Medicine, psychiatry and euthanasia: an argument against mandatory psychiatric review

The paper critically appraises the argument that requests for active assistance to die should be subject to mandatory psychiatric assessment.

The argument for mandatory psychiatric assessment is usually supported by an appeal to the need for safeguards against errors and omissions in both the diagnosis of psychiatric conditions affecting the terminally ill and the exploration of the meanings of their requests. This intuitively appealing view is challenged through a broader analysis which examines connections between medicine's traditional adherence to the moral distinction between acts and omissions and the following issues: the historical relationship between medical practice and dying, the recent development of research into treatment-withdrawal decisions, the scientific status of psychiatry, the logic of rationality and decision-making competence.

The analysis reveals a number of hitherto unexamined and unacknowledged influences which would make psychiatric review of requests for assisted death a much less objective and impartial process than is assumed.

Mandatory psychiatric review is an instance of the medicalisation of death and dying which could abridge the freedom of certain individuals to make decisions about their deaths.