INTRODUCTION In an increasing number of jurisdictions, physician-assisted death is legal. (Appelbaum, 2017) An important justification for this option is that physicians should be able to relieve the unbearable and irremediable suffering of mentally competent patients, even by assisting their death. (Berghmans, Widdershoven, & Widdershoven-Heerding, 2013) The Netherlands, Belgium, Luxembourg, and Switzerland are the only countries where psychiatric patients are granted legal access to physician assisted death. (Shaffer, Cook, & Connolly, 2016) Since 2012, the prevalence of physician assisted death due to psychiatric suffering in the Netherlands has increased, peaking at 83 deaths in 2017. In 2018, 1.1% (N=67) of all cases of physician-assisted death were due to psychiatric suffering. (Dutch Regional Euthanasia Review Committees - Annual Reports) A majority of these patients were women over age 50 years who suffered from a complex combination of psychiatric disorders and had long treatment histories. About 50% of these patients were diagnosed as having depression or personality disorders. (Kim, de Vries, & Peteet, 2016; van Veen, Weerheim, Mostert, & van Delden, 2018) The increasing number of physician-assisted deaths in psychiatry might be related to the establishment of the Expert Centre on Euthanasia (ECE; formerly called the End-of-Life Clinic) in the Netherlands, an organization of physicians who are specialized in giving advice on and performing complex physician-assisted death requests. In 2018, ECE received 640 requests for physician-assisted death from psychiatric patients and assisted with 56 deaths (9%). What happened to the 91% of psychiatric patients who requested but did not receive physician-assisted death is unclear. (ECE, 2018) This Open Forum introduces the case of a psychiatric patient who asked his physician for assistance in dying but recovered during the assessment process. We will use this case to reflect on how to deal with uncertainty about physician assisted death of psychiatric patients and to argue for implementation of a due-diligence procedure, such as the one proposed in the Dutch Psychiatric Association’s recent guideline concerning this issue. CASE DESCRIPTION A 36-year-old man with a history of attention-deficit hyperactivity disorder, drug abuse, psychological trauma, obsessive-compulsive personality disorder, and therapy resistant schizophrenia had been experiencing psychotic episodes with delusions and imperative acoustic hallucinations (hearing voices) for 10 years. After the second psychotic episode was treated 8 years ago, the patient repeatedly heard songs from his childhood throughout the day. Their effect on the patient and their intensity increased when his mood worsened and when he was in a stressful environment. This new symptom was initially interpreted as an acoustic hallucination, and for several LAST-MINUTE RECOVERY OF A PSYCHIATRIC PATIENT REQUESTING PHYSICIAN-ASSISTED DEATH | 31 2
RkJQdWJsaXNoZXIy MjY0ODMw