A recent survey suggests that a significant proportion of doctors in the Netherlands are prepared to carry out assisted suicide for people with mental illness.

The survey was undertaken in 2011-2012 by Dr. Eva Bolt and colleagues at the EMGO Institute for Health and Care Research, Amsterdam, the Netherlands. They sent questionnaires to 2,269 randomly selected general practitioners (family doctors) and specialists in elderly care, cardiology, respiratory medicine, intensive care, neurology, and internal medicine. Of these, 1,456 completed the survey.

Respondents were asked if they had ever helped a patient who was suffering with cancer, another physical disease, a mental illness, dementia, or without a severe physical disease but was “tired of living” to die.

This showed that a large majority (86 percent) would consider helping a patient to die. Six out of ten had actually done so.

Overall, 77 percent (and more than 90 percent of GPs) had been asked at least once for help to die. Only a few of the respondents (seven percent) had actually helped a patient who did not have cancer or another severe physical illness to die, whereas over half (56 percent) had helped a cancer patient to die, and around a third (31 percent) had assisted someone with another physical disease.

But feelings about euthanasia and assisted death varied for each health condition. The likelihood of helping was high for cancer patients (85 percent) and those with another physical disease (82 percent).

For mental illness, only 34 percent would consider helping the patient die, and 40 percent would help someone with early-stage dementia to die. The rate was slightly lower for late-stage dementia, at 33 percent.

Just over a quarter (27 percent) would be prepared to help someone tired of living to die if they had a severe medical condition. But fewer than one in five (18 percent) would do so in these circumstances if the person had no other medical grounds for suffering.

Full results are published in the Journal of Medical Ethics. The current situation in The Netherlands is that euthanasia or assisted suicide is legally permissible “for those whose suffering is psychiatric/psychological in nature,” but it rarely occurs.

The authors write, “Euthanasia and physician-assisted suicide (EAS) in patients with psychiatric disease, dementia, or patients who are tired of living (without severe morbidity) is highly controversial. Although such cases can fall under the Dutch Euthanasia Act, Dutch physicians seem reluctant to perform EAS, and it is not clear whether or not physicians reject the possibility of EAS in these cases.

“This study shows that a minority of Dutch physicians find it conceivable that they would grant a request for EAS from a patient with psychiatric disease, dementia, or a patient who is tired of living. For physicians who find EAS inconceivable in these cases, legal arguments and personal moral objections both probably play a role.”

Said┬áBolt, “Each physician needs to form his or her own standpoint on euthanasia, based on legal boundaries and personal values. We would advise people with a future wish for euthanasia to discuss this wish with their physician in time, and we would advise physicians to be clear about their standpoint on the matter.”

In The Netherlands, the “Termination of Life on Request and Assisted Suicide Act” took effect on April 1, 2002. It legalizes euthanasia and physician-assisted suicide under very specific circumstances. Several stringent conditions must be fulfilled including that “the patient’s suffering is unbearable with no prospect of improvement.”

This legal requirement, the question of unbearable suffering, was explored by a related team of researchers at Radboud University Nijmegen Medical Centre, the Netherlands. They state in the journal Psycho-Oncology, “Unbearable suffering is difficult to assess, so evaluation of the current knowledge of unbearable suffering is needed in the ongoing debate about the conditions on which EAS can be approved.”

They evaluated a range of definitions of suffering and studies on suffering, but “found no definition of unbearable suffering in the context of a request for EAS.” They also report that they “found no studies that brought together the views of the patients, relatives, and healthcare professionals.”

The experts propose their own conceptual definition: “Unbearable suffering in the context of a request for EAS is a profoundly personal experience of an actual or perceived impending threat to the integrity or life of the person, which has a significant duration and a central place in the person’s mind.”

References

Bolt, E. E. et al. Can physicians conceive of performing euthanasia in case of psychiatric disease, dementia or being tired of living? Journal of Medical Ethics, 18 February 2015 doi 10.1136/medethics-2014-102150

Dees, M. et al. Unbearable suffering of patients with a request for euthanasia or physician-assisted suicide: an integrative review. Psycho-oncology, 19 April 2010 doi: 10.1002/pon.1612.