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Cited by 19Healthcare Decision-Making and RestraintsPalliative Care and End-of-Life IssuesEthics and bioethics in healthcare

The influence of cognitive distortions on decision-making capacity for physician aid in dying

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Dembo, Justine, van Veen, Sisco, Widdershoven, Guy·2020·International Journal of Law and Psychiatry
DOI 10.1016/j.ijlp.2020.101627
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Abstract

As international laws on physician aid in dying (PAD) evolve, the question of permitting PAD in non-terminal illness, and in sole psychiatric illness, is under intense debate. In jurisdictions where PAD is permissible, certain safeguards and eligibility requirements must be met for all patients making a PAD request, and one of these requirements is that the patient have sound decision-making capacity with respect to the request. Legal criteria already exist for the determination of capacity, and they are quite similar between different jurisdictions. In current debates about the question of psychiatric PAD, one concern that has been raised is that cognitive distortions in mental disorders may affect a patient's decision-making capacity. At the same time, it has been established that all persons, with or without a mental disorder, experience cognitive distortions. If cognitive distortions are ubiquitous, it is likely that the severity and frequency of cognitive distortions is dimensional rather than categorical, between samples with and without mental illness. Furthermore, currently, there is no requirement for a formalized evaluation of cognitive distortions as part of capacity assessment for any type of medical decision, including PAD decisions. The current paper examines the literature related to cognitive distortions in mental disorders and in healthy populations. It proposes that the existence of cognitive distortions, alone, cannot be used as an argument for a blanket exclusion of psychiatric PAD. It therefore concludes that further research and ethical analysis should be undertaken to examine the impact of cognitive distortions on decision-making for consequential medical decisions, including PAD, in patients with and without mental disorders.

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  • While standardized tests for mental capacity exist, studies suggest clinicians rarely use formal assessments in clinical practice.

    “While standardized tests for mental capacity exist, studies suggest clinicians rarely use formal assessments in clinical practice (45, 46).”

    From Assisted death in eating disorders: a systematic review of cases and clinical rationales (2024) · cites this paper as [45]

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Authors
Dembo, J., van Veen, S., & Widdershoven, G.
Affiliations
  • Sunnybrook Health Science Centre (CA)
  • Amsterdam University Medical Centers (NL)
Corresponding author
Dembo, Justine
ORCID
Widdershoven, Guy
Venue
International Journal of Law and Psychiatry
Publisher
Elsevier BV
Published
2020-09
Volume
72
Pages
101627
ISSN
0160-2527 (ISSN-L)
DOI
10.1016/j.ijlp.2020.101627
OpenAlex
W3087428244
Cited by
19
References
70
Citations by year
2026: 3 · 2025: 3 · 2024: 5 · 2023: 5 · 2022: 2 · 2021: 1
FWCI
0.18
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Law and Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (acceptedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
Keywords
cognitive distortions, decision-making capacity, mental illness, capacity assessment, eligibility requirements, euthanasia legislation
MeSH terms
Mental Disorders, Decision Making, Humans, Mental Competency, Suicide, Assisted, Cognitive Dysfunction

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