2015-21, general practitioner, psychiatric disorders, voluntary and well-considered request, unbearable suffering without prospect of improvement, no reasonable alternative

KEY POINT: psychiatric disorder

A woman with severe psychiatric problems, for whom no treatment had had a satisfactory effect, requested euthanasia. As her attending psychiatrist could not comply with her euthanasia request, she contacted the End-of-Life Clinic (SLK). After consulting with the patient’s attending psychiatrists and two independent psychiatrists, the SLK physician concluded that the due care criteria had been complied with.

The patient, a woman in her forties, had for years suffered from a suspected personality disorder with avoidant and borderline characteristics, which led to chronic depression and post-traumatic stress disorder (PTSD) with dissociation and severe self-harming. She had been severely traumatised in her youth.

The patient underwent a wide range of treatments, including medication, outpatient psychotherapy, cognitive behavioural therapy, group therapy and trauma therapy. The patient tried all the treatments proposed to her. None of them, however, had a lasting positive effect on her problems. Her condition was incurable. She could only be treated palliatively.

The patient’s suffering consisted of reliving events and dissociation, resulting in severe selfharm. The patient was preoccupied all day long and could not stop the stream of thoughts running through her head. She was tired and lonely, could not see a single ray of hope and could not bear the thought that she would be depressed for the rest of her life, with dissociation leading to severe self-harm. She suffered from the absence of any prospect of improvement in her situation. The patient experienced her suffering as unbearable.

Four months before her death, the patient and the physician affiliated with the SLK discussed euthanasia for the first time. On that occasion, the patient immediately asked the physician to actually perform the procedure to terminate her life. After that, the physician and the patient talked about euthanasia on five other occasions. The physician also spoke to her attending specialists.

At the physician’s request, two independent psychiatrists gave a second opinion following the patient’s request for euthanasia. Both concluded that the patient was decisionally competent and her request was voluntary and had been made repeatedly. They were convinced the patient was suffering unbearably and concluded that in the current state of medical knowledge there was no realistic prospect of improvement in the quality of her life. The independent physician was satisfied that the due care criteria had been complied with.

The committee notes that if a patient is suffering from a psychiatric disorder, physicians must exercise particular caution when dealing with a euthanasia request. The committee found that in the case under review the physician did so. In  consultation with the patient’s attending psychiatrists, the physician went through a process lasting approximately four months in which he spoke with the patient on six occasions and in which great care was taken in assessing whether there were any treatment options still available to the patient.

The physician asked two independent psychiatrists for a second opinion and consulted an independent physician. Partly on the basis of their findings, the physician was satisfied that the due care criteria had been complied with, in particular that the patient was decisionally competent, that she was suffering with no prospect of improvement and that there were no realistic treatment options available.