Psychiatric euthanasia and suicide prevention: a clinical-ethical study.

Belgium and the Netherlands are among the few countries in the world that permit euthanasia and assisted suicide based on a psychiatric disorder (psychiatric EAS). Emerging evidence about the practice points to important ethical and clinical questions, such as how to assess unbearable suffering or ‘irremediability’ in a person with a psychiatric disorder. But a salient issue remains underexplored, namely the tension between allowing psychiatric EAS while preventing suicide. In practice, a person with a psychiatric disorder who wants to die might be treated very differently, depending on how they express their wish to die. While suicidal behavior might lead to an involuntary hospitalization, a request for euthanasia would likely not. So far, this tension has been addressed by characterizing suicide as impulsive and euthanasia as carefully planned. But this distinction is not tenable. Patients’ clinical profiles and the process they undertake to bring about their death can be similar in both cases. This raises the major question of what should be considered a ‘voluntary and well-considered request’ for psychiatric EAS. The standard approach to suicide prevention suggests that current standards for psychiatric EAS may not be sufficient. We need to reconsider how we address each situation and what the standards are for an informed decision in the two contexts.