Assessing Competency for Assisted Suicide Is Unethical

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

A group of psychiatrists published a letter in the Journal of Clinical Psychiatry titled: Assessing Competency for Physician-Assisted Suicide is Unethical in response to the letter by Yager et al: Working With Decisionally Capable Patients Who Are Determined to End Their Own Lives.

Yager et al suggest that psychiatrists can assess a person who is asking for assisted suicide and a patient with psychiatric conditions, if decisionally capable, can be prescribed lethal drugs.

Komrad et al state that assessing competency for assisted suicide is unethical. They argue:

Dr Mark Komrad

If, as we believe, PAS is inherently unethical—a position also taken by the World Medical Association—then it is perforce unethical for psychiatrists to be involved in performing competency assessments on patients requesting PAS. By analogy: the American Psychiatric Association has taken the position that psychiatrists should not perform competency assessments on prisoners slated for execution, though psychiatrists are permitted to relieve the prisoner’s “acute suffering” while he is awaiting execution.

Again, by analogy, we believe that, where PAS or euthanasia is legal in the United States and internationally, the psychiatrist’s role vis-à-vis patients requesting PAS should be limited to (1) determining if the patient is at immediate risk of self-harm, in which case emergency procedures could be initiated, and (2) alleviating acute suffering, such as panic attacks or extreme emotional distress, using appropriate psychiatric interventions. We also envision the possibility that a connection with a psychiatrist may help the patient work through existential and psychosocial issues that may underlie the wish for death or assisted suicide.

However, in our view, performing a competency assessment entails colluding with a process (PAS) that violates the most basic tenet of Hippocratic medicine—one that has sustained it through two millennia and a multitude of societies that have come and gone, namely, “I will not give a fatal draught to anyone if I am asked, nor will I suggest any such thing.”

The issue of assisted suicide for people with mental disorders is being debated by some state legislatures where the assisted suicide bill permits people with mental disorders to die by assisted suicide.

For instance, New Mexico's assisted suicide bill (House Bill 90) allows people with mental health disorders to die by assisted suicide. The bill enables licensed psychiatrist, psychologist, master social worker, psychiatric nurse practitioner or professional clinical mental health counselor to approve assisted suicide for people with mental health disorders.

The assisted suicide lobby is pushing to expand the scope of assisted suicide laws in the United States. One of the expansions is to permit assisted suicide for people with psychiatric conditions.