Euthanasia and assisted suicide in neurological diseases: a systematic review

Neurology and physician-assisted suicide: position of the Italian society of neurology

This position paper explores the complex issue of Physician-Assisted Suicide (PAS) in the context of Neurology. It discusses the legal, ethical, and clinical challenges surrounding PAS, including the role of neurologists in assessing eligibility based on prognosis, decision-making capacity, and functional status. The paper outlines Italy's legal framework regarding PAS, following a landmark 2019 Constitutional Court ruling, which permits PAS under strict conditions for patients suffering from incurable illnesses. It also compares PAS regulations in other European and non-European countries. The Italian Society of Neurology (SIN) emphasizes the importance of respecting patient autonomy while advocating for comprehensive palliative care (PC). The SIN's position is that PAS should be legalized under specific circumstances but insists on ensuring equitable access to PC services before considering PAS. Additionally, the SIN supports the training of neurologists in palliative and end-of-life care, underlining the need for careful monitoring and regulation of PAS practices to prevent potential ethical and legal abuses.

Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders

PURPOSE OF REVIEW

Over the last 30 years, medical assistance in dying (MAiD) including euthanasia (EU) and physician-assisted death (or suicide, PAS) has become the center of a large debate, particularly when these practices have involved people with psychiatric illness, including resistant depression, schizophrenia, personality, or other severe psychiatric disorders. We performed a review utilizing several databases, and by including the most relevant studies in full journal articles investigating the problem of MAiD in patients with psychiatric disorders but not in physical terminal conditions (non-terminal, MAiD-NT).

RECENT FINDINGS

Literature has shown that a small percentage of people with psychiatric disorders died by MAiD-NT in comparison with patients with somatic diseases in terminal clinical conditions (e.g., cancer, AIDS). However, the problem in the field is complex and not solved yet as confirmed by the fact that only a few countries (e.g., the Netherlands, Belgium, Luxemburg) have legalized MAiD-NT for patients with psychiatric disorders, while most have maintained the practices accessible only to people with somatic disease in a terminal phase. Also, how to make objective the criterion of irremediability of a mental disorder; how to balance suicide prevention with assisted suicide; how to avoid the risk of progressively including in requests for MAiD-NT vulnerable segments of the population, such as minors, elderly, or people with dementia, in a productive-oriented society, are some of the critical points to be discussed. The application of MAiD-NT in people with psychiatric disorders should be further explored to prevent end-of-life rights from contradicting the principles of recovery-oriented care.