Hostname: page-component-76fb5796d-45l2p Total loading time: 0 Render date: 2024-04-25T13:55:16.148Z Has data issue: false hasContentIssue false
  • English
  • Français

Attitudes toward assisted suicide requests in the context of severe and persistent mental illness: A survey of psychiatrists in Switzerland

Published online by Cambridge University Press:  27 May 2019

Martina A. Hodel Open the ORCID record for Martina A. Hodel [Opens in a new window] ,
Paul Hoff ,
Scott A. Irwin ,
Nikola Biller-Andorno ,
Florian Riese  and
Manuel Trachsel
Martina A. Hodel*
Affiliation:
Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
Paul Hoff
Affiliation:
Psychiatric University Hospital Zurich, Zurich, Switzerland
Scott A. Irwin
Affiliation:
Cedars-Sinai Health System, Los Angeles, CA
Nikola Biller-Andorno
Affiliation:
Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
Florian Riese
Affiliation:
Psychiatric University Hospital Zurich, Zurich, Switzerland
Manuel Trachsel
Affiliation:
Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
*
Author for correspondence: Martina A. Hodel, Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006, Zurich, Switzerland. E-mail: martina.hodel@ibme.uzh.ch
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Switzerland is among the few countries worldwide where a request for assisted suicide (AS) can be granted on the basis of a primary psychiatric diagnosis. Psychiatrists play an increasingly important role in this regard, especially when the request for AS arises in the context of suffering caused by severe and persistent mental illness (SPMI). The objective of the survey was to assess general attitudes among psychiatrists in Switzerland regarding AS requests from patients with SPMI.

Method

In a cross-sectional survey of 1,311 German-speaking psychiatrists in Switzerland, participants were asked about their attitude to AS for patients with SPMI, based on three case vignettes of patients diagnosed with anorexia nervosa, treatment-refractory depression, or severe persistent schizophrenia.

Result

From a final sample of 457 psychiatrists (a response rate of 34.9%) whose mean age was 57.8 years, 48.6% of respondents did not support access to AS for persons diagnosed with SPMI, 21.2% were neutral, and 29.3% indicated some degree of support for access. In relation to the case vignettes, a slightly higher percentage of respondents supported the patient's wish to seek AS: 35.4% for those diagnosed with anorexia nervosa, 32.1% for those diagnosed with depression, and 31.4% for those diagnosed with schizophrenia.

Significance of results

Although a majority of the responding psychiatrists did not support AS for SPMI patients, about one-third would have supported the wishes of patients in the case vignettes. In light of the increasing number of psychiatric patients seeking AS and the continuing liberalization of AS practices, it is important to understand and take account of psychiatrists’ perspectives.

