Department of Psychology, University of Milan-Bicocca, Milan, Italy; Department of Adult Psychiatry, Nîmes University Hospital, Nîmes, France; PSNREC, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France.
PSNREC, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France.
J Psychiatr Res. 2021 Mar;135:153-173. doi: 10.1016/j.jpsychires.2020.12.006. Epub 2020 Dec 3.
The number of psychiatric patients requesting Euthanasia or Assisted Suicide (EAS) continues to increase. The aims of this systematic review were to: 1) describe the available data related to psychiatric patients having received or requesting EAS (pEAS) for each country in which is allowed; 2) and describe the ethically salient points that arise. PubMed, PsycINFO, and Scopus databases were searched to identify articles published up to September 2020. Among the retrieved publications, only studies on pEAS cases (pEAS-C), pEAS requests, or physician reports/attitude towards pEAS reporting some quantitative data on patients having received or requesting pEAS were retained. Among the 24 included studies, thirteen (54%) were about pEAS in the Netherlands, four (17%) in Belgium, and seven (29%) in Switzerland. Results were different across different countries. In the Netherlands, pEAS-C were mostly women (70-77%) and often had at least two psychiatric disorders (56-97%). Mood disorders were mainly represented (55-70%) together with personality disorders (52-54%). History of suicide attempts was present in 34-52%. Moreover, 37-62% of them had at least one comorbid medical condition. In Belgium pEAS-C were mostly women (75%), but the majority (71%) had a single diagnosis, mood disorder. In Switzerland available data were less detailed. As pEAS-C seem to be very similar to 'traditional suicides', pEAS procedures should be carefully revised to establish specific criteria of access and guidelines of evaluation of the request. A deeper focus on unbearable suffering, decision capacity and possibilities of improvements is warranted as well as the involvement of mental health professionals.
要求安乐死或协助自杀（EAS）的精神科患者人数持续增加。本系统评价的目的是：1）描述每个允许安乐死或协助自杀的国家中与接受或要求 EAS（pEAS）的精神科患者相关的可用数据；2）描述出现的伦理要点。检索了 PubMed、PsycINFO 和 Scopus 数据库，以确定截至 2020 年 9 月发表的文章。在所检索到的出版物中，仅保留了关于 pEAS 病例（pEAS-C）、pEAS 请求或医生对报告/对 pEAS 报告的态度的研究，这些研究报告了一些有关接受或要求 pEAS 的患者的定量数据。在纳入的 24 项研究中，有 13 项（54%）是关于荷兰的 pEAS，4 项（17%）是关于比利时的 pEAS，7 项（29%）是关于瑞士的 pEAS。结果因国家而异。在荷兰，pEAS-C 大多为女性（70-77%），且通常至少患有两种精神障碍（56-97%）。心境障碍（55-70%）主要代表，同时伴有人格障碍（52-54%）。有自杀企图史的患者占 34-52%。此外，37-62%的患者至少有一种合并的躯体疾病。在比利时，pEAS-C 大多为女性（75%），但大多数（71%）患者只有单一诊断，即心境障碍。在瑞士，可用数据较为简略。由于 pEAS-C 似乎与“传统自杀”非常相似，因此应仔细审查 pEAS 程序，以建立准入的具体标准和请求评估指南。还需要更加关注无法忍受的痛苦、决策能力和改善的可能性，并让精神卫生专业人员参与进来。
