Evaluating PAD Requests in Psychiatry: The Importance of Involving Others

Abstract

Kious and Battin (2019) explore the tension between physician-assisted dying (PAD) and prevention of suicide in psychiatry, and argue for the need for standards by which the severity of a person’s mental as well as physical suffering could be evaluated in order to assess eligibility for PAD. We agree that a thorough evaluation is needed, but rather than standards, we argue that a prudent process is necessary in order to deal with the complexities around PAD in psychiatry. In this process, involving others is of vital importance. In our elaboration, we refer to the revised Dutch guideline for PAD in psychiatry, published by the Dutch Association for Psychiatry in 2018, as this guideline stresses that the assessment of a PAD request in psychiatry requires active involvement of the patient, other professionals, and family members (Dutch Association for Psychiatry 2018). In the Netherlands, PAD for patients who suffer from a mental illness is legally possible under the Termination of Life on Request and Assisted Suicide Act (2002). This act states that euthanasia and physicianassisted suicide are not punishable if due care criteria are met. This means that the attending physician is convinced that the patient’s request is voluntary and well considered, and that suffering is unbearable and without prospect of improvement. Moreover, the patient should be well informed about the diagnosis and prospects, and the physician and the patient should come to a joint