Euthanasia and assisted suicide in patients with personality disorders: a review of current practice and challenges

Borderline Personality Disorder and Emotion Dysregulation - Tập 7 Số 1 - 2020
Lars Mehlum1, Christian Schmahl2, Ann Berens3, Stephan Doering4, Joost Hutsebaut5, Andres Kaera6, Uëli Kramer7, Paul Moran8, Babette Renneberg9, Joaquim Soler10, Sebastian Simonsen11, Michaela Swales12, Svenja Taubner13, Ester di Giacomo14
1National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
2Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
3University Psychiatric Centre Duffel, CAPRI, faculty Medicine and Health Sciences, University Antwerp, Antwerp, Belgium
4Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
5De Viersprong Institute for Studies on Personality Disorders, Bergen op Zoom, The Netherlands
6Kanta-Häme Central Hospital, Hämeenlinna, Finland
7Department of Psychiatry, University of Lausanne, Lausanne, Switzerland
8Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
9Freie Universität, Berlin, Germany
10Department of Psychiatry and Legal Medicine, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, UAB, Barcelona, Spain
11Stolpegaard Psychotherapy Centre, Copenhagen, Denmark
12NWCPP, School of Psychology, Bangor University, Bangor, UK
13Institute for Psychosocial Prevention, University-Hospital Heidelberg, Heidelberg, Germany
14School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy

Tóm tắt

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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Borderline Personality Disorder and Emotion Dysregulation

Tập 7 Số 1

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