Developing a training module for psychiatrists dealing with requests for physician assisted suicide of psychiatric patients in the Netherlands
Hulp bij zelfdoding is in de psychiatrische praktijk een zeldzame gebeurtenis. In de psychiatrie wordt de wens om dood te gaan (terecht) allereerst gezien als symptoom van de aandoening, stoornis of levensfaseproblematiek. De doodswens van een psychiatrische patiënt wordt dan ook vooral begrepen in termen van suïcidaliteit en niet als reëel verzoek om hulp bij zelfdoding. De laatste jaren is er toenemende maatschappelijke en professionele aandacht voor psychiatrische patiënten met een verzoek om hulp bij zelfdoding. Daarbij wordt onderkend dat de bestaande terughoudendheid ten aanzien van hulp bij zelfdoding onvoldoende recht doet aan wilsbekwame psychiatrische patiënten die uitzichtloos en ondraaglijk lijden en een consistente doodswens hebben. Het doel van het onderzoek is om, d.m.v. verkregen inzicht in de ethische overwegingen van de verschillende betrokkenen, handvatten te verlenen aan psychiaters voor het omgaan met verzoeken tot hulp bij zelfdoding in de psychiatrische praktijk.
Auteur: E. Ettema, C. Gijsbers van Wijk, S. Hulst, G. Widdershoven
Magazine: Tijdschrift voor Psychiatrie
Auteur: Eric Ettema en Andrea Ruissen
Magazine: Tijdschrift voor Gezondheidszorg en Ethiek
Samenvatting van de aanvraag
The Termination of Life on Request and Assisted Suicide Act (WTL) provides procedures for the termination of life on request and assisted suicide. In order not to be prosecuted, physicians have to act in accordance with the statutory due care criteria. The physician must: a) be satisfied that the patient’s request is voluntary and well-considered; b) be satisfied that the patient’s suffering is unbearable, with no prospect of improvement; c) have informed the patient about his situation and his prospects; d) have come to the conclusion together with the patient that there is no reasonable alternative in the patient’s situation; e) consult at least one other, independent physician, who must see the patient and give a written opinion on whether the due care criteria set out in (a) to (d) have been fulfilled; f) have terminated the patient’s life or provided assistance with suicide with due medical care and attention. Although the WTL does not distinguish between somatic and mental suffering, Physician Assisted Suicide (PAS) rarely occurs in psychiatric healthcare.* In psychiatry, a patient’s wish to hasten death is often caused by the patient’s mental disease. In that case, the patient is considered not to have the mental capacity to determine his own wishes freely and not to have a full understanding of his disease. Therefore, a request for PAS of a psychiatric patient is and must be primarily understood as a request for helping to live. This does not take away, however, that psychiatric patients may suffer unbearably with no prospect of improvement and have a genuine wish to die. In these cases, there may be a situation in which PAS is a legally and morally justifiable option. In recent years, the issue of PAS in psychiatry has received increasing attention, indicating a concern that the restrictive attitude of professionals regarding PAS in psychiatry takes insufficiently account of psychiatric patients who suffer unbearably and have no prospect of improvement. Psychiatric patients may therefore end up in degrading situations which not seldom result in suicide. Because of this situation, many psychiatrists feel insecure about how to deal with a wish to die of a chronic psychiatric patient. They struggle with the ethical complexity of the felt duty: 1) to do justice to both the patient’s psychiatric condition and the patient as a person; 2) to relieve the patient’s suffering, whether this is by treatment or PAS; and 3) to do justice to the duty to help a person and to protect life, especially of an extremely vulnerable person. Psychiatrists may base their way of dealing with a request for PAS of a psychiatric patient on other values as well, as there are the fear that to discuss the patient’s wish to die may lead to false hope or to feelings of being stuck of the psychiatrist. The aim of this research is to develop a training module for psychiatrists for dealing with conflicting values around PAS-request of psychiatric patients in the Netherlands. In order to do so, the research investigates what a request for PAS means for the psychiatrist and other stakeholders and in what respect cases in which the psychiatrist grants the request for PAS differ from cases in which the psychiatrist does not grant the request. The basic values and norms of the stakeholders involved in the cases are explored and didactically elaborated into a training module to support psychiatrists who are confronted with psychiatric patients who express a wish to die. The training module consists of a reader and a work book, which contains assignments with regard to ethical knowledge transfer, personal reflection case analysis and moral deliberation. By doing so, this research supports and improves the care for psychiatric patients, especially for those who suffer unbearable with no prospect of improvement and have a request for physician assisted suicide. The research follows an empirical ethical approach in which the moral considerations of psychiatrists and other stakeholders involved in dealing with requests for PAS are explored. We conduct the exploration by means of dialogical research. Psychiatrists with experience in dealing with requests for PAS will be interviewed. The interviews are analysed with the help of Interpretive Phenomenological Analysis and Comparative Analysis. The findings will be presented to nurses, social workers and family members and related to their experiences and views in homogeneous focus groups and heterogeneous dialogue groups. The results are used as input for a training module to support psychiatrists who have to deal with the weighing of conflicting values that are inherent to dealing with a request for PAS of a psychiatric patient. The training module will be evaluated with stakeholders including patients. * In relation to psychiatry, the Dutch (juridical) literature speaks of PAS. This does not mean that euthanasia is excluded (Delbeke, 2012: 368). We follow her the use of PAS.