Deliens, L., Cohen, J., & Chambaere, K. (2017). Euthanasia for people with psychiatric disorders or dementia in Belgium: Analysis of officially reported cases. BMC Psychiatry 17, 203.CrossRefGoogle ScholarPubMed
Dinga, R., Marquand, A. F., Veltman, D. J., Beekman, A. T. F., Schoevers, R. A., Van Hemert, A. M., … Schmaal, L. (2018). Predicting the naturalistic course of depression from a wide range of clinical, psychological, and biological data: A machine learning approach. Translational Psychiatry 8(1), 241.CrossRefGoogle ScholarPubMed
Doernberg, S. N., Peteet, J. R., & Kim, S. Y. (2016). Capacity evaluations of psychiatric patients requesting assisted death in the Netherlands. Psychosomatics 57, 556–565.CrossRefGoogle ScholarPubMed
Elo, S., & Kyngas, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing 62, 107–115.CrossRefGoogle ScholarPubMed
EuthanasiaCode (2018). Review procedures in practice. Retrieved from https://english.euthanasiecommissie.nl/the-committees/code-of-practice. Regional Euthanasia Review Committees (Accessed June 2018).Google Scholar
Frati, P., Gulino, M., Mancarella, P., Cecchi, R., & Ferracuti, S. (2014). Assisted suicide in the care of mentally ill patients: The Lucio Magri's case. Journal of Forensic and Legal Medicine 21, 26–30.CrossRefGoogle ScholarPubMed
Gastmans, C. (2018). Ethisch advies 20: Levenseindezorg voor niet-terminale patiënten met ernstige psychiatrische aandoeningen. Retrieved from https://www.zorgneticuro.be/publicaties/ethisch-advies-20-levenseindezorg-voor-niet-terminale-pati%C3%ABnten-met-ernstige. (Accessed June 2018).Google Scholar
Graneheim, U. H., & Lundman, B. (2004). Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today 24, 105–112.CrossRefGoogle ScholarPubMed
Griffith, J., Weyers, H., & Adams, M. (2008). Euthanasia and Law in Europe. Portland, OR: Hart Publishing.Google Scholar
Groenewoud, J. H., Van Der Heide, A., Tholen, A. J., Schudel, W. J., Hengeveld, M. W., Onwuteaka-Philipsen, B. D., … Van Der Wal, G. (2004). Psychiatric consultation with regard to requests for euthanasia or physician-assisted suicide. General Hospital Psychiatry 26, 323–330.CrossRefGoogle ScholarPubMed
Haekens, A., Calmeyn, M., Lemmens, W., Pollefeyt, D., & Bazan, A. (2017). Mogen we nu (eindelijk) vragen stellen over euthanasie bij psychisch lijden? In VRT Nieuws.Google Scholar
Hamilton, N. G., Edwards, P. J., Boehnlein, J. K., & Hamilton, C. A. (1998). The doctor-patient relationship and assisted suicide: A contribution from dynamic psychiatry. American Journal of Forensic Psychiatry 19, 59–75.Google ScholarPubMed
Hirsch, J. (2016). The wish to die: Assisted suicide and mental illness. Journal of Social Work in End-of-life & Palliative Care 12, 231–235.CrossRefGoogle ScholarPubMed
Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D. S., Quinn, K., … Wang, P. (2010). Research domain criteria (RDoC): Toward a new classification framework for research on mental disorders. American Journal of Psychiatry 167, 748–751.CrossRefGoogle Scholar
Jansen, L. A., Wall, S., & Miller, F. G. (2019). Drawing the line on physician-assisted death. Journal of Medical Ethics 45(3), 190–197.CrossRefGoogle ScholarPubMed
Jones, D. A., Gastmans, C., & MacKellar, C. (2017). Euthanasia and assisted suicide: Lessons from Belgium. Cambridge, UK: Cambridge University Press.CrossRefGoogle Scholar
Kelly, B. D. (2017). Invited commentary on … when unbearable suffering incites psychiatric patients to request euthanasia. British Journal of Psychiatry 211(4), 248–249.CrossRefGoogle ScholarPubMed
Kelly, B. D., & McLoughlin, D. M. (2002). Euthanasia, assisted suicide and psychiatry: A Pandora's box. British Journal of Psychiatry 181, 278–279.CrossRefGoogle ScholarPubMed
