Euthanasia and assisted suicide of persons with psychiatric disorders: the challenge of personality disorders
| Autor: | Scott Y. H. Kim, G Kevin Donovan, John R. Peteet, Marie E Nicolini |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent media_common.quotation_subject Comorbidity Psychological Trauma Personality Disorders Suicide Assisted Young Adult 03 medical and health sciences Psychiatric treatments 0302 clinical medicine Physicians medicine Humans Personality 030212 general & internal medicine Assisted suicide Psychiatry Applied Psychology Aged Netherlands media_common Aged 80 and over Euthanasia business.industry Middle Aged medicine.disease Personality disorders 030227 psychiatry Psychiatry and Mental health Physician managing Female Clinical Ethics business Self-Injurious Behavior |
| Zdroj: | Psychological Medicine. 50:575-582 |
| ISSN: | 1469-8978 0033-2917 |
| DOI: | 10.1017/s0033291719000333 |
| Popis: | BackgroundEuthanasia or assisted suicide (EAS) for psychiatric disorders, legal in some countries, remains controversial. Personality disorders are common in psychiatric EAS. They often cause a sense of irremediable suffering and engender complex patient–clinician interactions, both of which could complicate EAS evaluations.MethodsWe conducted a directed-content analysis of all psychiatric EAS cases involving personality and related disorders published by the Dutch regional euthanasia review committees (N = 74, from 2011 to October 2017).ResultsMost patients were women (76%, n = 52), often with long, complex clinical histories: 62% had physical comorbidities, 97% had at least one, and 70% had two or more psychiatric comorbidities. They often had a history of suicide attempts (47%), self-harming behavior (27%), and trauma (36%). In 46%, a previous EAS request had been refused. Past psychiatric treatments varied: e.g. hospitalization and psychotherapy were not tried in 27% and 28%, respectively. In 50%, the physician managing their EAS were new to them, a third (36%) did not have a treating psychiatrist at the time of EAS request, and most physicians performing EAS were non-psychiatrists (70%) relying on cross-sectional psychiatric evaluations focusing on EAS eligibility, not treatment. Physicians evaluating such patients appear to be especially emotionally affected compared with when personality disorders are not present.ConclusionsThe EAS evaluation of persons with personality disorders may be challenging and emotionally complex for their evaluators who are often non-psychiatrists. These factors could influence the interpretation of EAS requirements of irremediability, raising issues that merit further discussion and research. |
| Databáze: | OpenAIRE |
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