Palliative psychiatry and euthanasia in refractory obsessive-compulsive disorder: A case report

Area of Science:

• Psychiatry
• Neuroscience
• Medical Ethics

Background:

• Spain's Organic Law 3/2021 permits medical aid in dying (MAiD) for individuals with severe, incurable conditions causing intolerable suffering.
• MAiD for psychiatric conditions is exceptional, requiring documented refractoriness, intact decision-making capacity, and unbearable mental suffering within a legal framework.

Purpose of the Study:

• To present the clinical and legal case of a young woman with severe obsessive-compulsive disorder (OCD) who underwent MAiD.
• To illustrate the stringent requirements and ethical considerations for MAiD in refractory psychiatric conditions.

Main Methods:

• A 24-year-old woman with treatment-refractory OCD underwent multiple pharmacological and neurosurgical interventions, including deep brain stimulation.
• Longitudinal capacity evaluations by independent psychiatrists confirmed decision-making ability and absence of concurrent psychiatric emergencies.
• MAiD was performed following reiterated requests, comprehensive information, psychiatric consultation, and regional commission authorization.

Main Results:

• Despite extensive guideline-concordant treatments and neurosurgery, the patient experienced persistent, irremediable suffering from OCD.
• MAiD was successfully and uneventfully performed in a hospital setting by the responsible psychiatrist.

Conclusions:

• A small subset of OCD patients may endure irremediable suffering even after exhaustive treatments.
• Transparent documentation of treatment refractoriness, ongoing capacity assessment, and palliative care are vital for ethical and legal MAiD in Spain.