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Int J Law Psychiatry. 2013 Sep-Dec;36(5-6):436-43. doi: 10.1016/j.ijlp.2013.06.020. Epub 2013 Jul 2.

Physician-assisted suicide in psychiatry and loss of hope.

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Department of Health, Ethics and Society/Metamedica, CAPHRI, School of Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.


In the Netherlands, euthanasia and physician-assisted suicide (PAS) are considered acceptable medical practices in specific circumstances. The majority of cases of euthanasia and PAS involve patients suffering from cancer. However, in 1994 the Dutch Supreme Court in the so-called Chabot-case ruled that "the seriousness of the suffering of the patient does not depend on the cause of the suffering", thereby rejecting a distinction between physical (or somatic) and mental suffering. This opened the way for further debate about the acceptability of PAS in cases of serious and refractory mental illness. An important objection against offering PAS to mentally ill patients is that this might reinforce loss of hope, and demoralization. Based on an analysis of a reported case, this argument is evaluated. It is argued that offering PAS to a patient with a mental illness who suffers unbearably, enduringly and without prospect of relief does not necessarily imply taking away hope and can be ethically acceptable.


Ethics; Euthanasia; Hope; Physician-assisted suicide; Psychiatry; The Netherlands

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