Euthanasia for the Mentally Ill: Untreatable or Simply Untreated?

To those who consider patient autonomy one of the most important concepts in modern healthcare, being able to choose when to die is respected as part of that autonomy. However, euthanasia is a hotly contested issue and is especially debated with respect to mental illness.  Euthanasia for untreatable psychiatric illness is currently permitted by law in the Netherlands, Belgium, and Switzerland.  However, a recent study by the National Institutes of Health (NIH) has shown that many psychiatric patients euthanized in the Netherlands may have suffered from treatable mental illnesses, such as depression. In fact, of the patients whose case files were studied, more than half had previously refused at least one form of treatment with many of those patients citing “lack of motivation” as the reason for their refusal. Moreover, the study found that many of the psychiatric patients who requested to be euthanized were motivated by “loneliness” or “social isolation,” often symptoms of depression.

Although Dutch law requires that a “disorder be intractable and untreatable” to warrant euthanasia, the study also found that patients are able to seek out euthanasia after being refused, from other physicians, non-psychiatrists, and on-call mobile euthanasia clinics, sometimes on rather questionable grounds.  As a result, the study questions whether the Dutch system “provides sufficient regulatory oversight” and casts doubt on diagnostic criteria that allow a symptom of an underlying, possibly treatable condition to determine whether the condition itself is untreatable. While the ethical use of euthanasia for patients suffering from mental illness will undoubtedly continue to be debated, the NIH study certainly makes clear that questions about the treatability of “untreatable” mental conditions must be resolved to protect an already vulnerable population from falling victim to its own self-fulfilling prophecy.


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