Demoralisation, Depression and Desire for Death: Problems with the Dutch Guidelines for Euthanasia of the Mentally Ill

Kissane, David W.; Kelly, Brian J.

doi:10.1080/j.1440-1614.2000.00692.x

Cited by 64Suicide and Self-Harm StudiesPalliative and Oncologic CarePalliative Care and End-of-Life Issues

Demoralisation, Depression and Desire for Death: Problems with the Dutch Guidelines for Euthanasia of the Mentally Ill

Kissane, David W., Kelly, Brian J.·2000·Australian & New Zealand Journal of Psychiatry

DOI 10.1080/j.1440-1614.2000.00692.x

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Abstract

Objective: Given the recent publication of Dutch guidelines for euthanasia of the mentally ill, our aim in this paper is to review the clinical role of the psychiatrist in assessing patients who seek euthanasia or physician-assisted suicide. Method: Three areas are examined that are informative of the role of the psychiatrist in assessing patients who desire death: recent surveys of psychiatrists' attitudes, empirical and clinical studies, and treatment issues. Results: Demoralisation and depression emerge as pertinent clinical issues worthy of psychiatric intervention. The role of the psychiatrist is complex and includes issues of assessment, systems, countertransference and treatment. Conclusions: Dutch guidelines for physician-assisted suicide in the mentally ill generate serious concern given the uncertainty of prognosis, potential range and variability of outcome of treatments of suicidality and the boundary violations that are involved for the psychiatrist. The guidelines have the potential to dangerously alter the practice of psychiatry and should be condemned.

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Patients with psychiatric disorders may have a life expectancy of decades.
“Therefore, patients may have a life expectancy of decades.12,32”
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 [12]
It is possible for a person to be both depressed and competent.
“Kissane and Kelly, for example, note that “the transition phase through which competence is sustained before a depressed patient loses their previously-held positive world view is unclear,” suggesting that it is possible for someone to be both depressed and competent [2].”
From Is the exclusion of psychiatric patients from access to physician-assisted suicide discriminatory? (2019) · cites this paper as [2]

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BackgroundInfluential

Authors: Kissane, D. W., & Kelly, B. J.
Affiliations: The University of Melbourne (AU)
The University of Queensland (AU)
ORCID: Kissane, David W.
Kelly, Brian J.
Venue: Australian & New Zealand Journal of Psychiatry
Publisher: SAGE Publications
Published: 2000-04
Volume: 34
Issue: 2
Pages: 325-333
ISSN: 0004-8674 (ISSN-L)
1440-1614
DOI: 10.1080/j.1440-1614.2000.00692.x
OpenAlex: W2046178462
Cited by: 64
References: 82
Citations by year: 2026: 1 · 2025: 4 · 2023: 2 · 2022: 4 · 2021: 4 · 2020: 4 · 2019: 6 · 2016: 2 · 2015: 1 · 2014: 2 · 2013: 5 · 2012: 3
FWCI: 2.23
Type: journal article
Language: en
Open access: closed
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Australian & New Zealand Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
Keywords: physician-assisted suicide, demoralization, depression, suicidality, countertransference, boundary violations, psychiatrists' attitudes
MeSH terms: Attitude to Death, Mental Disorders, Depression, Euthanasia, Health Personnel, Helsinki Declaration, Humans, International Cooperation, Mental Health Services, Netherlands, Psychiatry, Suicide, Assisted, Ethics, Research

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Demoralisation, Depression and Desire for Death: Problems with the Dutch Guidelines for Euthanasia of the Mentally Ill

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