Euthanasia and assisted suicide in patients with personality disorders: a review of current practice and challenges
Background Over the last two decades an increasing number of countries have legalized euthanasia and physician-assisted suicide (EAS) leading to considerable debate over the inherent ethical dilemmas. Increasing numbers of people with personality disorders, faced with unbearable suffering, have requ...
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| Published in | Borderline personality disorder and emotion dysregulation Vol. 7; no. 1; pp. 15 - 7 |
|---|---|
| Main Authors | , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
London
BioMed Central
30.07.2020
BioMed Central Ltd Springer Nature B.V BMC |
| Subjects | |
| Online Access | Get full text |
| ISSN | 2051-6673 2051-6673 |
| DOI | 10.1186/s40479-020-00131-9 |
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| Abstract | Background
Over the last two decades an increasing number of countries have legalized euthanasia and physician-assisted suicide (EAS) leading to considerable debate over the inherent ethical dilemmas. Increasing numbers of people with personality disorders, faced with unbearable suffering, have requested and received assistance in terminating their lives. EAS in people with personality disorders has, however, received very sparse attention from clinicians and researchers. In this paper, we examine the literature on the practice and prevalence of EAS in people with personality disorders to date and discuss the associated challenges for research and practice.
Methods
Narrative review of the literature combined with the authors’ collective experience and knowledge of personality disorders.
Results
In six of the eight countries where EAS is currently legal, mental disorders are accepted as disorders for which EAS may be granted. In four of these countries, EAS in minors with mental disorders is also accepted. Our literature search resulted in 9 papers on the subject of EAS in people with personality disorders. These studies suggest that most clinicians who grant EAS have indeed perceived their patients’ suffering as chronic, unbearable and untreatable without prospect of improvement. The majority of patients with personality disorders had tried some form of psychotherapy, but very few had received any of the relevant evidence-based treatments. The decision to grant EAS based on a perception of the patient’s illness as being untreatable with no prospect of improvement, could, thus, in many cases fail to meet the due care criteria listed in EAS laws. People with personality disorders more often wish for death for extended periods of time than people without these disorders. However, there is ample empirical data to show that suicidal tendencies and behaviour can be treated and that they fluctuate rapidly over time.
Conclusions
In light of our findings, we believe that the current legislation and practice of EAS for people with personality disorders is based on an inadequate understanding of underlying psychopathology and a lack of awareness about the contemporary treatment literature. Moreover, we assert that this practice neglects the individual’s potential for having a life worth living. |
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| AbstractList | Over the last two decades an increasing number of countries have legalized euthanasia and physician-assisted suicide (EAS) leading to considerable debate over the inherent ethical dilemmas. Increasing numbers of people with personality disorders, faced with unbearable suffering, have requested and received assistance in terminating their lives. EAS in people with personality disorders has, however, received very sparse attention from clinicians and researchers. In this paper, we examine the literature on the practice and prevalence of EAS in people with personality disorders to date and discuss the associated challenges for research and practice. Narrative review of the literature combined with the authors' collective experience and knowledge of personality disorders. In six of the eight countries where EAS is currently legal, mental disorders are accepted as disorders for which EAS may be granted. In four of these countries, EAS in minors with mental disorders is also accepted. Our literature search resulted in 9 papers on the subject of EAS in people with personality disorders. These studies suggest that most clinicians who grant EAS have indeed perceived their patients' suffering as chronic, unbearable and untreatable without prospect of improvement. The majority of patients with personality disorders had tried some form of psychotherapy, but very few had received any of the relevant evidence-based treatments. The decision to grant EAS based on a perception of the patient's illness as being untreatable with no prospect of improvement, could, thus, in many cases fail to meet the due care criteria listed in EAS laws. People with personality disorders more often wish for death for extended periods of time than people without these disorders. However, there is ample empirical data to show that suicidal tendencies and behaviour can be treated and that they fluctuate rapidly over time. In light of our findings, we believe that the current legislation and practice of EAS for people with personality disorders is based on an inadequate understanding of underlying psychopathology