TABLE 1. Continued Year Source Article type Main argument regarding irremediability Conceptual studies 2017 Kirby J. Medical Assistance in Dying for Suffering Arising from Mental Health Disorders: Could augmented safeguards enhance its ethical acceptability? J Ethics Ment Heal. 2017;10(1). Essay 1) Irremediability is harder to establish in psychiatric than in somatic medicine. 2) Because IPS is not terminal, new therapies may be discovered that are beneficial to the patient. 3) Irremediability of psychiatric suffering is especially hard to determine in adolescent patients. 2017 Steinbock B. Physician-Assisted Death and Severe, Treatment-Resistant Depression. Hastings Cent Rep. 2017;47(5):30-42. Conceptual article 1) There is no consensus over what constitutes TRD. 2) Uncertainty about disease progression pervades most areas of medicine, competent patients should be able to make treatment choices, including PAD. 2017 Kelly BD. Invited commentary on… When unbearable suffering incites psychiatric patients to request euthanasia. Br J Psychiatry. 2017;211(4):248-249. Commentary “With mental illness, there is no point at which we can say that a person’s illness is untreatable or that their suffering cannot be alleviated.” Therefore PAD should not be accessible for psychiatric patients. 2017 Reel et al. Assisted death in mental health: Our last, best judgement. Ethics Ment Heal use. 2017:293-314. Book chapter Hope is not always a benign entity, false hope can be harmful if it leads to prolonged suffering, loss of dignity and self and fractures in the therapeutic alliance. 2017 Bay, M. The Devil is in the Details: Thoughts on Medical Aid in Dying for Persons with Mental Illness. J Ethics Ment Heal. 2017;10. Lecture transcript 1) worries that IPS is caused by a disjointed and underfunded healthcare system as well as a society that is persistently hostile to this population. 2) Because of the episodic nature of some mental illnesses a one year waiting period should be considered in the case of mental illness. 2018 Rooney et al. Are Concerns About Irremediableness, Vulnerability, or Competence Sufficient to Justify Excluding All Psychiatric Patients from Medical Aid in Dying? Health Care Anal. 2018;26(4):326-343 Case report 1) It is possible to determine if psychiatric suffering is irremediable. 2) The relative long survival of psychiatric patients that suffer irremediably makes exclusion from PAD especially harmful. 2018 Dembo et al. “For Their Own Good”: A Response to Popular Arguments Against Permitting Medical Assistance in Dying (MAID) where Mental Illness Is the Sole Underlying Condition. Can J Psychiatry. 2018;63(7):451-456. Essay 1) Psychiatric suffering can be irremediable. 2) The possibility of future treatments is no reason to ban PAD for IPS. 2018 Simpson AIF. Medical Assistance in Dying and Mental Health : A Legal, Ethical, and Clinical Analysis. Can J Psychiatry. 2018. Essay 1) Because of the complexity of predicting individual disease progression PAD due to psychiatric suffering should not be possible. 2) Carers and clinicians should always stay hopeful, even when patients are suicidal. 2018 Appelbaum PS. Physician-assisted death in psychiatry. World Psychiatry. 2018;17(2):145-146. Essay 1) It is very complicated to determine IPS. 2) Giving up hope leads to hopelessness. 2018 Demyttenaere et al. The Impact of (the Concept of) Treatment-Resistant Depression: An Opinion Review. Int J Neuro-psychopharmacol. 2018;(July). Opinion review The concept of TRD is highly questionable, including estimation and evaluation of treatment effect (and of spontaneous evolution), this should be taken into account when deciding about PAD. 64 | PART II - CHAPTER 4 4
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