“An Emerging Ethical Crisis”

Physician Assisted Suicide and Euthanasia of Non-Terminal Psychiatric Patients

In several European countries physician-assisted suicide and euthanasia by lethal injection are being made available to psychiatric patients with non-terminal mental illnesses, commonly administered by their own treating psychiatrists giving the injection. Canada now offers euthanasia by injection for patients who are not strictly terminally ill and is on the verge of making it available to those with psychiatric disorders only. This raises profound ethical questions, for psychiatrists in particular, who have a core ethos and skill set to prevent suicide, help patients cope with suffering, find alternative paths to a better future, even make meaning of suffering. Allowing psychiatrists to help their patients suicide inverts the fundamental ethical framework and very definition of what it means to be a psychiatrist. This lecture examines the history of developments in Europe, Canada, and the U.S. regarding physician-assisted suicide and euthanasia of non-terminal psychiatric patients. Data from Belgium and Netherlands are reviewed. The positions of medical and psychiatric organizations around the world are shown, especially the new ethical position against such practices by the American Psychiatric Association. Fundamental ethical arguments in favor of psychiatric euthanasia are contrasted with those against. Clinical, social, and professional consequences are reviewed, including some specific cases, relevant data, and evidence for a “slippery slope’ of these policies and practices. Finally, the way these activities challenge the fundamental identity of physicians in general and the psychiatrists in particular will be discussed, and how this is an unanticipated consequence of pursuing parity for the mentally ill.

Mark Komrad MD is the Ethicist-in-Residence for the Sheppard Pratt Health Systems, where he chaired the Ethics Committee for over 20 years. He is on the teaching faculty of Johns Hopkins and the University of Maryland. He is a member of the APA Assembly and previously served 6 years on the APA Ethics Committee. In these two capacities, he helped craft the new APA Position Statement, just approved this past December:

 “…a psychiatrist should not prescribe or administer any intervention to a NON-terminally ill person for the purpose of causing death.” 

He is now lecturing widely through the U.S., Canada, and Europe to address the ethical concerns that several hundred suicidal psychiatric patients in Belgium and the Netherlands are being voluntarily euthanized each year with lethal injections, typically by their own treating psychiatrists. He has consulted several times to policy makers in Canada, trying to dissuade them from extending the current Canadian law — permitting physician-assisted suicide for non-terminal patients— to now include psychiatric patients in this new Canadian right, a goal being promoted by certain advocacy groups there.

Dr. Komrad maintains a private practice and has a special interest in helping families convince a troubled loved one to get a psychiatric consultation, using ideas from his book You Need Help: A Step-by-Step Plan to Convince a Loved One to Get Counseling (YouNeedHelpBook.com).  He lectures and gives workshops on these ideas to mental health advocacy and support organizations throughout the country.  For this work he was given NAMI’s “Exemplary Psychiatrist Award” and its “Mental Health Professional of the Year Award.” He was also host of the national radio call-in talk show, “Komrad On Call,” which broadcast to 43 million listeners throughout the U.S., and he continues to appear regularly on TV, radio, and podcasts to discuss topics in psychiatry.

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