and a lack of awareness about the contemporary treatment literature. Moreover, we assert that this practice neglects the individual's potential for having a life worth living. Background Over the last two decades an increasing number of countries have legalized euthanasia and physician-assisted suicide (EAS) leading to considerable debate over the inherent ethical dilemmas. Increasing numbers of people with personality disorders, faced with unbearable suffering, have requested and received assistance in terminating their lives. EAS in people with personality disorders has, however, received very sparse attention from clinicians and researchers. In this paper, we examine the literature on the practice and prevalence of EAS in people with personality disorders to date and discuss the associated challenges for research and practice. Methods Narrative review of the literature combined with the authors' collective experience and knowledge of personality disorders. Results In six of the eight countries where EAS is currently legal, mental disorders are accepted as disorders for which EAS may be granted. In four of these countries, EAS in minors with mental disorders is also accepted. Our literature search resulted in 9 papers on the subject of EAS in people with personality disorders. These studies suggest that most clinicians who grant EAS have indeed perceived their patients' suffering as chronic, unbearable and untreatable without prospect of improvement. The majority of patients with personality disorders had tried some form of psychotherapy, but very few had received any of the relevant evidence-based treatments. The decision to grant EAS based on a perception of the patient's illness as being untreatable with no prospect of improvement, could, thus, in many cases fail to meet the due care criteria listed in EAS laws. People with personality disorders more often wish for death for extended periods of time than people without these disorders. However, there is ample empirical data to show that suicidal tendencies and behaviour can be treated and that they fluctuate rapidly over time. Conclusions In light of our findings, we believe that the current legislation and practice of EAS for people with personality disorders is based on an inadequate understanding of underlying psychopathology and a lack of awareness about the contemporary treatment literature. Moreover, we assert that this practice neglects the individual's potential for having a life worth living. Keywords: Personality disorder, Euthanasia, Physician-assisted suicide Background Over the last two decades an increasing number of countries have legalized euthanasia and physician-assisted suicide (EAS) leading to considerable debate over the inherent ethical dilemmas. Increasing numbers of people with personality disorders, faced with unbearable suffering, have requested and received assistance in terminating their lives. EAS in people with personality disorders has, however, received very sparse attention from clinicians and researchers. In this paper, we examine the literature on the practice and prevalence of EAS in people with personality disorders to date and discuss the associated challenges for research and practice. Methods Narrative review of the literature combined with the authors’ collective experience and knowledge of personality disorders. Results In six of the eight countries where EAS is currently legal, mental disorders are accepted as disorders for which EAS may be granted. In four of these countries, EAS in minors with mental disorders is also accepted. Our literature search resulted in 9 papers on the subject of EAS in people with personality disorders. These studies suggest that most clinicians who grant EAS have indeed perceived their patients’ suffering as chronic, unbearable and untreatable without prospect of improvement. The majority of patients with personality disorders had tried some form of psychotherapy, but very few had received any of the relevant evidence-based treatments. The decision to grant EAS based on a perception of the patient’s illness as being untreatable with no prospect of improvement, could, thus, in many cases fail to meet the due care criteria listed in EAS laws. People with personality disorders more often wish for death for extended periods of time than people without these disorders. However, there is ample empirical data to show that suicidal tendencies and behaviour can be treated and that they fluctuate rapidly over time. Conclusions In light of our findings, we believe that the current legislation and practice of EAS for people with personality disorders is based on an inadequate understanding of underlying psychopathology and a lack of awareness about the contemporary treatment literature. Moreover, we assert that this practice neglects the individual’s potential for having a life worth living. Over the last two decades an increasing number of countries have legalized euthanasia and physician-assisted suicide (EAS) leading to considerable debate over the inherent ethical dilemmas. Increasing numbers of people with personality disorders, faced with unbearable suffering, have requested and received assistance in terminating their lives. EAS in people with personality disorders has, however, received very sparse attention from clinicians and researchers. In this paper, we examine the literature on the practice and