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Assessing Patients Who Seek Help Ending Their Lives.

Sheila Hafter Gray1, Philip J Candilis2, Edmund G Howe3

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Psychiatrists assessing patients for end-of-life assistance need specialized interviews. A narrative inquiry exploring emotional capacity and life history offers a neutral, understanding approach beyond standard cognitive tests.

Keywords:
capacity assessmentdecision-making capacityend of life decision-makingnarrativethe psychiatric interview

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Area of Science:

  • Psychiatry
  • Bioethics
  • Mental Health Law

Background:

  • Increasing end-of-life choice movements necessitate psychiatric involvement in patient capacity assessments.
  • Standard clinical and cognitive assessments are insufficient for evaluating end-of-life requests due to their finality and limitations.
  • Ethical considerations require a nuanced approach to assessing a patient's emotional capacity for end-of-life decisions.

Purpose of the Study:

  • To propose a specialized interview method for psychiatrists assessing patients requesting physician-assisted end-of-life.
  • To outline an approach that moves beyond technicalities and standard cognitive tests.
  • To provide a framework for understanding patient emotional capacity in end-of-life contexts.

Main Methods:

  • A narrative inquiry methodology is proposed.
  • The interview focuses on the patient's life story, past coping mechanisms, and reversible emotional states.
  • Emphasis is placed on a neutral, understanding approach rather than judgment.

Main Results:

  • The proposed narrative inquiry facilitates a deeper exploration of emotional capacity.
  • This method allows for a comprehensive understanding of the patient's perspective and life context.
  • It provides a framework for assessing capacity that respects the gravity of end-of-life decisions.

Conclusions:

  • A narrative inquiry approach is recommended for assessing emotional capacity in patients seeking end-of-life assistance.
  • This method offers a more sensitive and comprehensive alternative to standard assessments.
  • Psychiatrists can utilize this neutral approach to better understand patients' end-of-life requests.