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        An odd choice for an editorial!
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        An odd choice for an editorial!
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It is puzzling that this article by Shaw et al received the mantle of an editorial!1 The authors express opposition to psychiatric interview and psychological questionnaires in the assessment of individuals seeking assisted suicide. In my opinion the article should have been published for debate, with a contrary view presented.

The authors, ethicists in Switzerland, argue that for medical specialists to cause delay to assisted suicide is unethical, if a person with sound ‘decision-making capacity’ clearly and repeatedly and without any ambivalence expresses a wish for assisted suicide over a period of time.

One has to wonder why the authors oppose psychiatric assessments and psychological questionnaires. Psychiatrists are generally regarded among the most skilled of medical interviewers. In the opinion of many, untreated depression should be carefully excluded by psychiatric assessment before assisted suicide is supported. Sadly, there are countries where this is not the case.

The article acknowledges that relatives may coerce for financial gain. The person may wish to please relatives, be afraid to speak against them, etc – and still demonstrate sound decision-making capacity. But the article does not deal with how this thorny problem is to be tackled. In fact, examination beyond decision-making capacity is required: the person's motivation must be clearly established.

Psychological questionnaires have long been designed to clarify a respondent's unspoken beliefs and wishes. It is not hard to imagine a case of elder abuse in which a person fears to directly express their situation – and through an indirect questionnaire, followed by skilled interviewing, a wrongful death might be prevented.

Reference

1Shaw, D, Trachsel, M, Elger, B. Assessment of decision-making capacity in patients requesting assisted suicide. Br J Psychiatry 2018; 213: 393–5.