Capacity Evaluations of Psychiatric Patients Requesting Assisted Death in the Netherlands

• Published in: Psychosomatics (Washington, D.C.) Vol. 57; no. 6; pp. 556 - 565
• Main Authors: Doernberg, Samuel N., BA, Peteet, John R., MD, Kim, Scott Y.H., MD, PhD
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.11.2016
• Subjects: Adult; Aged; Aged, 80 and over; assisted suicide; Clinical Decision-Making - methods; decision-making capacity; Euthanasia; Female; Humans; Internal Medicine; Male; Mental Competency; Mental Disorders - psychology; mental health; Middle Aged; Netherlands; Physician-Patient Relations; Psychiatry; Suicide, Assisted; assisted suicide; euthanasia; Netherlands; decision-making capacity; mental health
• ISSN: 0033-3182; 1545-7206
• DOI: 10.1016/j.psym.2016.06.005

Objective Euthanasia or physician-assisted suicide (EAS) of psychiatric patients is legal in some countries but remains controversial. This study examined a frequently raised concern about the practice: how physicians address the issue of decision-making capacity of persons requesting psychiatric EAS. Methods A review of psychiatric EAS case summaries published by the Dutch Regional Euthanasia Review Committees. Directed content analysis using a capacity-specific 4 abilities model (understanding of facts, applying those facts to self, weighing/reasoning, and evidencing choice) was used to code texts discussing capacity. 66 cases from 2011–2014 were reviewed. Results In 55% (36 of 66) of cases the capacity-specific discussion consisted of only global judgments of patients′ capacity, even in patients with psychotic disorders. 32% (21 of 66) of cases included evidentiary statements regarding capacity-specific abilities; only 5 cases (8%) mentioned all four abilities. Physicians frequently stated that psychosis or depression did or did not impact capacity but provided little explanation regarding their judgments. Physicians in 8 cases (12%) disagreed about capacity; even when no explanation is given for the disagreement, the review committees generally accepted the judgment of the physician performing EAS. In one case, the physicians noted that not all capacity-specific abilities were intact but deemed the patient capable. Conclusion Case summaries of psychiatric EAS in the Netherlands do not show that a high threshold of capacity is required for granting EAS. Although this may reflect limitations in documentation, it likely represents a practice that reflects the normative position of the review committees.