Review article Euthanasia and assisted suicide in psychiatric patients: A systematic review of the literature
Raffaella Calati abcde Emilie Olié cde Déborah Dassa cd Carla Gramaglia fg Sébastien Guillaume cde Fabio Madeddu a Philippe Courtetcde
Journal of Psychiatric Research
a Department of Psychology, University of Milan-Bicocca, Milan, Italy
b Department of Adult Psychiatry, Nîmes University Hospital, Nîmes, France
c PSNREC, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France
d Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
e FondaMental Foundation, Créteil, France
f Department of Translational Medicine, Institute of Psychiatry, University of Eastern Piedmont, Novara, Italy
g Psychiatry Ward, Maggiore della Carità University Hospital, Novara, Italy
Volume 135, March 2021, Pages 153-173
https://doi.org/10.1016/j.jpsychires.2020.12.006Highlights
- • Features of psychiatric patients having received Euthanasia or Assisted Suicide (pEAS) were different across countries.
- • In the Netherlands the percentage of pEAS cases increased from 0% to 1.1% (from 0 to 68) in 2009–2019.
- • In Belgium the percentage of pEAS cases increased from 0% to 2.2% (from 0 to 40) in 2002–2013.
- • Mood disorders were mainly represented.
- • Cases of pEAS seem to be very similar to ‘traditional suicides’.
Abstract
The
number of psychiatric patients requesting Euthanasia or Assisted
Suicide (EAS) continues to increase. The aims of this systematic review
were to: 1) describe the available data related to psychiatric patients
having received or requesting EAS (pEAS) for each country in which is
allowed; 2) and describe the ethically salient points that arise.
PubMed,
PsycINFO, and Scopus databases were searched to identify articles
published up to September 2020. Among the retrieved publications, only
studies on pEAS cases (pEAS-C), pEAS requests, or physician
reports/attitude towards pEAS reporting some quantitative data on
patients having received or requesting pEAS were retained. Among the 24
included studies, thirteen (54%) were about pEAS in the Netherlands,
four (17%) in Belgium, and seven (29%) in Switzerland. Results were
different across different countries. In the Netherlands, pEAS-C were
mostly women (70–77%) and often had at least two psychiatric disorders
(56–97%). Mood disorders were mainly represented (55–70%) together with
personality disorders (52–54%). History of suicide attempts was present
in 34–52%. Moreover, 37–62% of them had at least one comorbid medical
condition. In Belgium pEAS-C were mostly women (75%), but the majority
(71%) had a single diagnosis, mood disorder. In Switzerland available
data were less detailed.
As pEAS-C seem to be
very similar to ‘traditional suicides’, pEAS procedures should be
carefully revised to establish specific criteria of access and
guidelines of evaluation of the request. A deeper focus on unbearable
suffering, decision capacity and possibilities of improvements is
warranted as well as the involvement of mental health professionals.
Keywords Euthanasia Assisted suicide End-of-life care Psychiatric disorders Depression