عنوان انگلیسی مقاله:
Psychiatric patients requesting euthanasia: Guidelines for sound clinical and ethical decision making
ترجمه فارسی عنوان مقاله:
بیماران روانی درخواست کشتن از سر ترحم: دستورالعمل هایی برای تصمیم گیری بالینی و اخلاقی سالم
Sciencedirect - Elsevier - International Journal of Law and Psychiatry, 64 (2019) 150-161: doi:10:1016/j:ijlp:2019:04:004
Monica Verhofstadta,⁎, Kristof Van Asscheb, Sigrid Sterckxa,c, Kurt Audenaertd, Kenneth Chambaerea
Background: Since Belgium legalised euthanasia, the number of performed euthanasia cases for psychological
suffering in psychiatric patients has significantly increased, as well as the number of media reports on controversial
cases. This has prompted several healthcare organisations and committees to develop policies on the
management of these requests.
Method: Five recent initiatives that offer guidance on euthanasia requests by psychiatric patients in Flanders
were analysed: the protocol of Ghent University Hospital and advisory texts of the Flemish Federation of
Psychiatry, the Brothers of Charity, the Belgian Advisory Committee on Bioethics, and Zorgnet-Icuro. These were
examined via critical point-by-point reflection, focusing on all legal due care criteria in order to identify: 1)
proposed measures to operationalise the evaluation of the legal criteria; 2) suggestions of additional safeguards
going beyond these criteria; and 3) remaining fields of tension.
Results: The initiatives are well in keeping with the legal requirements but are often more stringent. Additional
safeguards that are formulated include the need for at least two positive advices from at least two psychiatrists;
an a priori evaluation system; and a two-track approach, focusing simultaneously on the assessment of the
patients euthanasia request and on that persons continuing treatment. Although the initiatives are similar in
intent, some differences in approach were found, reflecting different ethical stances towards euthanasia and an
emphasis on practical clinical assessment versus broad ethical reflection.
Conclusions: All initiatives offer useful guidance for the management of euthanasia requests by psychiatric patients.
By providing information on, and proper operationalisations of, the legal due care criteria, these initiatives
are important instruments to prevent potential abuses. Apart from the additional safeguards suggested,
the importance of a decision-making policy that includes many actors (e.g. the patients relatives and other care
providers) and of good aftercare for the bereaved are rightly stressed. Shortcomings of the initiatives relate to the
aftercare of patients whose euthanasia request is rejected, and to uncertainty regarding the way in which attending
physicians should manage negative or conflicting advices, or patients suicide threats in case of refusal.
Given the scarcity of data on how thoroughly and uniformly requests are handled in practice, it is unclear to
what extent the recommendations made in these guidelines are currently being implemented.
Keywords: Medical assistance in dying | Psychiatry | Mental health | Belgium | Euthanasia | Guidelines