Requests for Euthanasia/Physician-Assisted Suicide on the Basis of Mental Suffering: Vulnerable Patients or Vulnerable Physicians?

In only a few countries, such as Belgium and the Netherlands, and in some states in the United States, euthanasia/physician-assisted suicide (EAS) is legally possible under some circumstances. Arguments in favor of legalization of EAS are that it might function as a safeguard to semilegal practices, that it fosters transparency, and that it enables one to verify whether criteria of due care are met. It also provides legal safety for the physicians involved. In these places, EAS has increasingly become an acceptable option for patients with serious irreversible diseases, such as cancer, that are accompanied by unbearable physical suffering and that finally lead to death.¹ Euthanasia/physician-assisted suicide in cases of mental suffering, however, is much more controversial. In Belgium, euthanasia for mental suffering is possible under certain extra due care conditions, such as the advice of 2 other physicians. In 2011, “unbearable mental suffering due to an irreversible disease” was the only motive for euthanasia in 3.5% of all the reported euthanasia cases (N = 1133) in Belgium (Figure).² However, requests for euthanasia based on unbearable mental suffering are much more common.³