A dialogue on death: On mental illness and physician-assisted dying

The Dutch Termination of Life on Request and Assisted Suicide Act (2002) allows physicians to assist in the death of patients suffering from a medical condition. This allows patients who suffer unbearably and without prospect of improvement from severe mental illness to request physician-assisted death (PAD). Existing literature is primarily quantitative and/or medical ethical in nature. Our aim was to study the experiences, views and considerations of stakeholders. Therefore, we conducted a survey study among general practitioners and qualitative studies (in-depth interviews) with psychiatrists, general practitioners, patients suffering from mental illness who have a PAD wish, and their relatives. The results show that all stakeholders struggle when a patient with mental illness considers or requests PAD. Physicians weigh moral, epistemological, practical and contextual reasons. The variety in views seems to be related to a difference in the view on the nature of mental illness. Some physicians stress the difference, whereas others point out the similarities between somatic and mental illness. Patients indicated that a PAD request can have different meanings: a) autonomy and self-determination, b) ending the suffering, c) recognition, d) a dignified end-of-life. Being able to discuss a PAD wish, and being taken seriously by a physician, could lead to new perspectives on life.
Relatives experience conflicting feelings, characterised by their understanding of the wish to die, while also hoping that the patient would make another choice. It was indicated that some felt left out by the physician, and that they preferred it to be a joint trajectory.