Refused and granted requests for euthanasia and assisted suicide in the Netherlands: interview study with structured questionnaire
BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7265.865 (Published 07 October 2000) Cite this as: BMJ 2000;321:865All rapid responses
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EDITOR,
Haverkate et al’s paper on assisted suicide in the Netherlands (1)
communicates that requests for euthanasia are more likely to be refused in
the presence of recognised depression. However, their statistics suggest
requests have been granted in the presence of unrecognised depression.
Though heartened that no cases with a diagnosis of ‘psychiatric disorder’
received physician assisted suicide (P.A.S.), this is belied by the fact
that 3% (weighted percentage) of P.A.S. cases had depression as a
predominant complaint. The implication is that depression in the context
of cancer, cardiovascular disease, diseases of the nervous system or
respiratory disease has not been recognised as falling within a
psychiatric domain. The under-treatment of depression in medically unwell
patients has been identified as a problem (2, 3), despite a treatment
response comparable to psychiatric patients with primary depression (4).
That such patients may then be offered euthanasia would be scandalous.
John F. Morgan, liaison psychiatrist,
Department of Psychiatry, St. George’s Hospital Medical School, London
SW17 ORE, UK
E-mail: jmorgan@sghms.ac.uk
(1) Haverkate I, Onwuteaka-Philipsen BD, van der Heide A, Kostense
PJ, van der Wal G, van der Maas PJ. Refused and granted requests for
euthanasia and assisted suicide in the Netherlands: interview study with
structured questionnaire. BMJ 2000; 321: 865-866.
2. Freedland KE, Lustman PJ, Carney RM, Hong BA. Underdiagnosis of
depression in patients with coronary artery disease. Int J Psychiatry
Med. 1992;22:221-229.
3. Carney RM, Rich MW, TeVelde A, Saini J, Clark K, Jaffe AS. Major
depressive disorder in coronary artery disease. Am J Cardiol. 1987;
60:1273-1275.
4. Veith RC, Raskind MA, Caldwell JH, Barnes RF, Gumbrecht G, Ritchie
JL. Cardiovascular effects of tricyclic antidepressants in depressed
patients with chronic heart disease. N Eng J Med. 1982; 306: 954-959.
Competing interests: No competing interests
Re: Underrecognition of depression in the medically ill?
Dr Morgan suggests that the presence of depression in terminally ill patients who request assisted suicide should not be a legitimate reason to grant the request because such depressions can respond to treatment just as well as depression not associated with serious physical illness. While I certainly agree that depression should be vigorously detected and treated in physicall ill patients, I'm not sure depression should disqualify a patient from consideration for assisted suicide. The rate of response to treatment of depression is far from 100%, and there is a latency of response. If suffering is unbearable and the expected time to death is brief, I can imagine that the most humane course would be to assist the patient to die.
Also, the diagnosis of depression under these conditions is uncertain. Studies showing that drug treatment helps depression with physical illness have not used terminally ill patients.
Yours truly,
Arthur Rifkin, MD
Competing interests: No competing interests