Futility and terminal mental illness: the conceptual clarification continues
Abstract
Conceptual parity posits that both medical and mental illness are both simply illness, and thus should be considered as fundamentally the same, especially in health services and policy. Recent controversy over medical assistance in dying (MAID) highlights both the unequal treatment of physical and mental illnesses in end-of-life care and the need for more conceptual clarification of terminal mental illness. This article presents an argument for the necessary elements in terminal mental illness, the value of qualitative assessments, and important areas that require further research and clarity in order for terminal mental illness to be appropriately identified. Given current conceptual limitations, palliative psychiatry, and not MAID, is recommended in severely treatment-resistant cases of mental illness.
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Some scholars have raised concerns that in psychiatry, clinicians have little empirical basis to make prognostic predictions about irremediability.
“Some scholars have raised concerns that in psychiatry, clinicians have little empirical basis to make prognostic predictions about irremediability (30).”
From Assisted death in eating disorders: a systematic review of cases and clinical rationales (2024) · cites this paper as [30]
In the United States, there are increasing calls for laws to be amended to allow MAiD for mental illness on the grounds of parity.
“In the United States, there are increasing calls for laws to be amended to allow MAiD for mental illness on the grounds of parity (30, 83).”
From Assisted death in eating disorders: a systematic review of cases and clinical rationales (2024) · cites this paper as [30]
Cited by
Sorted by citations
Assisted death in eating disorders: a systematic review of cases and clinical rationales
Roff, C., & Cook-Cottone, C. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1431771 · Cited by 16 · see citing works
“Some scholars have raised concerns that in psychiatry, clinicians have little empirical basis to make prognostic predictions about irremediability (30).”
BackgroundPalliative psychiatry: research, clinical, and educational priorities
Levitt, S. E., Cooper, R. B., Gupta, M., Kirby, J., Panko, L., Rosenbaum, D., Stajduhar, K., Trachsel, M., Vinoraj, D., Westermair, A. L., et al. (2024) · Annals of Palliative Medicine · doi:10.21037/apm-23-471 · Cited by 12 · see citing works
Bastidas-Bilbao, H., Stergiopoulos, V., van Kesteren, M. R., Stewart, D. E., Cappe, V., Gupta, M., Buchman, D. Z., Simpson, A. I. F., Castle, D., Campbell, B. H., et al. (2023) · Social Science & Medicine · doi:10.1016/j.socscimed.2023.116075 · Cited by 9 · see citing works
Bastidas-Bilbao, H., Stergiopoulos, V., Cappe, V., van Kesteren, M. R., Stewart, D. E., Gupta, M., Simpson, A. I. F., Dawthorne, M., Rajji, T. K., Castle, D., et al. (2023) · Qualitative Health Research · doi:10.1177/10497323231197365 · Cited by 7 · see citing works
“…autonomy, which also converges with a conceptualization of treatment futility — known as qualitative futility — that aims to determine the quality of the medical treatment outcomes based on the treatment and life goals autonomously set by the individual (Levitt & Buchman, 2021; Xu & Sisti, 2021).”
BackgroundSuicidal behaviour is pathological: implications for psychiatric euthanasia
Sisti, D. A., Mann, J. J., & Oquendo, M. A. (2024) · Journal of Medical Ethics · doi:10.1136/jme-2023-109522 · Cited by 3 · see citing works
“23 Recognition of the difficulty of prognostication in the context of mental illness provides grounding for the application of a general precautionary principle to psychiatry MAID.”
Self-citationBraslow, J. T. (2026) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2026.01.005 · Cited by 1 · see citing works
Ben-Dor, G. A., Alebdy, D., & Xu, Y. E. (2024) · AJOB Neuroscience · doi:10.1080/21507740.2023.2292494 · Cited by 1 · see citing works
“This is foundational work on how psychiatry can assess treatment futility, but further clarification remains on how such analyses can be standardized and ethically introduced to clinical settings (Sisti, Xu, and Zhong 2021; Xu and Sisti 2021).”
BackgroundInfluentialSelf-citationChallenges in the End‐of‐Life Care for Patients With Severe Persistent Mental Illness: A Case Series
Jayakody, K., Bajaj, I., & Blomeley, D. (2026) · Psychogeriatrics · doi:10.1111/psyg.70164
La futilidad médica en salud mental y el papel de la psiquiatría paliativa
Pozón, S. R., & del Olmo, B. R. (2025) · Revista Colombiana de Bioética · doi:10.18270/rcb.4685
Last resort: the ethical obligation to offer ketamine in psychiatric euthanasia and assisted suicide
Zhang, J., & Sisti, D. A. (2026) · Journal of Medical Ethics · doi:10.1136/jme-2025-111672
Self-citationThe relationship between palliative psychiatry and assisted dying: a scoping review
Forte, M., Panko, L., Tsiandoulas, K., Rodak, T., Costa, L., Levitt, S. E., & Buchman, D. Z. (2026) · EClinicalMedicine · doi:10.1016/j.eclinm.2026.104200
“52, 58 We separated this Publications differed in the way that palliative psychiatry could serve as an alternative to AD, from completely replacing AD to having both available.”
Influential
- Authors
- Xu, Y. (., & Sisti, D.
- Venue
- Perspectives in biology and medicine
- Publisher
- Project MUSE
- Published
- 2021
- Volume
- 64
- Issue
- 1
- Pages
- 44-55
- ISSN
- 0031-5982 (ISSN-L)
- 1529-8795
- OpenAlex
- W3138665007
- Cited by
- 11
- References
- 0
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 4 · 2023: 2
- FWCI
- 1.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Perspectives in biology and medicine (publishedVersion)
- PubMed (publishedVersion)
- Project Muse (Johns Hopkins University) (submittedVersion)
- Topics
- 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
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- medical assistance in dying, end-of-life care, palliative psychiatry, treatment-resistant mental illness, qualitative evaluation, futility, euthanasia
- MeSH terms
- Mental Disorders, Humans, Palliative Care, Terminal Care, Suicide, Assisted, Medical Futility
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