Demoralisation, Depression and Desire for Death: Problems With the Dutch Guidelines for Euthanasia of the Mentally ill

The aim in this paper is to review the clinical role of the psychiatrist in assessing patients who seek euthanasia or physician-assisted suicide. 3 areas were examined: recent surveys of psychiatrists’ attitudes; empirical & clinical studies; & treatment issues. Demoralisation & depression emerge as pertinent clinical issues worthy of psychiatric intervention. The role of the psychiatrist is complex & includes issues of assessment, systems, countertransference, & treament. Dutch guidelines for physician-assisted suicide in the mentally ill generate serious concern given the uncertainty of prognosis, potential range & variability of outome of treatments of suicidality, & the boundary violations that are involved for the psychiatrist. The guidelines have the potential to dangerously alter the practice of psychiatry & should be condemned. (66 refs.)