prevalence of EAS in people with personality disorders to date and discuss the associated challenges for research and practice.BACKGROUNDOver the last two decades an increasing number of countries have legalized euthanasia and physician-assisted suicide (EAS) leading to considerable debate over the inherent ethical dilemmas. Increasing numbers of people with personality disorders, faced with unbearable suffering, have requested and received assistance in terminating their lives. EAS in people with personality disorders has, however, received very sparse attention from clinicians and researchers. In this paper, we examine the literature on the practice and prevalence of EAS in people with personality disorders to date and discuss the associated challenges for research and practice.Narrative review of the literature combined with the authors' collective experience and knowledge of personality disorders.METHODSNarrative review of the literature combined with the authors' collective experience and knowledge of personality disorders.In six of the eight countries where EAS is currently legal, mental disorders are accepted as disorders for which EAS may be granted. In four of these countries, EAS in minors with mental disorders is also accepted. Our literature search resulted in 9 papers on the subject of EAS in people with personality disorders. These studies suggest that most clinicians who grant EAS have indeed perceived their patients' suffering as chronic, unbearable and untreatable without prospect of improvement. The majority of patients with personality disorders had tried some form of psychotherapy, but very few had received any of the relevant evidence-based treatments. The decision to grant EAS based on a perception of the patient's illness as being untreatable with no prospect of improvement, could, thus, in many cases fail to meet the due care criteria listed in EAS laws. People with personality disorders more often wish for death for extended periods of time than people without these disorders. However, there is ample empirical data to show that suicidal tendencies and behaviour can be treated and that they fluctuate rapidly over time.RESULTSIn six of the eight countries where EAS is currently legal, mental disorders are accepted as disorders for which EAS may be granted. In four of these countries, EAS in minors with mental disorders is also accepted. Our literature search resulted in 9 papers on the subject of EAS in people with personality disorders. These studies suggest that most clinicians who grant EAS have indeed perceived their patients' suffering as chronic, unbearable and untreatable without prospect of improvement. The majority of patients with personality disorders had tried some form of psychotherapy, but very few had received any of the relevant evidence-based treatments. The decision to grant EAS based on a perception of the patient's illness as being untreatable with no prospect of improvement, could, thus, in many cases fail to meet the due care criteria listed in EAS laws. People with personality disorders more often wish for death for extended periods of time than people without these disorders. However, there is ample empirical data to show that suicidal tendencies and behaviour can be treated and that they fluctuate rapidly over time.In light of our findings, we believe that the current legislation and practice of EAS for people with personality disorders is based on an inadequate understanding of underlying psychopathology and a lack of awareness about the contemporary treatment literature. Moreover, we assert that this practice neglects the individual's potential for having a life worth living.CONCLUSIONSIn light of our findings, we believe that the current legislation and practice of EAS for people with personality disorders is based on an inadequate understanding of underlying psychopathology and a lack of awareness about the contemporary treatment literature. Moreover, we assert that this practice neglects the individual's potential for having a life worth living. Abstract Background Over the last two decades an increasing number of countries have legalized euthanasia and physician-assisted suicide (EAS) leading to considerable debate over the inherent ethical dilemmas. Increasing numbers of people with personality disorders, faced with unbearable suffering, have requested and received assistance in terminating their lives. EAS in people with personality disorders has, however, received very sparse attention from clinicians and researchers. In this paper, we examine the literature on the practice and prevalence of EAS in people with personality disorders to date and discuss the associated challenges for research and practice. Methods Narrative review of the literature combined with the authors’ collective experience and knowledge of personality disorders. Results In six of the eight countries where EAS is currently legal, mental disorders are accepted as disorders for which EAS may be granted. In four of these countries, EAS in minors with mental disorders is also accepted. Our literature search resulted in 9 papers on the subject of EAS in people with personality disorders. These studies suggest that most clinicians who grant EAS have indeed perceived their patients’ suffering as chronic, unbearable and untreatable without prospect of improvement. The majority of patients with personality disorders