Treatment-resistant major depressive disorder and assisted dying
Open accessAbstract
Competent patients suffering from treatment-resistant depressive disorder should be treated no different in the context of assisted dying to other patients suffering from chronic conditions that render their lives permanently not worth living to them. Jurisdictions that are considering, or that have, decriminalised assisted dying are discriminating unfairly against patients suffering from treatment-resistant depression if they exclude such patients from the class of citizens entitled to receive assistance in dying.
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Decision-making competence in persons with mental disorders may be compromised by their illness and more difficult to assess.
“decision-making competence may be compromised by their illness and more difficult to assess”
From Assisted suicide in persons with mental disorders: a review of clinical-ethical arguments and recommendations (2024) · cites this paper as [7]
In “TRD, COMPETENCE AND AUTHENTICITY” (page unavailable), the authors say depression influences patients’ views but that this does not establish impaired competence. They state that there is no evidence depression per se renders patients incompetent and argue that competence assessments should be treated no differently from those of other patients, contrary to the attributed claim. (LLM, conf=0.85)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe severity of suffering in persons with mental disorders may be more difficult to evaluate from an external perspective.
“the severity of suffering may be more difficult to evaluate from an external perspective”
From Assisted suicide in persons with mental disorders: a review of clinical-ethical arguments and recommendations (2024) · cites this paper as [7]
The BACKGROUND TRD section (page not provided) says it is difficult to make the suffering of clinically depressed people intersubjective, supporting the point about evaluation from an external perspective. The claim extends that point to people with mental disorders generally, which the passage does not establish. (LLM, conf=0.85)
Experimental — accuracy not yet measuredA multidisciplinary framework is widely recommended to mitigate bias and distribute evaluative responsibility.
“A multidisciplinary framework is widely recommended to mitigate bias and distribute evaluative responsibility.”
From Medical Assistance in Dying for the Sole Underlying Condition of Mental Disorder (MAiD MD-SUMC): an analysis and qualitative evidence synthesis (2026) · cites this paper as [59]
The section “Depression and Assisted Dying in the Netherlands” describes assessment by three independent physicians, including two psychiatrists, to check competence and ensure treatment options are not overlooked. It does not say a multidisciplinary framework is widely recommended, or describe mitigating bias and distributing evaluative responsibility as its purposes. (LLM, conf=0.78)
Experimental — accuracy not yet measuredSchuklenk and van de Vathorst's proposed framework offers a widely cited foundation for assessments of MAiD requests on the basis of mental disorders, emphasising patient competence, ability to assess prospects based on current scientific evidence, voluntary and informed decision-making, perception of quality of life as not worth sustaining with minimal or no likelihood of improvement, and一致性 in决策
“Schuklenk and van de Vathorst’s proposed framework offers a widely cited foundation for such assessments, emphasising:”
From Medical Assistance in Dying for the Sole Underlying Condition of Mental Disorder (MAiD MD-SUMC): an analysis and qualitative evidence synthesis (2026) · cites this paper as [59]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThe wish to die in persons with mental disorders may be more variable over time.
“the wish to die may be more variable over time”
From Assisted suicide in persons with mental disorders: a review of clinical-ethical arguments and recommendations (2024) · cites this paper as [7]
In ‘Depression and assisted dying in the Netherlands’ (page unavailable), the paper reports that some psychiatric patients’ requests were refused because their wish to die was judged more or less impulsive. But in ‘TRD, Competence and Authenticity’ (page unavailable), it argues that patients with treatment-resistant depression may continue to regard their lives as not worth living. The paper does not establish that the wish to die is generally more variable over time in people with mental disorders. (LLM, conf=0.77)
Experimental — accuracy not yet measured
Excluding mentally ill persons when terminal illness with life-expectancy less than 6 months is required constitutes a considerable infringement of the right to self-determination and unjustified discrimination of a group often already disadvantaged in access to effective treatment and support.
“This exclusion constitutes a considerable infringement of the individual's right to self-determination and therefore constitutes an unjustified discrimination of a group of patients who are often already disadvantaged in terms of access to effective treatment and support (7).”
