Physician Aid-in-Dying and Suicide Prevention in Psychiatry: A Moral Crisis?

Abstract

Involuntary psychiatric commitment for suicide prevention and physician aid-in-dying (PAD) in terminal illness combine to create a moral dilemma. If PAD in terminal illness is permissible, it should also be permissible for some who suffer from nonterminal psychiatric illness: suffering provides much of the justification for PAD, and the suffering in mental illness can be as severe as in physical illness. But involuntary psychiatric commitment to prevent suicide suggests that the suffering of persons with mental illness does not justify ending their own lives, ruling out PAD. Since both practices have compelling underlying justifications, the most reasonable accommodation might seem to be to allow PAD for persons with mental illness whose suffering is severe enough to justify self-killing, but prohibit PAD for persons whose suffering is less severe. This compromise, however, would require the articulation of standards by which persons’ mental as well as physical suffering could be evaluated. Doing so would present a serious philosophical challenge.

Keywords:

• Suicide
• physician aid-in-dying
• psychiatry
• civil commitment
• mental illness
• suffering

This article is referred to by:

Kious and Battin’s Dilemma Resolved: Outlaw Physician Aid-in-Dying

Irremediability Is Key

Social Determinants of Mental Health and Physician Aid-in-Dying: The Real Moral Crisis

Physician Aid-in-Dying and Suicide Prevention in Psychiatry: A Moral Imperative Over a Crisis

Parity Arguments for ‘Physician Aid-in-Dying’ (PAD) for Psychiatric Disorders: Their Structure and Limits

The Unbearable Burden of Suffering: Moral Crisis or Structural Failure?

Evaluating PAD Requests in Psychiatry: The Importance of Involving Others

Why Normative Judgment Is Inescapable

When a Theoretical Commitment to Broad Physician Aid-in-Dying Faces the Reality of Its Implementation

Moralities of Method: Putting Normative Arguments in Their (Social and Cultural) Place

“When the Fall Is All There Is…”: Refocusing on the Critical (Unique?) Characteristic of “Dying” in Physician Aid-in-Dying

Physician Aid-in-Dying for Individuals With Serious Mental Illness: Clarifying Decision-Making Capacity and Psychiatric Futility

Concerning the Basic Idea that the Wish to End Suffering Legitimates Physician Aid in Dying for Psychiatric Patients

Deep Uncertainties in the Criteria for Physician Aid-in-Dying for Psychiatric Patients

Euthanasia for Mental Suffering Reduces Stigmatization But May Lead to an Extension of This Practice Without Safeguards

Medical Aid-in-Dying is an Ethical and Important End-of-Life Care Option

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Response to Open Peer Commentaries on “Physician Aid-in-Dying and Suicide Prevention in Psychiatry”

ACKNOWLEDGMENTS

We thank the anonymous reviewers for their insightful critiques, which improved our article greatly. We are also grateful for the comments and questions we received from attendees at a meeting of the University of Utah Program in Bioethics and Humanities in which we presented an earlier version of this work. The article has particularly benefitted from conversations with Gretchen Case, Linda Carr-Lee Faix, Leslie Francis, Jennifer Kious, Benjamin Lewis, Ryan Nelson, Anthony Smith, and James Tabery.

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the authors. ▪

Notes

1. We mention but do not argue for the controversial idea that some mental illnesses could also be considered terminal; were that the case, it would be a further reason for thinking terminality cannot exclude all mental illnesses from PAD.