Introduction: The Intricate Ethical Dilemma of Euthanasia in the Mental Health Domain
The issue of euthanasia, especially concerning people who are suffering through the difficulties that come with mental conditions, arouses much emotional response and puts forth profoundly ethical questions that cannot be ignored. Euthanasia is often seen as a compassionate and humane intervention toward eliminating the suffering associated with patients dealing with terminal physical conditions. However, its application in battling mental health-related problems presents a complex ethical dilemma that is hard to handle and understand. Recently, this has become a topic of debate in many countries like Belgium, Switzerland, and the Netherlands, where assisted suicide and euthanasia have been legalized. Although the initial intent was to limit euthanasia and assisted suicide to a last-resort option for a very small number of terminally ill people, some jurisdictions now extend the practice to newborns, children, and people with dementia. A terminal illness is no longer a prerequisite. In the Netherlands, euthanasia for anyone over the age of 70 who is “tired of living” is now being considered.
As part of the team of psychologists at Solh Wellness, dedicated to promoting and enhancing mental health for everyone, we aim to present a nuanced perspective on this particular issue. We aim to provide a well-rounded view that considers various aspects and encourages a comprehensive understanding.
We want to take a moment to stress the grave need for empathy, compassion, and, most importantly, proper and appropriate care towards those who have various mental issues. We aim to go much deeper into the complex and sensitive conflict between the treatment and management of mental health issues and the growing requests that are being made for assisted suicide in light of cases where individuals face tremendous mental challenges.
*Reported euthanasia cases with a diagnosis of psychiatric disorder or dementia, 2002–2013
The Psychological Perspective of Mental Illness and Autonomy
Mental illness can dramatically change a person's view of themselves and reality, which then complicates the concept of what constitutes "autonomous choice." The ability for autonomy is a central tenet within the world of medical ethics and is fiercely supported, especially when there is controversy over a patient's right to take his or her life voluntarily. However, within the context of the issue of mental health, this is an exceedingly difficult thing to quantify. Clinical symptoms of many psychiatric conditions, such as depression, borderline personality disorder, and schizophrenia, commonly take the form of continuous and constant suicidal thoughts that intensify the haze of decision and judgment.
Suicidal thoughts typically are not the culmination of an intentional and deeply considered desire for death but, instead, often suggest the presence of some underlying condition that may be treated successfully, such as a mental illness. Mental health issues can impair an individual's ability to use rational reasoning because it warps the judgment of a person in significant ways. This issue makes it particularly difficult for the person to delineate his or her actual wishes about euthanasia. Moreover, the question of whether a patient who has been diagnosed with a psychiatric illness can make an informed and voluntary decision that would result in death poses a deep and complex ethical issue that requires serious consideration.
Notable Cases of Euthanasia Chosen by Individuals with Mental Health Conditions
Here are a few real-world cases where individuals suffering from severe mental health issues opted for euthanasia, highlighting the complexity and emotional depth of this choice:
A study in the Netherlands examined 1,122 patients with psychiatric disorders who requested euthanasia or assisted suicide between 2012 and 2018. It found that patients who often made requests were suffering from depressive disorders.
According to official data from 2020, Medical assistance in dying (MAID) accounted for 1.9% of all deaths in Belgium. Between 2002 and 2021, a total of 370 patients received euthanasia for unbearable mental suffering caused by a psychiatric disorder. This corresponds to 1.4% of the total number of euthanasia cases, although in recent years, the incidence has slightly decreased to between 0.9 and 1%. The most common diagnoses (data on 2002‐2019, N=325) were mood disorders (55.7%) and personality disorders (19.4%), followed by psychotic disorders (6.2%), anxiety disorders and post‐traumatic stress disorder (6.2%), autism spectrum disorder (4.6%), eating disorders (1.5%), and other and/or combination of disorders (6.5%).
*Source by Federal Statistical Office, Switzerland
The role of mental health support: the significance of treatment against assisted dying
In most of the countries that offer euthanasia to mentally ill patients, it is generally the case that such a major and serious decision is not taken unless all other treatment options available are considered and finally discarded. But there does remain a critical and deep issue that hangs in the air: do the treatments for mental health conditions include euthanasia if such treatments fail to produce the comfort and results that they are supposed to yield?
Mental health treatments, although they have indeed made some pretty significant advances of late, are still pretty rudimentary and back-of-birth for most specific areas. While there are plenty of developments that have been made in therapeutic techniques and psychopharmacology, a significant proportion of those afflicted with serious mental illness still face very great difficulties in finding effective, long-term remedies for their symptoms. This situation is further compounded by wait times that many have to endure in order to receive psychiatric services and a marked lack of available resources. Moreover, disparities in accessibility stemming from geographical location or socioeconomic status only add greater depth to these difficulties in accessing needed support for these individuals.
Instead of finding therapeutic support, individuals were offered euthanasia as a countermeasure. That can be troublesome because it begins to suggest the disturbing trend toward nearly using assisted dying not as a humanitarian last resort for persons in agony but as an acceptable substitute for the critical and, therefore, missing psychiatric care for those needing this treatment.
It certainly alarms me because this is clearly quite alarming for a psychologist: It says we are failing to effectively treat the fundamental source of pain. There is much more at play and a bigger question about the entire treatment process and its overall effectiveness.
Solh Wellness: Preventive Care and Early Intervention
It's time to take preventive mental health measures and appreciate the merits of early intervention strategies. Solh Wellness is diligent in the belief that a mental health framework that is comprehensive in range yet accessible to all who need that support to maintain sound mental wellness should be in place. Here, we have several tools that enable users to assess themselves, track their mood, and give access directly to licensed mental health professionals to help in times of need. One of the essential parts of our core mission is to work actively towards reducing stigma frequently associated with mental illness while nurturing and fostering overall wellness through a proactive approach that focuses on prevention and early intervention—long before mental illness has its debilitating effect on individual lives.