Keywords

Assisted suicidemedical aid in dyingrational suicidesevere and persistent mental illnesstreatment resistance
Type
Original Article
Information
Palliative & Supportive Care , Volume 17 , Issue 6 , December 2019 , pp. 621 - 627
Copyright
Copyright © Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Appelbaum, PS (2016) Physician-assisted death for patients with mental disorders—reasons for concern. JAMA Psychiatry 73, 325–326.Google Scholar
Arcelus, J, Mitchell, AJ, Wales, J, et al. (2011) Mortality rates in patients with anorexia nervosa and other eating disorders: A meta-analysis of 36 studies. Archives of General Psychiatry 68, 724–731.Google Scholar
Baweja, R and Singareddy, R (2013) Concomitant use of maintenance ECT and vagus nerve stimulation for more than 10 years in treatment-resistant depression. American Journal of Psychiatry 170, 1059–1061.Google Scholar
Bolt, EE, Snijdewind, MC, Willems, DL, et al. (2015) Can physicians conceive of performing euthanasia in case of psychiatric disease, dementia or being tired of living? Journal of Medical Ethics 41, 592–598.Google Scholar
Brauer, S, Bolliger, C, and Strub, J-D (2015) Swiss physicians’ attitudes to assisted suicide: A qualitative and quantitative empirical study. Swiss Medical Weekly 145, 1–8.Google Scholar
Brenner, HD, Dencker, SJ, Goldstein, MJ, et al. (1990) Defining treatment refractoriness in schizophrenia. Schizophrenia Bulletin 16, 551–561.Google Scholar
Dierickx, S, Deliens, L, Cohen, J, et al. (2017) Euthanasia for people with psychiatric disorders or dementia in Belgium: Analysis of officially reported cases. BMC Psychiatry 17.Google Scholar
Dyer, O, White, C, and Rada, AG (2015) Assisted dying: law and practice around the world. BMJ 351, h4481.Google Scholar
Emanuel, EJ, Onwuteaka-Philipsen, BD, Urwin, JW, et al. (2016) Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe. JAMA 316, 79–90.Google Scholar
Fischer, S, Bosshard, G, Faisst, K, et al. (2006) Swiss doctors’ attitudes towards end-of-life decisions and their determinants: A comparison of three language regions. Swiss Medical Weekly 136(23–24), 370–376.Google Scholar
Gamondi, C, Borasio, GD, Oliver, P, et al. (2017) Responses to assisted suicide requests: An interview study with Swiss palliative care physicians. BMJ Supportive & Palliative Care 9, e7.Google Scholar
Harding, L (2005) Swiss hospital the first to allow assisted suicides. The Guardian. Retrieved February 12, 2018, from http://www.theguardian.com/society/2005/dec/19/health.medicineandhealthGoogle Scholar
Hewitt, J (2013) Why are people with mental illness excluded from the rational suicide debate? International Journal of Law and Psychiatry 36, 358–365.Google Scholar
Ivbijaro, G (2017) Excess mortality in severe mental disorder: The need for an integrated approach. World Psychiatry 16, 48–49.Google Scholar
Kim, S and Lemmens, T (2016) Should assisted dying for psychiatric disorders be legalized in Canada? Canadian Medical Association Journal 188, 337–339.Google Scholar
Kim, SYH, Conwell, Y, and Caine, ED (2018) Suicide and physician-assisted death for persons with psychiatric disorders: How much overlap? JAMA Psychiatry 75, 1099–1100.Google Scholar
Kouwenhoven, PS, Raijmakers, NJ, van Delden, JJ, et al. (2013) Opinions of health care professionals and the public after eight years of euthanasia legislation in the Netherlands: A mixed methods approach. Palliative Medicine 27, 273–280.Google Scholar
Laursen, TM, Nordentoft, M, and Mortensen, PB (2014) Excess early mortality in schizophrenia. Annual Review of Clinical Psychology 10, 425–448.Google Scholar
Miller, FG and Appelbaum, PS (2018) Physician-assisted death for psychiatric patients—misguided public policy. New England Journal of Medicine 378, 883–885.Google Scholar
Regional euthanasia review committees (2017) Annual reports. Retrieved January 15, 2019, from https://english.euthanasiecommissie.nl/the-committees/documents/publications/annual-reports/2002/annual-reports/annual-reportsGoogle Scholar
Rietjens, JAC, Van Tol, DG, Schermer, M, et al. (2009) Judgement of suffering in the case of a euthanasia request in The Netherlands. Journal of Medical Ethics 35, 502–507.Google Scholar
Rousseau, S, Turner, S, Chochinov, HM, et al. (2017) A national survey of Canadian psychiatrists’ attitudes toward medical assistance in death. Canadian Journal of Psychiatry 62, 787–794.Google Scholar
Schuklenk, U and van de Vathorst, S (2015) Treatment-resistant major depressive disorder and assisted dying: Response to comments. Journal of Medical Ethics 41, 589–591.Google Scholar
Steck, N, Junker, C, and Zwahlen, M (2018) Increase in assisted suicide in Switzerland: Did the socioeconomic predictors change? Results from the Swiss National Cohort. BMJ Open 8, e020992.Google Scholar
Swiss Academy of Medical Sciences (SAMS) (2018) Guidelines: Management of dying and death. Accessed May 1, 2019. Retrieved from https://www.samw.ch/en/Ethics/Ethics-in-end-of-life-care/Guidelines-management-dying-death.htmlGoogle Scholar
Trachsel, M, Hodel, MA, Irwin, SA, et al. (2019). Acceptability of palliative care approaches for patients with severe and persistent mental illness: A survey of psychiatrists in Switzerland. BMC Psychiatry 19, 111.Google Scholar
Trachsel, M, Wild, V, Biller-Andorno, N, et al. (2015) Compulsory treatment in chronic anorexia nervosa by all means? Searching for a middle ground between a curative and a palliative approach. American Journal of Bioethics 15, 55–56.Google Scholar
Tuffs, A (2007) Swiss hospitals admit to allowing assisted suicide on their wards. British Medical Journal 335.Google Scholar
Vandenberghe, J (2018) Physician-assisted suicide and psychiatric illness. New England Journal of Medicine 378, 885–887.Google Scholar
Van Tol, D, Rietjens, J, van der Heide, A (2010) Judgment of unbearable suffering and willingness to grant a euthanasia request by Dutch general practitioners. Health Policy 97, 166–172.Google Scholar
Ziegler, SJ (2009) Collaborated death: An exploration of the Swiss model of assisted suicide for its potential to enhance oversight and demedicalize the dying process. Journal of Law, Medicine & Ethics 37, 318–330.Google Scholar
Ziegler, SJ and Bosshard, G (2007) Role of non-governmental organisations in physician assisted suicide. British Medical Journal 334, 295–298.Google Scholar