Guérinet L, Tournier M
Université de Bordeaux, 146, rue Léo Saignat, 33076 Bordeaux cedex, France.
Université de Bordeaux, 146, rue Léo Saignat, 33076 Bordeaux cedex, France; Université de Bordeaux, Inserm Bordeaux Population Health Research Centre, équipe pharmaco-épidémiologie, UMR 1219, 146, rue Léo Saignat, 33076 Bordeaux cedex, France; Centre hospitalier Charles-Perrens, 121, rue de la Béchade, 33076 Bordeaux cedex, France.
Encephale. 2021 Jun;47(3):246-253. doi: 10.1016/j.encep.2020.10.002. Epub 2021 Feb 12.
Assisted death has been discussed for years in medicine. Ten countries have adopted legislation that authorises some form of euthanasia or assisted suicide, and the incidence and practices vary from country to country. Consideration of psychological pain linked to psychiatric disorders as a sufficient legal condition for enabling assisted death has added a new layer of complexity to the debate. Thus, Switzerland, Netherlands, Belgium and Luxembourg legalised assisted suicide or euthanasia for psychiatric reasons. In these cases, it is not a question of choosing death conditions but the occurrence of death. This manuscript is a narrative review of the literature about characteristics of patients with psychiatric disorders who requested assisted death in these countries.
Scientific manuscripts, reports and legal documents were reviewed.
The incidence of assisted death for psychiatric reasons was low but has increased over the years. They represented 1.1 % of assisted deaths in Belgium (n=23) and 1.3 % in Netherlands (n=83) in 2017, and 4.5 % in Switzerland in 2014 when also considering dementia. The most frequent diagnoses were depressive and personality disorders. Patients were more often women than men, unlike suicide and middle aged.
Authors who support these practices emphasise the right to die with dignity and the inequality of ruling out patients with psychiatric reasons, whereas they meet the legal requirements, and psychological pain is as severe as somatic pain. Some major issues are highlighted: the close relationship between mood symptoms and death wish, thinking biases and cognitive disturbances that limit the ability to decide, access and consent to medical care, the difficulty of assessing psychological pain, and the definitions of incurability or treatment refractoriness in psychiatry. To date, medical knowledge and assessment tools are not sufficient to define possible indications and offer the best support possible to these patients.
医学领域对协助死亡的讨论已持续多年。十个国家已通过立法，授权某种形式的安乐死或协助自杀，其发生率和实施情况因国家而异。将与精神疾病相关的心理痛苦视为允许协助死亡的充分法律条件，给这场辩论增添了新的复杂层面。因此，瑞士、荷兰、比利时和卢森堡已将因精神疾病原因的协助自杀或安乐死合法化。在这些情况下，问题不在于选择死亡条件，而在于死亡的发生。本手稿是对这些国家中请求协助死亡的精神疾病患者特征相关文献的叙述性综述。
对科学手稿、报告和法律文件进行了综述。
因精神疾病原因的协助死亡发生率较低，但多年来有所上升。2017年，比利时因精神疾病原因的协助死亡占协助死亡总数的1.1%（n = 23），荷兰为1.3%（n = 83），2014年瑞士若将痴呆症患者也考虑在内则为4.5%。最常见的诊断是抑郁和人格障碍。与自杀情况不同，患者中女性多于男性，且多为中年人。
支持这些做法的作者强调有尊严地死亡的权利，以及排除有精神疾病原因的患者的不平等性，因为他们符合法律要求，且心理痛苦与躯体痛苦一样严重。突出了一些主要问题：情绪症状与死亡意愿之间的密切关系、限制决策能力的思维偏差和认知障碍、获得和同意医疗护理的问题、评估心理痛苦的困难，以及精神病学中不治之症或治疗难治性的定义。迄今为止，医学知识和评估工具尚不足以确定可能的适应症并为这些患者提供最佳支持。
