Choosing death in depression: a commentary on ‘Treatment-resistant major depressive disorder and assisted dying’
Abstract
Schuklenk and van de Vathorst's paper is a very welcome addition to the literature on the assisted dying debate and will be of great interest to clinicians working in the field of mental health.1 Many psychiatrists will have had patients who have asked them to allow them to die, to desist in their efforts to prevent their suicide, and one of us has had personal experience, outside of professional life, of being asked to aid in someone's attempt to end their life in the context of an episode of mood disorder. The person with depression asking professionals, friends and family members to aid them in ending their life is a very real phenomenon. In their discussion, Schuklenk and van de Vathorst's paper uses two principles that we endorse and add weight to their argument: namely, the reality of suffering in depression and the parity of mental and physical illness. Indeed, the case Schuklenk and van de Vathorst make is a strong one and our commentary will focus on the premise of the argument around choosing death and some empirical clarification about competence in depression and the nature of treatment-resistant depression (TRD) and its prognosis. The conceptual concern we wish to discuss in relation to assisted dying, endorsed by the state and legislature, is not linked to any moral or religious concern, or even on grounds related to ‘slippery slope’ or ‘abuse’ arguments. Rather the worry is how one could operationalise decisions around assisted dying as based on competence and capacity and view such decisions as rational. I think this concern is not limited to depressive illness, but to all decisions regarding choosing non-existence. Schuklenk and van de Vathorst offer the following useful criteria to regulate assisted suicide:1
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Treatment-resistant depression is often assumed in discussions to be by definition irremediable.
“Discussions have repeatedly invoked ‘the person with treatment-resistant depression’ as the paradigm case of an irremediable psychiatric condition (Blikshavn, Husum, & Magelssen, 2017; Broome & de Cates, 2015; Miller, 2015; Schuklenk & van de Vathorst, 2015; Steinbock, 2017), often assuming that treatment-resistant depression (TRD) is, by definition, irremediable.”
From Irremediability in psychiatric euthanasia: examining the objective standard (2023) · cites this paper as Broome & de Cates, 2015
Discussions have repeatedly invoked the person with treatment-resistant depression as the paradigm case of an irremediable psychiatric condition.
“Discussions have repeatedly invoked ‘the person with treatment-resistant depression’ as the paradigm case of an irremediable psychiatric condition (Blikshavn, Husum, & Magelssen, 2017; Broome & de Cates, 2015; Miller, 2015; Schuklenk & van de Vathorst, 2015; Steinbock, 2017), often assuming that treatment-resistant depression (TRD) is, by definition, irremediable.”
From Irremediability in psychiatric euthanasia: examining the objective standard (2023) · cites this paper as Broome & de Cates, 2015
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“Various authors argue that it may be possible that in this period, new treatments are discovered, which can eventually help relieve suffering.(11,22) However, when asked about the possibility of future new treatments, 56% of 248 Dutch psychiatrists thought that this should not be taken into account when deciding about…”
BackgroundPhysician‐Assisted Death and Severe, Treatment‐Resistant Depression
Steinbock, B. (2017) · Hastings Center Report · doi:10.1002/hast.768 · Cited by 36 · see citing works
Irremediability in psychiatric euthanasia: examining the objective standard
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Medical assistance in dying for people living with mental disorders: a qualitative thematic review
Favron-Godbout, C., & Racine, E. (2023) · BMC Medical Ethics · doi:10.1186/s12910-023-00971-4 · Cited by 6 · see citing works
“…to the complexity of the assessment of MAiD-MD requests [56, 58]; as well as to the interpretation and application of eligibility criteria [6, 56], mainly in relation to capacity [29, 77, 78], to the intolerability of suffering [17, 56, 64, 70], and to the irremediability of the condition [47, 51].”
Background
- Authors
- Broome, M. R., & de Cates, A.
- Affiliations
- University of Oxford (GB)
- Corresponding author
- Broome, Matthew R
- ORCID
- Broome, Matthew R
- Venue
- Journal of Medical Ethics
- Publisher
- BMJ
- Published
- 2015-06-22
- Volume
- 41
- Issue
- 8
- Pages
- 586-587
- ISSN
- 0306-6800 (ISSN-L)
- 1473-4257
- OpenAlex
- W2184987964
- Cited by
- 35
- References
- 17
- Citations by year
- 2024: 3 · 2023: 1 · 2022: 2 · 2021: 1 · 2020: 3 · 2019: 3 · 2018: 16 · 2017: 3 · 2016: 2 · 2015: 1
- FWCI
- 7.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Medical Ethics (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Funders
- National Institute for Health and Care Research (ACF-2011-08-003)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- assisted dying, treatment-resistant depression, major depressive disorder, assisted suicide, end-of-life decisions
- MeSH terms
- Euthanasia, Humans, Patient Advocacy, Psychiatry, Mental Competency, Depressive Disorder, Treatment-Resistant
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