December 8, 2021

The case for expanding physician-assisted death to psychiatric cases

Bioethicist Bonnie Steinbock suggests assisted death for psychiatric cases is the logical consequence of current euthanasia legislation.

Recently there has been a flurry of articles agitating for euthanasia for the mentally ill. The latest addition  by Hastings Center fellow Bonnie Steinbock, suggests assisted death for psychiatric cases is the logical consequence of current euthanasia legislation.

Steinbock suggests that no good argument has been made in defence of the current prohibitions on euthanasia for the mentally ill:  

“… the case for absolute exclusion of psychiatric conditions has not been made. It may be justified, in some cases and under certain conditions. Assisted death should always be a last resort, whether the condition prompting the request is physical illness or psychiatric condition.”

She discusses the potential objections that could be made to broadening the scope of the law, and suggests that none of them is convincing.

Many argue that the “terminal illness” requirement is appropriate. But Steinbock asserts that terminal illness is rarely the real motivation for patients seeking euthanasia:

“The data from Oregon show that physical suffering is not a primary reason why people request aid-in-dying. Loss of autonomy, loss of dignity, and loss of things that make life pleasurable and meaningful are more often cited as reasons. These too can cause intense suffering, although it is not the kind of suffering that can be addressed by morphine or other pain-relieving drugs. Moreover, concerns like these are not limited to those who are terminally ill.”

“The morally relevant features that justify restricting physician-assisted death are, I submit, incurable conditions and severe, unrelenting suffering, not terminal illness.”

Steinbock also addresses the claim that mental illness impairs decision making capacity:

“Certainly PAD should not be offered lightly. However, if a patient has undergone all available therapy for years, to no avail, and as a result has such severe and unrelenting suffering that he or she wants to die, it is hard to see why this isn’t a legitimate reason for requesting PAD and why a compassionate physician has to refuse such a request.”

She quotes the cautionary words of famous legal academic and euthanasia opponent Yale Kamisar; yet she suggests that checks and balances can be put in place to prevent the misuse of PAS for the mentally ill.

“The solution to the slippery slope is not to impose arbitrary restrictions based on the source of suffering, but to limit PAD to those with severe and unrelenting suffering that cannot be alleviated any other way.”

Kamisar tends to be quoted at his most moderate. In a 1976 essay, he presented a historical examination of euthanasia, discussing among other things forced euthanasia in Nazi Germany. Kamisar suggested that wherever euthanasia for the mentally ill has been authorized, involuntary euthanasia  might not be far off:

“Why should the prospects of the police state and the systematic extermination of certain political or racial minorities be taken any less seriously when we enter the sickroom or the mental institution, when we deal with not very healthy or not very useful people, when we discuss ‘euthanasia’ under whatever trade name?” 

The case for expanding physician-assisted death to psychiatric cases
Xavier Symons
Creative commons
existential suffering
mental illness