A conceptual framework for thinking about physician-assisted death for persons with a mental disorder.

Shaffer, Catherine S.; Cook, Alana N.; Connolly, Deborah A.

doi:10.1037/law0000082

Cited by 22Ethics and bioethics in healthcarePalliative Care and End-of-Life IssuesPalliative and Oncologic Care

A conceptual framework for thinking about physician-assisted death for persons with a mental disorder.

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Shaffer, Catherine S., Cook, Alana N., Connolly, Deborah A.·2016·Psychology, Public Policy, and Law

DOI 10.1037/law0000082

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Abstract

Physician-assisted death (PAD) has been enacted in a number of international jurisdictions, with several extending access to PAD for persons whose condition is not terminal, including those with a mental disorder. We argue that based on the state of the literature, it is too early to make well-defined recommendations on how relevant fields can proceed legally, ethically, and clinically, particularly in regard to PAD for persons with a mental disorder. The aim of this paper is to introduce a framework for further discussions on PAD for persons with a mental disorder to stimulate thoughtful and considered debate in our field. We provide a brief discussion of the principles that guide regulatory frameworks on PAD practices worldwide, including a discussion of jurisdictions in Europe and North America that allow PAD for those suffering from an incurable non-terminal disease, illness, or disability. Next, we present a conceptual framework as a series of questions that address legal, ethical, and clinical dilemmas arising from this trend. We conclude with a summary of guidelines on the practice of PAD from international jurisdictions in order to assist in the development of potential legal and professional regulations.

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Canada's assisted dying law states that suffering is irremediable when all treatments acceptable to the patient have failed, thus leaving more room for PAD after treatment refusal.
“Canada’s assisted dying law is more patient-centered, stating that suffering is irremediable when all treatments acceptable to the patient have failed, thus leaving more room for PAD after treatment refusal.2,41”
From Irremediable Psychiatric Suffering in the Context of Physician-assisted Death: A Scoping Review of Arguments: La souffrance psychiatrique irrémédiable dans le contexte du suicide assisté : Une revue étendue des arguments (2020) · cites this paper as [2]
The ‘Grievous and Irremediable Medical Condition’ section says patients may refuse alternative treatments if other PAD eligibility requirements are met, and ‘Defining Grievous and Irremediable Mental Disorder’ notes a Canadian right to refuse unwanted treatment. But the paper does not state that Canadian law defines suffering as irremediable once all patient-acceptable treatments have failed. It also cautions that refusing psychiatric care may warrant restricted access to PAD. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Many jurisdictions explicitly or implicitly ban patients with psychiatric disorders from accessing PAD, but the Netherlands, Belgium, Luxemburg, and Switzerland do not.
“Many jurisdictions explicitly or implicitly ban patients with psychiatric disorders (PPD) from accessing PAD, but this is not the case in the Netherlands, Belgium, Luxemburg, and Switzerland.2”
From Irremediable Psychiatric Suffering in the Context of Physician-assisted Death: A Scoping Review of Arguments: La souffrance psychiatrique irrémédiable dans le contexte du suicide assisté : Une revue étendue des arguments (2020) · cites this paper as [2]
Most jurisdictions that permit MAID for PPD demand that the patient is competent and has a medical condition causing irremediable and unbearable suffering.
“For this request to be granted, most of these jurisdictions demand that the patient is competent in her request and has a medical condition that causes irremediable and unbearable suffering.1,2”
From Irremediable psychiatric suffering in the context of medical assistance in dying: A delphi-study (2022) · cites this paper as [2]

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Authors: Shaffer, C. S., Cook, A. N., & Connolly, D. A.
Affiliations: Simon Fraser University (CA)
Corresponding author: Shaffer, Catherine S.
ORCID: Shaffer, Catherine S.
Cook, Alana N.
Connolly, Deborah A.
Venue: Psychology, Public Policy, and Law
Publisher: American Psychological Association (APA)
Published: 2016
Volume: 22
Issue: 2
Pages: 141-157
ISSN: 1076-8971 (ISSN-L)
1939-1528
DOI: 10.1037/law0000082
OpenAlex: W2346992978
Cited by: 21
References: 145
Citations by year: 2026: 1 · 2025: 1 · 2023: 2 · 2022: 1 · 2021: 2 · 2020: 6 · 2019: 1 · 2018: 3 · 2017: 3 · 2016: 1
FWCI: 2.65
Type: journal article
Language: en
Open access: green
summit.sfu.ca
Locations: Psychology Public Policy and Law (publishedVersion)
Summit (Simon Fraser University) (submittedVersion)
Funders: Simon Fraser University
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
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 › Palliative and Oncologic Care
Keywords: physician-assisted death, mental illness, conceptual framework, mental health law, clinical dilemmas

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A conceptual framework for thinking about physician-assisted death for persons with a mental disorder.

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