Kim Scott Y H, De Vries Raymond G, Peteet John R
Department of Bioethics, National Institutes of Health, Bethesda, Maryland.
Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor3CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
JAMA Psychiatry. 2016 Apr;73(4):362-8. doi: 10.1001/jamapsychiatry.2015.2887.
Euthanasia or assisted suicide (EAS) of psychiatric patients is increasing in some jurisdictions such as Belgium and the Netherlands. However, little is known about the practice, and it remains controversial.
To describe the characteristics of patients receiving EAS for psychiatric conditions and how the practice is regulated in the Netherlands.
DESIGN, SETTING, AND PARTICIPANTS: This investigation reviewed psychiatric EAS case summaries made available online by the Dutch regional euthanasia review committees as of June 1, 2015. Two senior psychiatrists used directed content analysis to review and code the reports. In total, 66 cases from 2011 to 2014 were reviewed.
Clinical and social characteristics of patients, physician review process of the patients' requests, and the euthanasia review committees' assessments of the physicians' actions.
Of the 66 cases reviewed, 70% (n = 46) were women. In total, 32% (n = 21) were 70 years or older, 44% (n = 29) were 50 to 70 years old, and 24% (n = 16) were 30 to 50 years old. Most had chronic, severe conditions, with histories of attempted suicides and psychiatric hospitalizations. Most had personality disorders and were described as socially isolated or lonely. Depressive disorders were the primary psychiatric issue in 55% (n = 36) of cases. Other conditions represented were psychotic, posttraumatic stress or anxiety, somatoform, neurocognitive, and eating disorders, as well as prolonged grief and autism. Comorbidities with functional impairments were common. Forty-one percent (n = 27) of physicians performing EAS were psychiatrists. Twenty-seven percent (n = 18) of patients received the procedure from physicians new to them, 14 of whom were physicians from the End-of-Life Clinic, a mobile euthanasia clinic. Consultation with other physicians was extensive, but 11% (n = 7) of cases had no independent psychiatric input, and 24% (n = 16) of cases involved disagreement among consultants. The euthanasia review committees found that one case failed to meet legal due care criteria.
Persons receiving EAS for psychiatric disorders in the Netherlands are mostly women and of diverse ages, with complex and chronic psychiatric, medical, and psychosocial histories. The granting of their EAS requests appears to involve considerable physician judgment, usually involving multiple physicians who do not always agree (sometimes without independent psychiatric input), but the euthanasia review committees generally defer to the judgments of the physicians performing the EAS.
在比利时和荷兰等一些司法管辖区，精神病患者的安乐死或协助自杀（EAS）现象正在增加。然而，人们对这种做法知之甚少，且它仍然存在争议。
描述接受精神病相关安乐死的患者特征以及荷兰对该做法的监管情况。
设计、背景和参与者：本调查回顾了荷兰地区安乐死审查委员会截至2015年6月1日在网上公布的精神病安乐死案例摘要。两名资深精神科医生采用定向内容分析法对报告进行审查和编码。共审查了2011年至2014年的66个案例。
患者的临床和社会特征、医生对患者请求的审查过程以及安乐死审查委员会对医生行为的评估。
在审查的66个案例中，70%（n = 46）为女性。其中，32%（n = 21）年龄在70岁及以上，44%（n = 29）年龄在50至70岁之间，24%（n = 16）年龄在30至50岁之间。大多数患者患有慢性重症疾病，有自杀未遂和精神病住院史。大多数患者有人格障碍，被描述为社会孤立或孤独。55%（n = 36）的案例中，抑郁症是主要的精神疾病问题。其他出现的疾病包括精神病性、创伤后应激或焦虑、躯体形式、神经认知和饮食失调，以及持续性悲伤和自闭症。伴有功能障碍的合并症很常见。实施安乐死的医生中有41%（n = 27）是精神科医生。27%（n = 18）的患者接受了对他们来说是新医生的操作，其中14名医生来自临终诊所，一家流动安乐死诊所。与其他医生的会诊很广泛，但11%（n = 7）的案例没有独立的精神科意见，24%（n = 16）的案例涉及会诊医生之间的分歧。安乐死审查委员会发现有一个案例不符合法定的应有关注标准。
在荷兰，接受精神病相关安乐死的人大多是女性，年龄各异，有复杂的慢性精神、医学和心理社会病史。批准他们的安乐死请求似乎需要医生进行相当多的判断，通常涉及多名意见不总是一致的医生（有时没有独立的精神科意见），但安乐死审查委员会通常会听从实施安乐死医生的判断。
