ABSTRACT
In most permissive countries and states physicians are only allowed to participate in either the joint action of ending a person's life or providing her access to lethal drugs if she has a limited life expectancy. In these jurisdictions it is a hotly debated question whether the permissibility of these actions should be extended. In this part that question is discussed, focussing on three categories of patients: psychiatric patients, old-aged people whose death wish is related to their age, and patients in an advanced stage of dementia who have requested to have their lives ended in an advance directive. The results of this discussion are taken account of in a final chapter that proposes a two-tiered system of legal regulation.
Should people suffering from mental illness be eligible for physician assistance in ending their lives? Almost no-one will dispute that a person's suffering can be equally severe, whether it is caused by mental or physical illness. There are, however, several reasons why it is often particularly difficult to assess whether the request of a psychiatric patient meets essential conditions. (1) The motivation of psychiatric patients for wanting to die is often unclear. (2) Uncertainties about the prognosis and the probability of effective treatment loom larger. (3) It is often difficult to determine to what extent the patient's decisional capacity is compromised by his illness.
Each of these complicating factors gives us a reason to require a long-standing therapeutic relationship between doctor and patient. It may help the doctor to better understand the meanings of the patient's death wish, verify its stability, assess his reasons for resisting treatment proposals and make an informed holistic judgement of his decisional capacity. The law should therefore permit a ‘dual track’ approach, a kind of contract in which doctor and patient are committed to explore both, possible ways of recovery and death as a final exit option. In addition a case can be made for opening access to lethal drugs to psychiatric patients, if the voluntary, well-considered and durable nature of their request for access can reliably be established.
