The appropriate role of psychiatrists in legalized physician-assisted suicide has yet to be defined. Groenewoud and colleagues, in a survey of Dutch psychiatrists described in this issue of the Journal, raise complex questions. The most provocative question the authors raise is whether assisted suicide is ever justified for patients whose intractable suffering is caused by a mental disorder, not by a terminal illness. Physicians in the Netherlands ask for a psychiatric evaluation in only 3 percent of cases in which patients request assistance with suicide. Experts in the United States have recommended mental health consultation for some, most, or all such patients.
Psychiatric consultation has two potential objectives.
Some experts have proposed that mental health professionals are best qualified to determine whether a request for assisted suicide is voluntary and rational or whether it reflects distorted judgment due to a mental disorder. This objective limits the psychiatrist's role to that of evaluating the patient's competence. A broader and more traditional objective is to evaluate the patient and provide treatment for potentially remediable sources of suffering, including depression. With this objective, the psychiatrist's role is similar to that of a consultant in palliative care. For example, the Oregon Death with Dignity Act, a referendum approved by voters in 1994, states that before honoring a patient's request for a lethal prescription, the primary physician must refer the patient to a psychologist or psychiatrist if the physician believes a psychiatric disorder may be present.