Kendler, K. S. (2019). From many to one to many-the search for causes of psychiatric illness. JAMA Psychiatry, 76(10), 1085–1091.CrossRefGoogle Scholar
Kim, S. Y., De Vries, R. G., & Peteet, J. R. (2016). Euthanasia and assisted suicide of patients with psychiatric disorders in the Netherlands 2011 to 2014. JAMA Psychiatry 73, 362–368.CrossRefGoogle ScholarPubMed
Kim, S. Y. H., & Lemmens, T. (2016). Should assisted dying for psychiatric disorders be legalized in Canada? Canadian Medical Association Journal 188(14), E337–E339.CrossRefGoogle ScholarPubMed
Kissane, D. W., & Kelly, B. J. (2000). Demoralisation, depression and desire for death: Problems with the Dutch guidelines for euthanasia of the mentally ill. Australian & New Zealand Journal of Psychiatry 34(2), 325–333.CrossRefGoogle ScholarPubMed
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gotzsche, P. C., Ioannidis, J. P., … Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration. British Medical Journal 339, b2700.CrossRefGoogle ScholarPubMed
McCullough, L. B., Coverdale, J. H., & Chervenak, F. A. (2007). Constructing a systematic review for argument-based clinical ethics literature: The example of concealed medications. Journal of Medicine and Philosophy 32, 65–76.CrossRefGoogle ScholarPubMed
McDougall, R. (2014). Systematic reviews in bioethics: Types, challenges, and value. Journal of Medicine and Philosophy 39, 89–97.CrossRefGoogle Scholar
Mertz, M., Strech, D., & Kahrass, H. (2017). What methods do reviews of normative ethics literature use for search, selection, analysis, and synthesis? In-depth results from a systematic review of reviews. Systematic Reviews 6, 261.CrossRefGoogle ScholarPubMed
Miller, F. G. (2015). Treatment-resistant depression and physician-assisted death. Journal of Medical Ethics 41(11), 885–886.CrossRefGoogle ScholarPubMed
Miller, F. G., & Appelbaum, P. S. (2018). Physician-assisted death for psychiatric patients – misguided public policy. New England Journal of Medicine 378(10), 883–885CrossRefGoogle ScholarPubMed
Miller, D. G., & Kim, S. Y. H. (2017). Euthanasia and physician-assisted suicide not meeting due care criteria in the Netherlands: A qualitative review of review committee judgements. BMJ Open 7, e017628-2017-017628.CrossRefGoogle Scholar
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine 6, e1000097.CrossRefGoogle ScholarPubMed
Naudts, K., Ducatelle, C., Kovacs, J., Laurens, K., Van Den Eynde, F., & Van Heeringen, C. (2006). Euthanasia: The role of the psychiatrist. British Journal of Psychiatry 188, 405–409.CrossRefGoogle ScholarPubMed
Nicolini, M. E., Peteet, J. R., Donovan, G. K., & Kim, S. Y. H. (2020). Euthanasia and assisted suicide of persons with psychiatric disorders: The challenge of personality disorders. Psychological Medicine, 50(4), 575–582.CrossRefGoogle ScholarPubMed
NVVP Nederlandse Vereniging voor Psychiatrie (2018). Levensbeëindiging op verzoek bij patiënten met een psychische stoornis. Retrieved from https://richtlijnendatabase.nl/richtlijn/levensbeeindiging_op_verzoek_psychiatrie/startpagina_-_levensbe_indiging_op_verzoek.html (Accessed June 2019).Google Scholar
Olié, E., & Courtet, P. (2016). The controversial issue of euthanasia in patients with psychiatric illness. Journal of the American Medical Association 316(6), 656–657.CrossRefGoogle ScholarPubMed
Onwuteaka-Philipsen, B. D., Legemaate, J., van Der Heide, A., van Delden, H., Evenblij, K., El Hammoud, I., … Willems, D. (2017). Derde evaluatie Wet toesting levensbeeindiging op verzoek en hulp bij zelfdoding (Third Evaluation of the Dutch Termination of Life on Request and Assisted Suicide Act). The Hague, The Netherlands.Google Scholar
