2016-01, psychiatrist, psychiatric disorders, no reasonable alternative

KEY POINTS: anorexia nervosa with depressive symptoms, a somatic symptom disorder and a personality disorder, need for particular caution in cases involving patients with a psychiatric disorder

The patient, a woman in her sixties, had suffered from anorexia nervosa since her youth. In addition she increasingly suffered from recurrent depressions, and had a personality disorder and a somatoform pain disorder (when a person has numerous physical symptoms for which there is no physical explanation – treatment focuses on psychiatric causes).

She had been treated extensively, on both an inpatient and outpatient basis, for anxieties, depressions and a strong death wish. The treatments she received included electroconvulsive therapy (in which an electric current is passed across the brain), pain medication, cognitive behavioural therapy (a form of short-term psychological therapy focusing on the present and future rather than on coming to terms with the past) and treatments focusing on MUPS (medically unexplained physical symptoms). These treatments did not result in any real changes.

In the end there was no further treatment offering any prospect of improvement. In the final years before her death, her condition continued to deteriorate. Her condition was incurable.

The patient experienced her suffering as unbearable and asked her physician for euthanasia. The physician was satisfied that this suffering was unbearable to her and with no prospect of improvement according to prevailing medical opinion.

The physician consulted an independent psychiatrist in order to rule out the existence of any treatment options.

In the opinion of the psychiatrist, treatment was theoretically possible. However, she believed it was extremely doubtful that the patient would be able to tolerate the treatment or be able to enter into and maintain an appropriate treatment relationship.
This doubt was partly rooted in the fact that the patient had indicated that she was no longer motivated to undergo treatment. The physicians thus came to the conclusion that there were no other means to alleviate the patient’s suffering that were acceptable to her.

The committee noted that physicians must exercise particular caution when dealing with a euthanasia request from a patient suffering from a psychiatric disorder. The committee found that in this case the physician did so.

Besides the independent SCEN physician, the physician also consulted an independent psychiatrist. The psychiatrist concluded, partly in view of the patient’s limited capacity to cope and her lack of motivation, that there were no relevant treatment options left. The independent physician confirmed the physician’s assessment that further treatment would not result in any lasting improvement and that there were no longer any realistic alternatives for her.

The committee found that, together, the physician and the patient could be satisfied that there was no reasonable alternative in her situation. The other due care criteria were also fulfilled.