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Invited commentary on… When unbearable suffering incites psychiatric patients to request euthanasia

  • Brendan D. Kelly (a1)
Summary

Euthanasia is available in Belgium and Luxembourg for untreatable and unbearable suffering resulting from ‘physical and/or psychological suffering that cannot be alleviated and results from a serious and incurable disease, caused by accident or illness'. Verhofstadt et al's valuable analysis of testimonials from psychiatric patients requesting euthanasia demonstrates that elements of this suffering might well be alleviated. We should not kill our patients.

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References
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1 Verhofstadt, M, Thienpont, L, Peters, G-JY. When unbearable suffering incites psychiatric patients to request euthanasia: qualitative study. Br J Psychiatry 2017; 211: 238–45.
2 Kelly, BD, McLoughlin, DM. Euthanasia, assisted suicide and psychiatry: a Pandora's box. Br J Psychiatry 2002; 181: 278–9.
3 Medical Council. Guide to Professional Conduct and Ethics for Registered Medical Practitioners (8th edn). Medical Council (Ireland), 2016.
4 General Medical Council. Treatment and Care Towards the End of Life: Good Practice in Decision Making. General Medical Council, 2010.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Invited commentary on… When unbearable suffering incites psychiatric patients to request euthanasia

  • Brendan D. Kelly (a1)
Submit a response

eLetters

Euthanasia - A response to Dr. Kelly.

Lachlan B. Campbell, Consultant Forensic Neuropsychiatrist, Blackfriars Medico-Legal Consultancy
13 October 2017

Although not an active protagonist of euthanasia, I feel I should take issue with Dr Brendan Kelly's Invited Commentary on Verhofstadt et al's paper [Br J psychiatry 211, 238-245] in spite of his impressive list of qualifications.

First of all the commentary is blatantly discriminatory in conceding the possibility of euthanasia for those suffering from a physical illness but never for those with a mental illness. It seems paternalism is not yet dead and buried. The General Medical Council in its publication "Treatment and care towards the end of life: Good practice in decision-making" accepts that a patient's own views are relevant to any decision regarding the prolongation of their life and therefore, by inference, to the non-prolongation of their life. The same publication makes reference to human rights principles relevant to this matter. There is of course a well-recognised "right to life" (Article 2, European Convention on Human Rights). Clearly this is a "right" but surely not an imperative. By analogy, Article 12 provides a "right to marry" but few would now regard this as a necessity. An individual could therefore reasonably choose not to invoke Article 2 for themselves.

Dr. Kelly queries whether a psychiatrist should "ever countenance actively assisting....a request for euthanasia by an otherwise healthy 16 year old [child]. There are two problems with this comment. Firstly the usual expectation for a psychiatrist, or any other doctor, is to adopt a position of equipoise, neither affirming nor rejecting a patient's expressed views. Furthermore it seems intuitively likely that any future euthanasia law would apply only to those who had reached their majority.

Dr. Kelly comments quite accurately that it is never possible to say for certain that there is no hope for improvement. Of course this must be true as there is never certainty in medicine or indeed any other human endeavour. For that obvious reason, we do not wait until we are certain before offering treatment to a patient. Perhaps more importantly, the role of a doctor surely is to provide a timely response to a patient's suffering, not to suggest that this might be alleviated on some (unknown) future date. To do the latter would be rather poor medicine. Treatment is an activity which takes place in the present and it is to the patient's present suffering that the doctor should direct their attention.

Finally Dr. Kelly comments, both in his Summary and in his Conclusions, that "we should not kill our patients". However it is hard to imagine any future euthanasia law allowing this. If such a law existed, presumably the patient would be referred (or perhaps self-refer themselves) to a Tribunal with appropriate decision-making powers. If approved, the actual act of "assisted suicide" need not be conducted by a doctor or any other healthcare professional. A trained technician could suffice. Dr. Kelly's suggestion that psychiatrists might be involved in actually killing their patients seems quite disingenuous.

I note that Dr. Kelly does not disclose any religious affiliation which might plausibly be influencing his opinions. I think this is a serious omission which should not have escaped the editors. In the interests of openness I should disclose my own affiliation; I am New Age.
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Conflict of interest: My religious affiliation is New Age.

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