Department of General Practice, Medical Ethics Section, Amsterdam UMC, Academic Medical Centre, Amsterdam, The Netherlands.
Department of Medical Ethics and Philosophy, Erasmus Medical Centre, Rotterdam, The Netherlands.
Scand J Prim Health Care. 2021 Jun;39(2):166-173. doi: 10.1080/02813432.2021.1913895. Epub 2021 Jul 9.
In the Netherlands, physician-assisted death (PAD) is allowed under certain conditions. Patients who suffer from mental illnesses are not excluded from this practice. In 2018, general practitioners (GPs) performed 20 out of a total of 67 cases of EAS for psychiatric suffering.
More insight into GPs' experiences and views with regard to PAD in psychiatry.
The data for this study were obtained through a survey amongst 500 randomly selected Dutch GPs and by in-depth interviews with 20 Dutch GPs.
A survey study and in-depth interviews.
Dutch GPs.
86 out of 101 GPs found it conceivable to perform EAS in case of somatic disease, and 51 out of 104 GPs found it conceivable in the case a patient suffered from a mental illness only. The main reason given for refusing an PAD request was that the criteria of due care were not met. Reasons for supporting psychiatric PAD related to responsibility, self-determination, compassion, fairness, and preventing suicide. Reasons for not supporting psychiatric PAD were related to the scope of medicine, a perceived lack of experience, uncertainties regarding the criteria of due care and life-expectancy.
GPs are less likely to perform PAD for suffering from a mental illness, compared to somatic suffering. Some GPs apply an extra criterion of 'life-expectancy' in case of PAD for suffering from a mental illness. Refusing PAD based on a long life expectancy keeps open the possibility of recovery, but may also just prolong the suffering and add to the unbearableness of it.KEY POINTSCurrently, there is no qualitative research on what the views are of general practitioners regarding the subject of physician-assisted death (PAD) for patients suffering from severe mental disorders.General practitioners are less likely to consider a request for physician-assisted death by a patient suffering from a psychiatric disorder, compared to somatic suffering. Reasons for supporting psychiatric PAD related to responsibility, self-determination, compassion, fairness, and preventing suicide.Reasons for not supporting psychiatric PAD were related to the scope of medicine, a perceived lack of experience, uncertainties regarding the criteria of due care and life-expectancy.Significance for the reader: Although allowed in the Netherlands, PAD in case of severe mental suffering remains a controversial topic. We need in-depth information about the actual practice of it to have an informed debate with regard to this subject.
在荷兰，在某些条件下允许医生协助死亡（PAD）。患有精神疾病的患者不被排除在这种做法之外。2018 年，普通医生（GP）执行了总共 67 例 EAS 中的 20 例，用于治疗精神痛苦。
更深入地了解全科医生在精神病学中对 PAD 的经验和看法。
这项研究的数据是通过对 500 名随机选择的荷兰全科医生进行调查以及对 20 名荷兰全科医生进行深入访谈获得的。
调查研究和深入访谈。
荷兰全科医生。
86 名全科医生认为在患有躯体疾病的情况下进行 EAS 是可以想象的，而 104 名全科医生中有 51 名认为在患者仅患有精神疾病的情况下进行 EAS 是可以想象的。拒绝 PAD 请求的主要原因是没有满足适当护理的标准。支持精神病 PAD 的主要原因与责任、自主、同情、公平和预防自杀有关。不支持精神病 PAD 的原因与医学范围、缺乏经验、对适当护理标准和预期寿命的不确定性有关。
与躯体痛苦相比，全科医生不太可能为精神痛苦而实施 PAD。一些全科医生在精神病 PAD 中应用了“预期寿命”的额外标准。根据预期寿命长而拒绝 PAD 保留了康复的可能性，但也可能只是延长痛苦并使其更加难以忍受。
目前，没有关于全科医生对患有严重精神障碍的患者进行医生协助死亡（PAD）的看法的定性研究。与躯体痛苦相比，全科医生不太可能考虑患有精神障碍的患者提出的 PAD 请求。支持精神病 PAD 的原因与责任、自主、同情、公平和预防自杀有关。不支持精神病 PAD 的原因与医学范围、缺乏经验、对适当护理标准和预期寿命的不确定性有关。
尽管在荷兰允许，但 PAD 在严重精神痛苦的情况下仍然是一个有争议的话题。我们需要深入了解其实际做法，以便就这个问题进行知情辩论。