had tried some form of psychotherapy, but very few had received any of the relevant evidence-based treatments. The decision to grant EAS based on a perception of the patient’s illness as being untreatable with no prospect of improvement, could, thus, in many cases fail to meet the due care criteria listed in EAS laws. People with personality disorders more often wish for death for extended periods of time than people without these disorders. However, there is ample empirical data to show that suicidal tendencies and behaviour can be treated and that they fluctuate rapidly over time. Conclusions In light of our findings, we believe that the current legislation and practice of EAS for people with personality disorders is based on an inadequate understanding of underlying psychopathology and a lack of awareness about the contemporary treatment literature. Moreover, we assert that this practice neglects the individual’s potential for having a life worth living. Over the last two decades an increasing number of countries have legalized euthanasia and physician-assisted suicide (EAS) leading to considerable debate over the inherent ethical dilemmas. Increasing numbers of people with personality disorders, faced with unbearable suffering, have requested and received assistance in terminating their lives. EAS in people with personality disorders has, however, received very sparse attention from clinicians and researchers. In this paper, we examine the literature on the practice and prevalence of EAS in people with personality disorders to date and discuss the associated challenges for research and practice. Narrative review of the literature combined with the authors' collective experience and knowledge of personality disorders. In six of the eight countries where EAS is currently legal, mental disorders are accepted as disorders for which EAS may be granted. In four of these countries, EAS in minors with mental disorders is also accepted. Our literature search resulted in 9 papers on the subject of EAS in people with personality disorders. These studies suggest that most clinicians who grant EAS have indeed perceived their patients' suffering as chronic, unbearable and untreatable without prospect of improvement. The majority of patients with personality disorders had tried some form of psychotherapy, but very few had received any of the relevant evidence-based treatments. The decision to grant EAS based on a perception of the patient's illness as being untreatable with no prospect of improvement, could, thus, in many cases fail to meet the due care criteria listed in EAS laws. People with personality disorders more often wish for death for extended periods of time than people without these disorders. However, there is ample empirical data to show that suicidal tendencies and behaviour can be treated and that they fluctuate rapidly over time. In light of our findings, we believe that the current legislation and practice of EAS for people with personality disorders is based on an inadequate understanding of underlying psychopathology and a lack of awareness about the contemporary treatment literature. Moreover, we assert that this practice neglects the individual's potential for having a life worth living. Background Over the last two decades an increasing number of countries have legalized euthanasia and physician-assisted suicide (EAS) leading to considerable debate over the inherent ethical dilemmas. Increasing numbers of people with personality disorders, faced with unbearable suffering, have requested and received assistance in terminating their lives. EAS in people with personality disorders has, however, received very sparse attention from clinicians and researchers. In this paper, we examine the literature on the practice and prevalence of EAS in people with personality disorders to date and discuss the associated challenges for research and practice. Methods Narrative review of the literature combined with the authors’ collective experience and knowledge of personality disorders. Results In six of the eight countries where EAS is currently legal, mental disorders are accepted as disorders for which EAS may be granted. In four of these countries, EAS in minors with mental disorders is also accepted. Our literature search resulted in 9 papers on the subject of EAS in people with personality disorders. These studies suggest that most clinicians who grant EAS have indeed perceived their patients’ suffering as chronic, unbearable and untreatable without prospect of improvement. The majority of patients with personality disorders had tried some form of psychotherapy, but very few had received any of the relevant evidence-based treatments. The decision to grant EAS based on a perception of the patient’s illness as being untreatable with no prospect of improvement, could, thus, in many cases fail to meet the due care criteria listed in EAS laws. People with personality disorders more often wish for death for extended periods of time than people without these disorders. However, there is ample empirical data to show that suicidal tendencies and behaviour can be treated and that they fluctuate rapidly over time. Conclusions In light of our findings, we believe that the current legislation and practice of EAS for people with personality disorders is based on an inadequate understanding of underlying psychopathology and a lack of awareness about the contemporary treatment literature. Moreover, we assert that this practice neglects the individual’s potential for having a life worth living. |
