为什么有精神疾病的成年人会要求安乐死:一项对生活经历、动机和预防因素的定性访谈研究。
Why adults with psychiatric conditions request euthanasia: A qualitative interview study of life experiences, motives and preventive factors.
机构信息
Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Brussels, Belgium.
Department of Psychiatry, Ghent University Hospital, Belgium.
出版信息
J Psychiatr Res. 2021 Dec;144:158-167. doi: 10.1016/j.jpsychires.2021.09.032. Epub 2021 Sep 23.
OBJECTIVE
As the empirical picture of adults with psychiatric conditions (further referred to as 'patients') requesting euthanasia is still incomplete, this study aims to deepen our understanding of why these patients request euthanasia, how this relates to the option of suicide, and what could have prevented these patients from considering death and requesting euthanasia.
METHODS
A qualitative study using in-depth, face-to-face interviews was conducted with 16 patients who had their euthanasia request under assessment in the period 2016-2020. Thematic coding was used.
FINDINGS
Most patients were in a state of feeling emotionally worn-out as a result of the many accumulated misfortunes and setbacks, leading to the all-pervasive sense that life is no longer worth living. Whereas some patients reported lifelong adversity, others struggled predominantly in later life. Whereas some patients longed for death strongly, others expressed ambivalence towards death ideation, and some even requested euthanasia to hear of their ineligibility for it, to restore hope and to (re)find meaning in life. patients valued euthanasia over suicide as being more dignified and acceptable, both for themselves and for their inner circle. With regard to preventive factors, patients posited the need for improved accessibility and quality of mental healthcare, as well as a profound change in society's perception of, and support for, these patients.
CONCLUSIONS
This study revealed the many complexities of euthanasia in the context of psychiatry, due to the many differences in patients' background characteristics, in their motives for requesting euthanasia, and the multi-layered aspects of mental suffering that go beyond the field of psychiatry.
目的
由于精神病患者(进一步称为“患者”)提出安乐死的经验图景仍不完整,本研究旨在深入了解为什么这些患者要求安乐死,这与自杀选择有何关系,以及有哪些因素可以防止这些患者考虑死亡并要求安乐死。
方法
使用深入的面对面访谈对 2016 年至 2020 年期间正在评估安乐死请求的 16 名患者进行了定性研究。使用主题编码。
发现
大多数患者由于许多累积的不幸和挫折而感到情绪疲惫,导致他们普遍认为生活不再值得活下去。一些患者报告说一生都处于逆境中,而另一些患者则主要在晚年挣扎。一些患者强烈渴望死亡,而另一些患者对死亡观念表示矛盾,还有一些患者请求安乐死只是为了听说自己没有资格获得安乐死,以恢复希望并重新找到生活的意义。患者认为安乐死比自杀更有尊严和可接受,无论是对自己还是对自己的内心圈子。关于预防因素,患者提出需要改善精神保健的可及性和质量,并彻底改变社会对这些患者的看法和支持。
结论
这项研究揭示了精神病学背景下安乐死的许多复杂性,这是由于患者的背景特征、请求安乐死的动机以及超出精神病学领域的精神痛苦的多层次方面存在许多差异所致。