Are Concerns About Irremediableness, Vulnerability, or Competence Sufficient to Justify Excluding All Psychiatric Patients from Medical Aid in Dying?

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Some jurisdictions that have decriminalized assisted dying (like Canada) exclude psychiatric patients on the grounds that their condition cannot be determined to be irremediable, that they are vulnerable and in need of protection, or that they cannot be determined to be competent. We review each of these claims and find that none have been sufficiently well-supported to justify the differential treatment psychiatric patients experience with respect to assisted dying. We find bans on psychiatric patients’ access to this service amount to arbitrary discrimination. Proponents of banning the practice ignore or overlook alternatives to their proposal, like an assisted dying regime with additional safeguards. Some authors have further criticized assisted dying for psychiatric patients by highlighting allegedly problematic practices in those countries which allow it. We address recent evidence from the Netherlands, showing that these problems are either misrepresented or have straightforward solutions. Even if one finds such evidence troubling despite our analysis, other jurisdictions need not adopt every feature of the Dutch system.

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    This standard, as this piece is being submitted, is under review.

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    Numbers sum to 100.1% due to rounding.

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    These data are separate because dementia is considered a neurological condition in the Netherlands.

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    Contact correspondence author for a copy.


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Correspondence to William Rooney.

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Rooney, W., Schuklenk, U. & van de Vathorst, S. Are Concerns About Irremediableness, Vulnerability, or Competence Sufficient to Justify Excluding All Psychiatric Patients from Medical Aid in Dying?. Health Care Anal 26, 326–343 (2018).

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  • Medical assistance in dying
  • Irremediable
  • Vulnerable
  • Competence assessment
  • Decisional capacity
  • Depression
  • Euthanasia
  • Physician assisted suicide