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精神疾病中的安乐死:两名抑郁症女性病例的临床与伦理问题

Euthanasia in Mental Disorders: Clinical and Ethical Issues in the Cases of Two Women Suffering from Depression.

作者信息

Bersani Giuseppe, Iannitelli Angela, Pimpinella Pascual, Sessa Francesco, Salerno Monica, Chisari Mario, Rinaldi Raffaella

机构信息

Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Roma, Italy.

Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio, 67100 L'Aquila, Italy.

出版信息

Healthcare (Basel). 2025 Aug 16;13(16):2019. doi: 10.3390/healthcare13162019.

Abstract

The extension of euthanasia and physician-assisted suicide to individuals with mental disorders presents a profound ethical, clinical, and legal challenge. While increasingly accepted in some jurisdictions, their application in psychiatric contexts-particularly in cases of depression-raises concerns about diagnostic precision, therapeutic adequacy, and the validity of informed consent. This study examines two controversial Belgian cases to explore the complexities of euthanasia for psychological suffering. A qualitative case analysis was conducted through a qualitative analysis of publicly available media sources. The cases were examined through clinical, psychoanalytic, and medico-legal lenses to assess diagnostic clarity, treatment history, and ethical considerations. No access to official medical records was available. The first case involved a young woman whose depressive symptoms were reportedly linked to trauma from a terrorist attack. The second concerned a middle-aged woman convicted of infanticide and later diagnosed with Major Depression. In both cases, euthanasia was granted on the grounds of "irreversible psychological suffering." However, the absence of detailed clinical documentation, potential unresolved trauma, and lack of psychodynamic assessment raised doubts about the robustness of the evaluations and the validity of informed consent. These findings highlight the need for a more rigorous, multidisciplinary, and ethically grounded approach to psychiatric euthanasia. This study underscores the importance of precise diagnostic criteria, comprehensive treatment histories, and deeper exploration of unconscious and existential motivations. Safeguarding clinical integrity and ethical standards is essential in end-of-life decisions involving mental illness.

摘要

将安乐死和医生协助自杀扩展至精神障碍患者,这带来了深刻的伦理、临床和法律挑战。尽管在一些司法管辖区越来越被接受,但它们在精神病学背景下的应用——尤其是在抑郁症病例中——引发了对诊断准确性、治疗充分性以及知情同意有效性的担忧。本研究考察了两起有争议的比利时案例,以探究因心理痛苦实施安乐死的复杂性。通过对公开可得的媒体来源进行定性分析,开展了一项定性案例分析。从临床、精神分析和法医学角度对这些案例进行审视,以评估诊断清晰度、治疗史和伦理考量。无法获取官方医疗记录。第一个案例涉及一名年轻女性,据报道其抑郁症状与一次恐怖袭击造成的创伤有关。第二个案例涉及一名被判杀婴罪的中年女性,后来被诊断为重度抑郁症。在这两个案例中,均以“无法逆转的心理痛苦”为由批准了安乐死。然而,缺乏详细的临床记录、潜在未解决的创伤以及缺乏心理动力学评估,让人对评估的可靠性和知情同意的有效性产生怀疑。这些发现凸显了对精神病学安乐死采取更严格、多学科且基于伦理的方法的必要性。本研究强调了精确诊断标准、全面治疗史以及深入探究无意识和存在动机的重要性。在涉及精神疾病的临终决策中,维护临床完整性和伦理标准至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5d83/12385801/c02c21073129/healthcare-13-02019-g001.jpg

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