Orde der Artsen (2019). Deontologische richtlijnen voor de toepassing van euthanasie bij patiënten die psychisch lijden ten gevolge van een psychiatrische aandoening. Retrieved from https://www.ordomedic.be/nl/adviezen/advies/deontologische-richtlijnen-voor-de-toepassing-van-euthanasie-bij-patienten-die-psychisch-lijden-ten-gevolge-van-een-psychiatrische-aandoening (Accessed May 2019).Google Scholar
Parker, M. (2013). Defending the indefensible? Psychiatry, assisted suicide and human freedom. International Journal of Law and Psychiatry 36(5–6), 485–497.CrossRefGoogle ScholarPubMed
Pearce, S. (2017). Invited commentary on … when unbearable suffering incites psychiatric patients to request euthanasia: A qualitative study. British Journal of Psychiatry 211(4), 246–247.CrossRefGoogle ScholarPubMed
Player, C. (2018). Death with dignity and mental disorder. Arizona Law Review 60, 116–161.Google Scholar
Pronk, R., Evenblij, K., Willems, D. L., & van de Vathorst, S. (2019). Considerations by Dutch psychiatrists regarding euthanasia and physician-assisted suicide in psychiatry: A qualitative study. Journal of Clinical Psychiatry 80(6), 19m12736.Google ScholarPubMed
Provencher-Renaud, G., Larivée, S., & Sénéchal, C. (2019). Access to medical assistance in dying for people with mental disorders. Annales Medico-Psychologiques 117, 801–808.CrossRefGoogle Scholar
Reel, K. (2018). Denying assisted dying where death is not reasonably foreseeable: Intolerable overgeneralization in Canadian end-of-life law. Canadian Journal of Bioethics/Revue canadienne de bioéthique 1, 71–81.Google Scholar
Rooney, W., Schuklenk, U., & van de Vathorst, S. (2018). Are concerns about irremediableness, vulnerability, or competence sufficient to justify excluding all psychiatric patients from medical aid in dying? Health Care Analysis 26, 326–343.CrossRefGoogle ScholarPubMed
Rousseau, S., Turner, S., Chochinov, H. M., Enns, M. W., & Sareen, J. (2017). A national survey of Canadian psychiatrists’ attitudes toward medical assistance in death. Canadian Journal of Psychiatry. Revue canadienne de psychiatrie 62, 787–794.CrossRefGoogle ScholarPubMed
RTE Regional Euthanasia Review Committees Annual Report (2017). Retrieved from https://www.euthanasiecommissie.nl/de-toetsingscommissies/uitspraken/jaarverslagen/2017/mei/17/jaarverslag-2017 (Accessed December 2018).Google Scholar
RTE Regional Euthanasia Review Committees Annual Report (2018). Retrieved from https://www.euthanasiecommissie.nl/de-toetsingscommissies/uitspraken/jaarverslagen/2018/april/11/jaarverslag-2018 (Accessed March 2019).Google Scholar
Rukavina, S. (2019). Quebec judge overturns parts of federal, provincial laws on medically assisted dying. Retrieved from https://www.cbc.ca/news/canada/montreal/medically-assisted-dying-law-overturned-quebec-1.5279067. In CBC Montreal.Google Scholar
Sagan, A. (2015). Equal in the presence of death? Journal of Medical Ethics: The Journal of the Institute of Medical Ethics 41, 584.CrossRefGoogle ScholarPubMed
SAMS Swiss Academy of Medical Sciences (2018). Management of dying and death. Bern, Switzerland: SAMS House of Academies.Google Scholar
Schoevers, R. A., Asmus, F. P., & Van Tilburg, W. (1998). Physician-assisted suicide in psychiatry: Developments in the Netherlands. Psychiatric Services 49(11), 1475–1480.CrossRefGoogle ScholarPubMed
Schuklenk, U., & van de Vathorst, S. (2015a). Treatment-resistant major depressive disorder and assisted dying. Journal of Medical Ethics 41(8), 577–583.CrossRefGoogle Scholar
Schuklenk, U., & van de Vathorst, S. (2015b). Treatment-resistant major depressive disorder and assisted dying: Response to comments. Journal of Medical Ethics 41(8), 589–591.CrossRefGoogle Scholar
Simpson, A. I. F. (2018). Medical assistance in dying and mental health: A legal, ethical, and clinical analysis. Canadian Journal of Psychiatry 63(2), 80–84.CrossRefGoogle ScholarPubMed
