Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
GGZinGeest, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, the Netherlands.
Int J Law Psychiatry. 2020 Sep-Oct;72:101627. doi: 10.1016/j.ijlp.2020.101627. Epub 2020 Sep 17.
As international laws on physician aid in dying (PAD) evolve, the question of permitting PAD in non-terminal illness, and in sole psychiatric illness, is under intense debate. In jurisdictions where PAD is permissible, certain safeguards and eligibility requirements must be met for all patients making a PAD request, and one of these requirements is that the patient have sound decision-making capacity with respect to the request. Legal criteria already exist for the determination of capacity, and they are quite similar between different jurisdictions. In current debates about the question of psychiatric PAD, one concern that has been raised is that cognitive distortions in mental disorders may affect a patient's decision-making capacity. At the same time, it has been established that all persons, with or without a mental disorder, experience cognitive distortions. If cognitive distortions are ubiquitous, it is likely that the severity and frequency of cognitive distortions is dimensional rather than categorical, between samples with and without mental illness. Furthermore, currently, there is no requirement for a formalized evaluation of cognitive distortions as part of capacity assessment for any type of medical decision, including PAD decisions. The current paper examines the literature related to cognitive distortions in mental disorders and in healthy populations. It proposes that the existence of cognitive distortions, alone, cannot be used as an argument for a blanket exclusion of psychiatric PAD. It therefore concludes that further research and ethical analysis should be undertaken to examine the impact of cognitive distortions on decision-making for consequential medical decisions, including PAD, in patients with and without mental disorders.
随着国际医师协助自杀（PAD）法律的发展，允许在非终末期疾病和单纯精神疾病中实施 PAD 的问题正在激烈争论中。在允许 PAD 的司法管辖区，所有提出 PAD 请求的患者都必须满足某些保障措施和资格要求，其中之一是患者在请求方面具有健全的决策能力。已经存在用于确定能力的法律标准，并且它们在不同的司法管辖区之间非常相似。在关于精神科 PAD 问题的当前辩论中，一个引起关注的问题是，精神障碍中的认知扭曲可能会影响患者的决策能力。同时，已经确定所有有或没有精神障碍的人都会经历认知扭曲。如果认知扭曲是普遍存在的，那么在有和没有精神疾病的样本之间，认知扭曲的严重程度和频率可能是维度的，而不是分类的。此外，目前，在任何类型的医疗决策（包括 PAD 决策）的能力评估中，都没有要求对认知扭曲进行正式评估。本文研究了与精神障碍和健康人群中的认知扭曲相关的文献。它提出，仅存在认知扭曲本身不能作为全面排除精神科 PAD 的论据。因此，它得出结论，应该进行进一步的研究和伦理分析，以检查认知扭曲对有和没有精神障碍的患者进行 consequential 医疗决策（包括 PAD）的决策的影响。
