So the impetus for this Clinical Problems in Consultation Psychiatry (CPCP) by Dr. Emily Morse, DO comes from her reading of a recent New Yorker article and a Psychiatric Times article about the subject of the right to die. Psychiatric consultants are asked to assist in situations like this (most often to diagnose psychiatric illness that might be substantially interfering with decisional capacity) and the scenarios are invariably sad and complicated. What was new and a little startling to me was that in some countries, like Belgium, those with psychiatric illness which is perceived to be untreatable can be considered eligible for physician-assisted suicide. I wonder what readers think about that, because it was a little jarring to me.
Although to some, the existence of an algorithm for making decisions about physician-assisted suicide might seem a little cold, it could actually be very helpful to patients, families, and health care professionals. I can readily see why it would be important to many people to focus on instilling hope and not seeing how assisting suicide could ever be integral to a psychiatrist’s self-perceived role as a healer.
I read the New Yorker article more than once and it made me very uncomfortable that in some cases little oversight seemed exercised over individual practitioners’ actions on behalf of some patients, especially those who seemed to have treatable mental disorders.
No two situations I’ve encountered in this arena have been the same, though I haven’t been involved in very many over my career. I’m troubled by a patient’s wish to die, but I’m also troubled by their evident suffering from terminal illness, or put another way, their evident burden of interminable suffering.
And so the meaning of misery, endless suffering, and death have never been the same for every person. PubMed doesn’t have an answer for every question that arises in the hospital room and after, upon reflection in one’s office. It’s humbling to learn that one’s own experience is not always the best teacher, and there is always something new to learn. I’m often grieving the loss of my sense of control and competence in these situations, when I can do little more than bear witness to how another bears the impending loss of her own life.
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