Depression and Autonomy in Physician-Assisted Suicide

The standard view in medical practice is that patients have to be in an appropriate state of mind to count as autonomous. For example, according to the Macarthur Competency Assessment Tool for Treatment patients need to be able to: (1) communicate a choice; (2) factually understand the issues; (3) appreciate their situation; and (4) rationally manipulate information. These capacities are normally taken to be compromised by factors that may diminish one's capacity to properly assess one's situation. One of these diminishing factors is depression, which is especially relevant to decisions about assisted suicide or termination of treatment, since depression might contribute to the patient's leaning towards an action resulting in her death. I argue, however, that in certain circumstances, depression and the accompanying desires can be appropriate. Specifically, I demonstrate that even when depression is a factor in the patient's decision, it does not automatically undermine autonomy.