Abstract
In a recent article, Henri Wijsbek discusses the 1991 Chabot “psychiatric euthanasia” case in the Netherlands, and argues that Chabot was justified in helping his patient to die. Dutch legislation at the time permitted physician assisted suicide when the patient’s condition is severe, hopeless, and unbearable. The Dutch Supreme Court agreed with Chabot that the patient met these criteria because of her justified depression, even though she was somatically healthy. Wijsbek argues that in this case, the patient’s integrity had been undermined by recent events, and that this is the basis for taking her request seriously; it was unreasonable to expect that she could start again. In this paper, I do not challenge the Dutch euthanasia criteria in the case of somatic illness, but I argue that both Chabot and Wijsbek are wrong because we can never be sufficiently confident in cases of severe exogenous depression to assist the patient in her irreversible act. This is partly because of the essential difference between somatic and mental illness, and because of the possibility of therapy and other help. In addition, I argue that Wijsbek’s concept of integrity cannot do the work that he expects of it. Finally, I consider a 2011 position paper from the Royal Dutch Medical Association on euthanasia, and the implications it might have for Chabot-style cases in the future.
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Notes
My question is similar to that posed by Huxtable and Möller [3], when they ask whether “suffering from life” is sufficient to justify physician assisted suicide. I will return to this question in the final section.
An anonymous reviewer chides both Wijsbek and myself for using the term “exogenous,” now considered old-fashioned among psychiatrists. I have preserved the term simply to indicate that the depression comprises an intelligible response to situational causes.
The impact of demoralization on autonomous choice is explored in [6], where the assumptive world of a patient immersed in hopelessness and meaninglessness can interfere with the patient’s autonomy, and the patient can fall into what Applebaum and Grisso [7] have termed the “MacArthur Test.” My thanks to an anonymous reviewer for this reference.
Indeed, it could be argued that if we consider an 18-year-old to have enough autonomy and legal capacity to join the army (and in the Netherlands in 1991, if we required an 18-year-old to enlist), to carry a dangerous weapon, and to risk his life in combat, then we should also consider him autonomous enough to be assisted in suicide. As it happens, the 20-year-old Peter was conscripted into the Dutch army, and it was with a Dutch army rifle that he killed himself.
References
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Cowley, C. Euthanasia in psychiatry can never be justified. A reply to Wijsbek. Theor Med Bioeth 34, 227–238 (2013). https://doi.org/10.1007/s11017-013-9252-6
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DOI: https://doi.org/10.1007/s11017-013-9252-6