A. Schneeberger, United States of AmericaAlbert Einstein College of Medicine Psychiatry
Moderator Of 1 Session
Recently, the discussion on physician aid-in-dying (PAD) extended to the context of mental disorders. Supporters of that view mainly argue based on patient autonomy. In Switzerland the Swiss Academy of Medical Sciences (SAMW) updated their recommendation, replacing the requirement of terminality with the criteria of unbearable suffering. This would allow people suffering from mental illness to access PAD. However, the Swiss Medical Association (FMH) decided not to adopt this recommendation and to restrict PAD to cases of terminal illness. In Germany, in 2020 the Federal Constitutional Court ruled that the right to self-determined death, including the freedom to seek assistance for suicide, if available, is a civil right. The implications of these decisions for legislation and practice on PAD in general and mental disorders in particular are not fully conceivable yet. The discourse about defining severe suffering and terminal illness in psychiatry is complex and challenges legal, ethical and professional positions on both an individual and a collective level. Suffering is a necessary but insufficient condition for PAD in psychiatry, the other criteria being decision-making capacity and refractoriness of the suffering. Additionally it has to be taken into account that suffering is a subjective experience that can only be quantified by the patient. The symposium aims to focus on the discussion of conditions under which severe mental illness might lead to such a pronounced and unbearable state of suffering, with no prospect of therapeutic improvement that - after a conscientious assessment - PAD can be considered.