According to (Mehlum et al.) in their journal article Euthanasia and assisted suicide in patients with a personality disorder , euthanasia can be defined as an act by a physician to end a patient's life mostly through lethal injection. In contrast, 'Physician-assisted Suicide'(PAS) denotes a circumstance where physicians offer ways of ending a patient life but does not administer it; preferably, the patient does it himself. Switzerland was the first nation to legalize EAS, while other countries such as Colombia, Netherlands, Belgium, and Canada followed suit. The authors reveal that the legalization of euthanasia and physician-assisted suicide (EAS) in many states has sparked a significant debate regarding its ethical impasse over the last twenty years. Such has mostly been attributed to the ever-increasing call by people with personality disorders for requested assistance in the termination of their lives due to the excruciating suffering they undergo. Moreover, due to the ethical dilemma that surrounds EAS, where people who have mental illness are now being considered qualified for its administration, which was not the case before, this paper aims at assessing the practice and occurrence of EAS in individuals with personality disorders currently and outline research and practice challenges as proposed by the authors in their study.
Methods
The authors conducted research which was based on online research through the Medline database (OVID) where peer-reviewed letters and articles published in English to the editor that had the following titles were searched: "Euthanasia," "Euthanasia Active," "Personality Disorder," and "Suicide Assisted." The articles dated from October 2019 backward, and the research was conducted on all countries that had legalized EAS. The participants who took part in the research were both men and women of all ages, and particularly in Belgium, children were also included in the research.
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Results
The authors reported that approximately 3% of EAS cases were associated with mental disorders in Belgium based on the research. Around 100 participants who had requested Euthanasia in Belgium were either suffering from resistant mood disorders or personality disorders (PD). Moreover, they reported that all patients who had PD were reported to be long-lasting and agonizing and had no recovery chances due to treatment resistance.
The authors also reported that in the Netherlands, 4% of deaths in 2018 were associated with EAS where the total cases of EAS were 6126, approximately 1% of these patients were suffering from a mental disorder with the incidence rate being higher in younger patients (Mehlum et al., 2020). Moreover, they indicated that from a sample size of 116 patients, only 74 of them had undergone a PD diagnosis. They also conveyed that the majority of patients at 72% who were suffering from PD had received some unspecified form of psychotherapy, and only one patient from the sample size had received any standard PD-specific evidence-based treatments that are available. Moreover, they pointed out that most people who had wished for EAS experienced several mental problems such as depressive disorders at 55%, posttraumatic stress disorders, and other anxiety disorders at 42%. The majority of patients suffering from personality-related problems were occasionally without PD diagnosis.
Discussion
The research study depicted various strengths that were critical in analyzing the statement problem of the research. Firstly, the study reveals that clinicians have the sole purpose of ensuring due care is provided to patients with PD and that their knowledge is used in the patient's best interest. Secondly, the study reveals various psychosocial interventions such as cognitive-behavioral therapy, mentalization-based therapy, and other specialized treatments that should be offered to patients suffering from PD before the administration of EAS (Mehlum et al., 2020). Such is because most of these treatments are known to decrease suicidal and self-harming behaviors among patients. Thirdly, the study also reveals that PD, which is usually perceived to be incurable, can be cured through various treatments (Mehlum et al., 2020). Moreover, the research reveals that it may indicate that the patient is lonely or is suffering mentally in an EAS request from a patient. Therefore, a dialogue should be initiated between the patient and the doctor rather than administering the EAS.
Despite its numerous strengths, the research is faced with various limitations. Firstly, the research does not provide the necessary data that can be used to prove that suicidal and self-harming tendencies by patients who contemplate suicide are immutable to change. Secondly, the research lacks the data to indicate the large proportion of patients who had requested EAS would have been treated more effectively. Moreover, the research fails to indicate the proportion of patients whom could not respond to even the best-specialized treatments. The research also fails to give the number of PD patients who had requested EAS and whether they were given evidenced-based PD specific treatment before the administration of EAS. To correct these misgivings, the researchers should have conducted surveys to different mental hospitals to complement their online sources, which could have helped get deeper insights regarding PD. One of the major social policy implications of the study is the adherence to the given guidelines in the treatment of PD and the correct application of EAS.
Conclusion
Based on the findings, there is a perceived wrong assumption and a lack of awareness regarding contemporary treatment of PD. Therefore, there are grave concerns about the ever-increasing legalization of EAS administration in many countries for persons suffering from PD, which is majorly based on insufficient understanding of the essential psychopathology of PD. Furthermore, EAS cuts downs an individual's potential of living a meaningful life. Thus, its administration should be done to a very limited number of extreme cases as most of these incidences do not adhere to the enlisted in EAS laws.
References
Mehlum, L., Schmahl, C., Berens, A., Doering, S., Hutsebaut, J., Kaera, A., Kramer, U., Moran, P. A., Renneberg, B., Ribaudi, J. S., Simonsen, S., Swales, M., Taubner, S., & Di Giacomo, E. (2020). Euthanasia and assisted suicide in patients with personality disorder: A review of current practice and challenges. Borderline Personality Disorder and Emotion Dysregulation , 7 (1). https://doi.org/10.1186/s40479-020-00131-9
