2016-41, general practitioner, psychiatric disorders, voluntary and well-considered request, unbearable suffering without prospect of improvement, no reasonable alternative

KEY POINTS: assessment of decisional competence, need for particular caution in cases involving patients with a psychiatric disorder

The patient, a woman in her forties, had been diagnosed with posttraumatic stress disorder (continually reliving bad experiences in thoughts or dreams) with psychotic features (during a psychotic episode, people experience the world differently from other people; they may hear voices, perceive smells differently or give special meaning to certain thoughts). Every day she relived traumas from her youth while experiencing symptoms of dissociation (a state in which thoughts, emotions, observations and memories are placed outside the person’s consciousness). She also suffered from severe sleeping disorders.

She was admitted to a specialised hospital several times and received a number of treatments including 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), Eye Movement Desensitisation and Reprocessing (EMDR, a treatment method mainly used with people with post-traumatic stress disorder) and other trauma treatment. She also received medication for depression and psychosis and she took sleeping medication.
The effects of these treatments were only temporary.

The patient had made an active effort to improve her future prospects by enrolling in education. However, she was unable to follow the course due to her persistent symptoms and constant exhaustion.

At the physician’s request, a clinical psychologist assessed whether any further treatment was possible. Starting with treatment again would require strong motivation on the patient’s part, because despite a lengthy history of treatment, no progress had been made. She indicated she was unable to summon the motivation.

The physician also asked an independent psychiatrist to assess whether there were any other solutions. In the opinion of the psychiatrist, everything possible had been done. After consulting the psychiatrist, the physician was satisfied that this suffering was unbearable to the patient and with no prospect of improvement according to prevailing medical opinion.

The committee noted that physicians must exercise particular caution when dealing with a euthanasia request from a patient suffering from a psychiatric disorder.

The physician, a general practitioner, consulted a clinical psychologist and a clinical psychiatrist. The committee found that the physician could be satisfied that the patient was suffering unbearably with no prospect of improvement and that her request was voluntary and well-considered. The other due care criteria were also fulfilled.