From Assisted suicide in persons with mental disorders: a review of clinical-ethical arguments and recommendations (2024) · cites this paper as [7]
The Introduction argues that restricting assisted dying to people with physical illnesses unjustly discriminates against competent people with psychiatric illnesses and invokes self-determination. The legislative-examples section describes a proposed six-month terminal-illness limit. Our copy does not establish that the excluded patients are often already disadvantaged in access to effective treatment and support; its discussion of improving professional care does not make that claim. Page numbers were unavailable. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe wish to die in persons with mental disorders may be a symptom of their mental disease and not an autonomous choice.
“their wish to die may be a symptom of their mental disease and not an autonomous choice”
From Assisted suicide in persons with mental disorders: a review of clinical-ethical arguments and recommendations (2024) · cites this paper as [7]
Prognostic uncertainty in mental illness makes it more difficult to determine whether severe suffering is treatment-resistant.
“the prognostic uncertainty in mental illness makes it more difficult to determine whether the severe suffering is, in fact, treatment-resistant”
From Assisted suicide in persons with mental disorders: a review of clinical-ethical arguments and recommendations (2024) · cites this paper as [7]
This is another strong ethical argument not to exclude mentally ill persons categorically from assisted suicide.
“This is another strong ethical argument not to exclude mentally ill persons categorically from assisted suicide (7).”
From Assisted suicide in persons with mental disorders: a review of clinical-ethical arguments and recommendations (2024) · cites this paper as [7]
We have no reason to think that decisionally capable psychiatric patients' evaluation of their quality of life is more unreliable than that of other decisionally capable patients.
“We have no reason to think that decisionally capable psychiatric patients’ evaluation of their quality of life is more unreliable than that of other decisionally capable patients.24”
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- Schuklenk U, Van de Vathorst S. J Med Ethics 2015;41:577-583. doi:10.1136/medethics-2014-102458 Feature article on September 11, 2023 by guest. Protected by copyright. http://jme.bmj.com/ J Med Ethics: first published as 10.1136/medethics-2014-102458 on 2 May 2015. Downloaded from
- Schuklenk U, Van de Vathorst S. J Med Ethics 2015;41:577-583. doi:10.1136/medethics-2014-102458 Feature article on September 11, 2023 by guest. Protected by copyright. http://jme.bmj.com/ J Med Ethics: first published as 10.1136/medethics-2014-102458 on 2 May 2015. Downloaded from
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“30 These mixed findings underscore that numerical increases in MAiD cases do not necessarily indicate coercion or misuse but highlight the need for careful monitoring of contextual factors.”
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Get the facts right: time for evidence-based ethics
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Physician-assisted dying and two senses of an incurable condition
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Euthanasia and assisted suicide for psychiatric disorders
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- Authors
- Schuklenk, U., & Vathorst, S. V. D.
- Affiliations
- Department of Philosophy, Queens University, Ontario, Canada
- Amsterdam UMC Location University of Amsterdam (NL)
- Venue
- Journal of Medical Ethics
- Publisher
- BMJ
- Published
- 2015-05-02
- Volume
- 41
- Issue
- 8
- Pages
- 577-583
- ISSN
- 0306-6800 (ISSN-L)
- 1473-4257
- OpenAlex
- W2128372426
- Cited by
- 93
- References
- 25
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 2 · 2023: 10 · 2022: 5 · 2021: 6 · 2020: 10 · 2019: 6 · 2018: 24 · 2017: 5 · 2016: 8 · 2015: 8
- FWCI
- 2.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Medical Ethics (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- 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 and Oncologic Care
- Health Sciences › Health Professions › General Health Professions › Health, Medicine and Society
- Keywords
- treatment-resistant depression, major depressive disorder, assisted dying, assisted suicide, right to die
- MeSH terms
- Canada, Cross-Cultural Comparison, Euthanasia, Humans, Netherlands, Patient Advocacy, Physician's Role, Psychiatry, Mental Competency, Guidelines as Topic, Depressive Disorder, Treatment-Resistant
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