Why psychiatrists should not participate in euthanasia and physician-assisted suicide

Public and professional discussions have recently raised the question of whether the long-standing proscription against physician-assisted suicide for terminally ill patients should be eliminated or changed. In this article we first review the history of the centuries-long debate, and repeat the arguments stated for and against such a change. We present our opposition to such a change based on the adverse consequences which would occur in the patient-doctor relationship, and the very likely extension of the practice from only terminally ill patients to some who are suffering but not dying, including patients with intractable mental suffering. We review the 10-year social experiment with public toleration of euthanasia in the Netherlands, and note its considerable expansion beyond the clear guidelines. We then discuss why we believe psychiatrists should continue to oppose the legalization of physician-assisted suicide. In addition to our concern about the extension to assisted-suicide for mental suffering, we point out the adverse affect such changes would have on both the psychiatrist's and the patient's perception of the role of the therapist in other suicide situations, and the difficulty of uncovering a competent patient's motivation for a request for such assistance.