New APA Policy Prohibits Participation in Euthanasia of Non-Terminally Ill
Abstract
The experience in Europe shows that countries with physician-assisted suicide have not been able to resist the slippery slope toward euthanasia of the non-terminally ill, said one Assembly co-author of the position statement.
A psychiatrist should not prescribe or administer any intervention to a non-terminally ill person to cause death, according to a position statement passed by the APA Assembly at its meeting in Washington, D.C., this past November. The statement was approved one month later by the APA Board of Trustees by unanimous consent.
Dionne Hart, M.D., Assembly representative from the Minnesota Psychiatry Society, comments on the need to ensure the confidentiality of data in prescription drug monitoring programs. Behind her is David Lott, M.D., representative from the American Academy of Addiction Psychiatry.
The precise wording of the Position Statement on Medical Euthanasia is as follows: “The American Psychiatric Association, in concert with the American Medical Association’s position on medical euthanasia, holds that a psychiatrist should not prescribe or administer any intervention to a non-terminally ill person for the purpose of causing death.”
(Policies and position statements approved by the Assembly are not official APA policy until they are approved by the Board. For a complete report on Board actions at its meeting this past December, see the next issue of Psychiatric News.)
In an interview with Psychiatric News, Mark S. Komrad M.D., an Assembly representative from the Southern Psychiatric Association who cosponsored the position statement in the Assembly, said it was crafted in response to reports from Belgium, the Netherlands, and elsewhere in Europe that physician involvement in “assisted suicide” had evolved from assisting terminally ill patients to die to actively helping non-terminally ill patients—including mentally ill individuals—die. Annette Hanson, M.D., was co-sponsor of the statement in the Assembly.
“So far, no other country that has implemented physician-assisted suicide has been able to constrain its application solely to the terminally ill, eventually including non-terminal patients as legally eligible as well,” Komrad said. “This is when psychiatric patients start to be included.”
He added, “We remain concerned about the vulnerability of current laws in the U.S. permitting physician-assisted suicide for the terminally ill—now legal in six states—to slip down the slope toward the non-terminally ill, particularly psychiatric patients.”
Komrad is a member of APA’s Ethics Committee and ethicist-in-residence at Sheppard Pratt Health System in Baltimore.
Simha Ravven, M.D., and Gwendolyn Lopez-Cohen, M.D., the Area 1 deputy representative and Area 1 representative, respectively, of the Assembly Committee of Early Career Psychiatrists, take a break between the Assembly’s plenary sessions.
On October 19, 2016, Washington Post opinion writer Charles Lane cited the biennial report from Belgium’s Federal Commission on the Control and Evaluation of Euthanasia showing that in 2014-2015 124 of the 3,950 euthanasia cases in Belgium involved people diagnosed with a mental or behavioral disorder.
“Recent newspaper articles and documentaries [inside and outside Belgium] focused on cases in which psychiatrists euthanized or offered to euthanize people with mental illnesses, some still in their 20s or 30s, under dubious circumstances,” Lane wrote. “In December, 65 Belgian mental health professionals, ethicists, and physicians published a call to ban euthanasia of the mentally ill.”
Among the relevant AMA policies cited in the position statement is this guidance from the AMA’s Council on Ethical and Judicial Affairs: “Euthanasia is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks. Euthanasia could readily be extended to incompetent patients and other vulnerable populations.”
The Assembly also approved the Position Statement on Screening and Treatment for Mental Health Disorders During Pregnancy and Postpartum. The Assembly asked APA to develop and announce a position statement recommending the need for screening and subsequent treatment for mood and anxiety disorders during pregnancy and the postpartum period and the need to address the higher rates of these disorders in low-income women from minority groups.
Among the action papers approved by the Assembly included the following:
Return of Interest for ABPN Continuous Pathways Payments asks that as part of APA’s efforts to have the American Board of Psychiatry and Neurology change its requirements for maintenance of certification, APA also demand that interest on the monies deposited toward the 10-year examination fee be returned to psychiatrists either directly or in the form of an appropriate discount on the examination fee.
Smart Guns as a Gun Safety Response to Gun Violence, a Public Health Hazard asks that APA support smart gun technology as one piece of a solution to gun violence and that the APA delegation to the AMA take this issue to the AMA. The action paper also requests that the Council on Advocacy and Government Relations and the Council on Psychiatry and the Law review the issues involved and, if so identified, make any additional recommendations to the APA Board of Trustees.
Improving the Confidentiality of Prescription Drug Monitoring Programs (PDMPs) asks APA to study the variations in the PDMPs to ensure that they are consistent with current federal regulations and to make recommendations to improve the PDMP system with special attention to ensuring appropriate confidentiality of patient records. ■
