The million dollar question

New England Journal of Medicine (Impact Factor: 55.87). 05/2005; 352(16):1632. DOI: 10.1056/NEJMp058081
Source: PubMed
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    ABSTRACT: In her paper, The case for physician assisted suicide: not (yet) proven, Bonnie Steinbock argues that the experience with Oregon's Death with Dignity Act fails to demonstrate that the benefits of legalising physician assisted suicide outweigh its risks. Given that her verdict is based on a small number of highly controversial cases that will most likely occur under any regime of legally implemented safeguards, she renders it virtually impossible to prove the case for physician assisted suicide. In this brief paper, we suggest some ways that may enable us to weigh the risks and benefits of legalisation more fairly and, hopefully, allow us to close the case for physician assisted suicide.
    Journal of Medical Ethics 07/2006; 32(6):335-8. DOI:10.1136/jme.2005.012864 · 1.51 Impact Factor
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    Heart rhythm: the official journal of the Heart Rhythm Society 07/2010; 7(7):1008-26. DOI:10.1016/j.hrthm.2010.04.033 · 5.08 Impact Factor
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    ABSTRACT: Objective: Assisted dying is a contentious and topical issue. Mental disorder is a relevant influence on requests of hastened death. The psychiatry of dying is not a prominent component in the assessment of euthanasia and physician-assisted suicide (PAS) in jurisdictions with liberalised assisted dying laws. The literature on the assessment processes, with particular reference to mental status, involved in euthanasia requests is considered. Methods: An experienced palliative medicine specialist and psychiatrist selectively reviewed the recent literature published about the mental health issues involved in euthanasia and PAS. Results: Assessments of competency, sustained wish to die prematurely, depressive disorder, demoralisation and 'unbearable suffering' in the terminally ill are clinically uncertain and difficult tasks. There is a growing psychiatric and psychological literature on the mental status of the terminally ill. As yet psychiatry does not have the expertise to 'select' those whose wish for hastened death is rational, humane and 'healthy'. Rarely in those societies with liberalised assisted dying laws are psychiatrists involved in the decision-making for individuals requesting early death. This role is fulfilled by non-specialists. Conclusions: There remain significant concerns about the accuracy of psychiatric assessment in the terminally ill. Mental processes are more relevant influences on a hastened wish to die than are the physical symptoms of terminal malignant disease. Psychiatric review of persons requesting euthanasia is relevant. It is not obligatory or emphasised in those legislations allowing assisted dying. Psychiatry needs to play a greater role in the assessment processes of euthanasia and PAS.
    Australian and New Zealand Journal of Psychiatry 10/2012; 46(10):936-45. DOI:10.1177/0004867411434714 · 3.41 Impact Factor