Monday, June 10, 2019

Against the Dutch method

The Atlantic has a good article looking at the Dutch experience with euthanasia and it's most troubling aspect - allowing it for psychiatric illness:
Until about 2010, the controversial practice of psychiatric euthanasia was rare, despite being permitted since the mid-1990s. Most Dutch psychiatrists—like most other doctors and the Dutch public—disapprove of psychiatric euthanasia. Still, there has been a steady increase, with 83 cases in 2017; the per-capita equivalent in the United States would be about 1,600 cases a year. Unlike euthanasia in general, psychiatric euthanasia is predominantly given to women. Most of these cases involve the End of Life Clinic, a network of facilities affiliated with the largest Dutch euthanasia-advocacy organization. These clinics routinely handle euthanasia requests refused by other doctors. (Noa Pothoven sought euthanasia there but was refused.)

An obvious question arises: How can any physician be sure that any patient with a serious psychiatric disorder, much less an 18-year-old, meets the legal criteria for euthanasia? The short answer is that the law gives considerable weight to their professional judgment.

Compared with cases involving cancer or other terminal illnesses, the application of the eligibility criteria in psychiatric euthanasia depends much more on doctors’ opinions. Psychiatric diagnosis is not based on an objective laboratory or imaging test; generally, it is a more subjective assessment based on standard criteria agreed on by professionals in the field. Some doctors reach conclusions with which other doctors might reasonably disagree. Indeed, an otherwise healthy Dutch woman was euthanized 12 months after her husband’s death for “prolonged grief disorder”—a diagnosis listed in the International Classification of Diseases but not in the Diagnostic and Statistical Manual of Mental Disorders used by psychiatrists and psychologists around the world.

Psychiatric disorders can indeed be chronic, but their prognosis is difficult to predict for a variety of reasons. There is a paucity of relevant, large longitudinal studies. Patients may get better or worse due to psychosocial factors beyond the control of mental-health providers. Also affecting prognoses is the varying quality and availability of mental-health care—which, even in wealthy countries, patients with significant symptoms may not receive. Noa Pothoven and her family had criticized the dearth of care options available in their country for patients like her. Indeed, more than one in five Dutch patients receiving psychiatric euthanasia have not previously been hospitalized; a significant minority with personality disorders did not receive psychotherapy, the staple of treatment for such conditions. When treatments are available, doctors in the Netherlands have the discretion to judge that there are “no alternatives” if patients refuse treatment.

It's very surprising that the Dutch people are not (as far as I know) agitating for a change to this practice.  

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