May 26, 2024

Why not non-voluntary euthanasia for psychiatric patients?

In Belgium and the Netherlands, it is now possible for patients with psychiatric disorders to request euthanasia. But what if a patient’s mental illness is so severe that he cannot request euthanasia? It seems unfair that he should be denied the benefits of euthanasia, argues Jukka Varelius, of the University of Turku, in Finland, in the journal Bioethics.

He sets the following scenario: Mary is so ill that she repeatedly attempts to commit suicide at her hospital. She is out of touch with reality; her suffering is unbearable; and her condition is incurable. Why can’t she be assisted to end her life instead of preventing her from committing suicide?

Varelius observes that it is common practice to withdraw life support from futile cases even if the patient is unconscious and has not requested to be killed. He says that this is non-voluntary passive euthanasia. If this is the case, why can’t the hospital euthanise Mary?

Consenting to euthanasia is impossible for Mary, but she did not consent to be a victim of her mental suffering either.

“Mary did not consent, while she still was competent, to undergo the agony she now experiences by issuing an advance directive to the effect that she wants to be kept alive (to wait for a possible cure for her condition) in case she falls severely ill. Accordingly, there is no good reason to think that she would now endorse undergoing the distress she experiences, were she autonomous. Finally, although a periodically non-autonomous person who regains autonomy might find some value in the suffering he experienced while he lacked autonomy, this is not a relevant option in Mary’s case, because her condition is deemed incurable. Accordingly, there is no good reason to think that leading the kind of life Mary now lives accords with what she autonomously wants or would want were she autonomous.”

Therefore Varelius concludes that “if passive euthanasia and voluntary psychiatric-assisted suicide are endorsed, Mary too should qualify as a candidate for physician-assisted dying.”

This is probably one of the first arguments in a major bioethics journal defending non-voluntary euthanasia. The scenario painted by Varelius is limited to a narrow range of patients. But is it a straw in the wind for other psychiatric patients and for comatose patients?
Creative commons
informed consent
mental illness