Offering early interventions tailored specifically through a personalized care plan alongside community support, preventive care platforms like the Solh Wellness app work to build an immense relationship between the person and the mental health care that may be necessary. This reduces isolation or hopelessness, which might sometimes make a person consider drastic measures, including even thinking about euthanasia. Our unique app is meant for more effective interactions with mental health professionals, builds value in guidance, and helps find support systems accessible to and affordable for everyone who needs it. Such support can go a long way to alleviate the distressing illness in the person's mental state and help him avoid feeling that he has explored every avenue possible.
With so many features designed to empower users to monitor their mental health progress, seek out therapy sessions, and actively engage with various wellness programs, sites such as Solh are likely to nurture an ecosystem that enables people to focus on genuine mental well-being. Being able to take significant strides in the availability of accessible mental care with an emphasis on preventive care options, therefore, means that there is a good chance that the worst and most undesirable solutions, such as extreme ones like euthanasia, can be altogether avoided. Of course, this is possible if people are equipped with all the essentials that make it possible for them to handle daily management and improve their mental health.
Collaboration Between Digital Platforms and Mental Health Professionals
Integrating such innovative digital platforms as Solh Wellness into the mental health field opens channels for many very important benefits for mental health professionals and their patients. The advanced, AI-driven features found within Solh Wellness enable it to provide personalized care plans that can be set and changed by mental health professionals based on the needs of each and every patient. This symbiosis of technology and healthcare enables timely and appropriate interventions so that when the patient needs support, that support is delivered in the exact right location at whatever stage the patient is currently experiencing on their journey toward recovery.
With the infusion of innovative digital tools in their practice, mental health professionals are now endowed with the remarkable opportunity to follow their clients' recovery process in real-time, making timely interventions and support possible. Further, they are empowered to afford their patients multiple resources that advocate for continuous self-care. These can be a determinant factor in sustaining mental health. For those who are experiencing severe mental illnesses, the simple yet significant fact that such care exists and can be readily found may greatly ease some of the deep feelings of isolation and hopelessness characterizing these difficult conditions. With these revolutionary innovations, we have enhanced the way we can deal with the issues affecting mental health before they become so dire that euthanasia seems the only way out for those seeking a way out. Solh has contributed to this process by helping professionals to take charge of the care aspects of the patients in a more effective and comprehensive manner than ever before and equipping users with the tools they need to navigate and manage their journey concerning their mental health.
The Different Problems Encountered in Assessing Mental Capacity for Euthanasia
Another important question that arises in the current debate over euthanasia for psychiatric patients has to do with the sometimes arduous process of determining when a patient may be regarded as competent to give informed consent. By their very nature, mental illnesses often lead to unstable and shifting thought patterns, which make it difficult to determine when it might be appropriate for an individual to be lucid enough and clear-thinking enough to make such a profoundly important decision. In important and daring strides, both the Netherlands and Belgium have allowed minors to decide on euthanasia, which has sparked much debate and thrown consequential questions, notably about the mental faculties of the patients involved, especially the young generation, to take such a serious and reversible decision. Mental health interventions can prove to be crucial in helping patients reach a more stable state of mind, effectively manage and control distressing symptoms that may be influencing their everyday lives, and obtain a clearer outlook on their situation and circumstances. From a clinical perspective, it is essential every possible avenue of treatment and therapy be explored and exhausted before euthanasia can even be considered as an alternative for those individuals in need.
Role of Psychologists in Providing Necessary Care and Support to People in Need
As committed mental health professionals, we stand in an important and influential position in society to help individuals as they venture through the complexities and challenges posed by mental illness. We do this by providing a variety of therapeutic interventions designed to aid them and offering them indispensable emotional support and insightful guidance. It's not only our duty but also our ethical obligation to ensure that our patients receive full care as involved as can be for their well-being, taking into account all aspects of their psychological and emotional needs. Psychologists are uniquely suited to supporting patients in changing their often self-destructive and negative thoughts to more positive thought patterns. They may be in a position to help tease out an end in sight when life seems altogether too dark and hopeless. When a patient indicates a desire for euthanasia, the underlying concerns that lie behind such requests should be probed, and these would be explored in full consultation with the patient. And in that collaborative process, one or more alternatives and solutions might be found and thus presented.
Psychotherapy, when given sensitively in conjunction with appropriate medical treatments, is often found to be enormously effective, even with patients who suffer from the most severe manifestations of mental disease. Conclusion What is arguably a specifically and sensitively complex issue about euthanasia for persons afflicted with various forms of mental disease presents some identifiably unique ethical, legal, and clinical challenges that deserve careful thought and compassion. As psychologists, our most important role is to speak out for kind, holistic mental health care that protects a patient's well-being without violating their autonomy. But an abdication of hope of that kind certainly does not lie in helping people die but in making sure people do not have to suffer from substandard mental health care.
As psychologists at Solh Wellness, we understand its integral role and importance in encouraging and facilitating preventive mental health care. Importantly, this will ensure that it will never get to the point where a human individual is left with no other choice or alternative but to consider it, like euthanasia, as an option. The provision of early intervention, along with professional advice and also unconditional support, can empower individuals to navigate and overcome various complexities that often accompany their journey into mental health, effectively eliminating the need to consider drastic measures such as euthanasia. Invoking the moment for a softer and more sympathetic approach, it cannot be overlooked that mental pain should not only signal a better plea for therapies to treat it but also be a call for wider availability of indispensable resources and continued, unrelenting aid. This is the essential perspective to recall before the moment has flitted out of our clasp, and urgency becomes all the more pertinent in our actions.