| ArticleNumber | 15 |
| Audience | Academic |
| Author | Hutsebaut, Joost Doering, Stephan Simonsen, Sebastian di Giacomo, Ester Kaera, Andres Schmahl, Christian Ribaudi, Joaquim Soler Swales, Michaela Renneberg, Babette Mehlum, Lars Berens, Ann Kramer, Ueli Taubner, Svenja Moran, Paul Anthony |
| Author_xml | – sequence: 1 givenname: Lars orcidid: 0000-0003-2813-0045 surname: Mehlum fullname: Mehlum, Lars email: lars.mehlum@medisin.uio.no organization: National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo – sequence: 2 givenname: Christian surname: Schmahl fullname: Schmahl, Christian organization: Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Heidelberg University – sequence: 3 givenname: Ann surname: Berens fullname: Berens, Ann organization: University Psychiatric Centre Duffel, CAPRI, faculty Medicine and Health Sciences, University Antwerp – sequence: 4 givenname: Stephan surname: Doering fullname: Doering, Stephan organization: Department of Psychoanalysis and Psychotherapy, Medical University of Vienna – sequence: 5 givenname: Joost surname: Hutsebaut fullname: Hutsebaut, Joost organization: De Viersprong Institute for Studies on Personality Disorders – sequence: 6 givenname: Andres surname: Kaera fullname: Kaera, Andres organization: Kanta-Häme Central Hospital – sequence: 7 givenname: Ueli surname: Kramer fullname: Kramer, Ueli organization: Department of Psychiatry, University of Lausanne – sequence: 8 givenname: Paul Anthony surname: Moran fullname: Moran, Paul Anthony organization: Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol – sequence: 9 givenname: Babette surname: Renneberg fullname: Renneberg, Babette organization: Freie Universität – sequence: 10 givenname: Joaquim Soler surname: Ribaudi fullname: Ribaudi, Joaquim Soler organization: Department of Psychiatry and Legal Medicine, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, UAB, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM – sequence: 11 givenname: Sebastian surname: Simonsen fullname: Simonsen, Sebastian organization: Stolpegaard Psychotherapy Centre – sequence: 12 givenname: Michaela surname: Swales fullname: Swales, Michaela organization: NWCPP, School of Psychology, Bangor University – sequence: 13 givenname: Svenja surname: Taubner fullname: Taubner, Svenja organization: Institute for Psychosocial Prevention, University-Hospital Heidelberg – sequence: 14 givenname: Ester surname: di Giacomo fullname: di Giacomo, Ester organization: School of Medicine and Surgery, University of Milan-Bicocca, Psychiatric Department-ASST Monza |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32742662$$D View this record in MEDLINE/PubMed |
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| Keywords | Physician-assisted suicide Personality disorder Euthanasia |
| Language | English |
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| PublicationTitle | Borderline personality disorder and emotion dysregulation |
| PublicationTitleAbbrev | bord personal disord emot dysregul |
| PublicationTitleAlternate | Borderline Personal Disord Emot Dysregul |
| PublicationYear | 2020 |
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| References | 131_CR6 MC Zanarini (131_CR15) 2015; 66 APA (131_CR12) 2013 SS Nash (131_CR23) 2009; 17 A Frances (131_CR26) 1986; 487 L Thienpont (131_CR8) 2015; 5 AL Pincus (131_CR16) 2014; 5 131_CR9 E Ronningstam (131_CR17) 2011; 17 K Hawton (131_CR22) 2016; 3 C Bando (131_CR4) 2018 L Sher (131_CR13) 2016; 246 131_CR7 131_CR11 WK Campbell (131_CR19) 2005; 31 CR Glenn (131_CR21) 2019; 48 JM Stoffers (131_CR29) 2012; 8 MM Linehan (131_CR14) 1993 U Benzenhöfer (131_CR1) 2009 EE Bolt (131_CR27) 2015; 41 S Simonsen (131_CR30) 2019; 6 H Diller (131_CR2) 1994 MH Hicks (131_CR25) 2006; 7 AR Daros (131_CR24) 2014; 5 SY Kim (131_CR10) 2016; 73 SA Hurst (131_CR5) 2003; 326 AL Pincus (131_CR18) 2009; 21 131_CR20 IA Cristea (131_CR28) 2017; 74 D Denys (131_CR3) 2018; 175 |
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Over the last two decades an increasing number of countries have legalized euthanasia and physician-assisted suicide (EAS) leading to considerable... Over the last two decades an increasing number of countries have legalized euthanasia and physician-assisted suicide (EAS) leading to considerable debate over... Background Over the last two decades an increasing number of countries have legalized euthanasia and physician-assisted suicide (EAS) leading to considerable... Abstract Background Over the last two decades an increasing number of countries have legalized euthanasia and physician-assisted suicide (EAS) leading to... |
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| SubjectTerms | Age Assisted suicide Child and Adolescent Psychiatry Death & dying Euthanasia Forensic Psychiatry Medicine Medicine & Public Health Medieval period Mental disorders Patients Personality disorder Personality disorders Physician-assisted suicide Psychiatry Psychopathology Psychotherapy Research Article Right to die |
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| Title | Euthanasia and assisted suicide in patients with personality disorders: a review of current practice and challenges |
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