Sofaer, N., & Strech, D. (2012). The need for systematic reviews of reasons. Bioethics 26, 315–328.CrossRefGoogle ScholarPubMed
Steinbock, B. (2017). Physician-assisted death and severe, treatment-resistant depression. The Hastings Center report 47, 30–42.CrossRefGoogle ScholarPubMed
Strech, D., & Sofaer, N. (2012). How to write a systematic review of reasons. Journal of Medical Ethics 38, 121–126.CrossRefGoogle ScholarPubMed
Swildens-Rozendaal, W. J. C., & van Wersch, P. J. M. (2015). Regionale toetsingscommissie euthanasie Code of Practice. Retrieved from https://www.euthanasiecommissie.nl/binaries/euthanasiecommissie/documenten/brochures/brochures/code-of-practice/1/code-of-practice-2015/RTE+Code+of+practice_april+2015.pdf (Accessed December 2018). The Hague, The Netherlands.Google Scholar
Tanner, R. (2018). An ethical-legal analysis of medical assistance in dying for those with mental illness. Alberta Law Review 56, 149–175.CrossRefGoogle Scholar
Thienpont, L., Verhofstadt, M., Van Loon, T., Distelmans, W., Audenaert, K., & De Deyn, P. P. (2015). Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: A retrospective, descriptive study. BMJ Open 5, e007454-2014-007454.CrossRefGoogle ScholarPubMed
Vandenberghe, J. (2011). [The ‘good death’ in the Flemish psychiatry]. Tijdschrift voor Psychiatrie 53(8), 551–553.Google Scholar
Vandenberghe, J. (2018). Physician-assisted suicide and psychiatric illness. New England Journal of Medicine 378, 885–887.CrossRefGoogle ScholarPubMed
Vandenberghe, J., Titeca, K., Matthys, F., Van den Broeck, K., Detombe, T., Claes, S., … Van Buggenhout, R. (2017). Hoe omgaan met een euthanasieverzoek in psychiatrie binnen het huidig wettelijk kader? Adviestekst van de Vlaamse Vereniging voor Psychiatrie (VVP) over te hanteren zorgvuldigheidsvereisten. Retrieved from http://vvponline.be/uploads/docs/bib/euthanasie_finaal_vvp_1_dec.pdf (Accessed December 2018).Google Scholar
Vanheule, S., Adriaens, P., Bazan, A., Bracke, P., Devisch, I., Feys, J. L., … Calmeyn, M. (2019). Belgian superior health council advises against the use of the DSM categories. The Lancet. Psychiatry 6, 726.CrossRefGoogle ScholarPubMed
van Os, J., Guloksuz, S., Vijn, T. W., Hafkenscheid, A., & Delespaul, P. (2019). The evidence-based group-level symptom-reduction model as the organizing principle for mental health care: Time for change? World Psychiatry 18, 88–96.CrossRefGoogle Scholar
van Veen, S. M. P., Weerheim, F. W., Mostert, M., & van Delden, J. J. M. (2019). [Euthanasia of Dutch psychiatric patients in 2015–2017]. Tijdschrift voor Psychiatrie 61, 241–247.Google Scholar
Varelius, J. (2016a). Active and passive physician-assisted dying and the terminal disease requirement. Bioethics 30, 663–671.CrossRefGoogle Scholar
Varelius, J. (2016b). On the moral acceptability of physician-assisted dying for non-autonomous psychiatric patients. Bioethics 30, 227–233.CrossRefGoogle Scholar
Verhofstadt, M., Thienpont, L., & Peters, G. Y. (2017). When unbearable suffering incites psychiatric patients to request euthanasia: Qualitative study. British Journal of Psychiatry 211, 238–245.CrossRefGoogle ScholarPubMed
Verhofstadt, M., Van Assche, K., Sterckx, S., Audenaert, K., & Chambaere, K. (2019). Psychiatric patients requesting euthanasia: Guidelines for sound clinical and ethical decision making. International Journal of Law and Psychiatry 64, 150–161.CrossRefGoogle ScholarPubMed
Vink, T. (2012). [Reaction on ‘assisted suicide in psychiatry; current situation and notes on a recent case’]. Tijdschrift voor Psychiatrie 54, 763–765.Google Scholar
Wijsbek, H. (2012). ‘To thine own self be true’: On the loss of integrity as a kind of suffering. Bioethics 26(1), 1–7.CrossRefGoogle ScholarPubMed
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