Skip to main content
SpringerLink
Log in

Euthanasia for Mental Suffering

  • Chapter
  • First Online:
New Directions in the Ethics of Assisted Suicide and Euthanasia

Part of the book series: International Library of Ethics, Law, and the New Medicine ((LIME,volume 64))

Abstract

The ethical (un)acceptability of euthanasia for severe physical suffering is undoubtedly one of the most controversial topics of our time. Perhaps even more controversial is the debate on whether euthanasia could also be justified for cases of mental suffering, which we understand as suffering without an underlying diagnosable condition or cause. Various widely debated cases from The Netherlands and Belgium have made this issue more than just a philosophical exercise. In this chapter we look into the ethical aspects of seeing mental suffering as a possibly allowable indication for euthanasia. First, we clarify the important concepts—such as ‘physical suffering’, ‘psychological suffering’, and ‘mental suffering’—that are used throughout this chapter. Next we focus on the following key question: can one consistently claim a right to request euthanasia for patients with diagnosable physical or psychological sources of suffering, while denying the same right to patients with mental suffering without medical diagnosis? We do so by identifying various reasons that could be given to justify why mental suffering is relevantly different from physical or psychological suffering. We will discuss the claims that mental suffering should be seen as special as it: (1) diminishes a person’s competence; (2) is a different type of suffering; (3) is undiagnosable; and (4) can never be proven to be incurable. We conclude with two important reasons to remain cautious about allowing euthanasia in cases of mental suffering.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    Since 2009, euthanasia is also legal in Luxembourg. The Luxembourg euthanasia law is similar to the Belgian and Dutch laws, but as few empirical data are available on the use of euthanasia in Luxembourg, we will not discuss it here.

  2. 2.

    We should mention here that the IASP definition of pain is subject to debate as it is questionable whether all types of physical pain can be adequately described in terms of tissue damage. However, we will not consider this issue here.

References

  • American Nurses Association (ANA). 2013. Position statement: Euthanasia, assisted suicide, and aid in dying. http://www.nursingworld.org/euthanasiaanddying. Accessed 7 July 2014.

  • Appelbaum, Paul S. 2007. Assessment of patients’ competence to consent to treatment. The New England Journal of Medicine 357: 1834–1840.

    Article  Google Scholar 

  • Beckford, Martin. 2008. Baroness Warnock: Dementia sufferers may have a ‘duty to die.’ Telegraph, 18 September. Available at: http://www.telegraph.co.uk/news/uknews/2983652/Baroness-Warnock-Dementia-sufferers-may-have-a-duty-to-die.html. Accessed 1 June 2015.

  • Boston, Patricia, Anne Bruce, and Rita Schreiber. 2011. Existential suffering in the palliative care setting: An integrated literature review. Journal of Pain and Symptom Management 41: 604–618.

    Article  Google Scholar 

  • Bourdieu, Pierre. 1999. The weight of the world: Social suffering in contemporary society. Cambridge: Polity Press.

    Google Scholar 

  • Brennan, Frank, Daniel B. Carr, and Michael Cousins. 2007. Pain management: A fundamental human right. Anesthesia and Analgesia 105: 205–221.

    Article  Google Scholar 

  • Cassell, Eric J. 1994. The nature of suffering and the goals of medicine. Oxford: Oxford University Press.

    Google Scholar 

  • Chambaere, Kenneth, Johan Bilsen, Joachim Cohen, Bregje D. Onwuteaka-Philipsen, Freddy Mortier, and Luc Deliens. 2010. Physician-assisted deaths under the euthanasia law in Belgium: A population-based survey. Canadian Medical Association Journal 182: 895–901.

    Article  Google Scholar 

  • Cholbi, Michael J. 2013a. Kantian paternalism and suicide intervention. In Paternalism: Theory and practice, eds. Christian Coons, and Michael E. Weber, 115–133. Cambridge: Cambridge University Press.

    Chapter  Google Scholar 

  • Cholbi, Michael J. 2013b. The terminal, the futile, and the psychiatrically disordered. International Journal of Law and Psychiatry 36: 498–505.

    Article  Google Scholar 

  • Cohen, Joachim, Isabelle Marcoux, Johan Bilsen, Patrick Deboosere, Gerrit van der Wal, and Luc Deliens. 2006. European public acceptance of euthanasia: Socio-demographic and cultural factors associated with the acceptance of euthanasia in 33 European countries. Social Science and Medicine 63: 743–756.

    Article  Google Scholar 

  • Dees, Marianne, Myrra Vernooij-Dassen, Wim Dekkers, and Chris van Weel. 2010. Unbearable suffering of patients with a request for euthanasia or physician-assisted suicide: an integrative review. Psycho-Oncology 19: 339–52.

    Google Scholar 

  • Dees, Marianne, Myrra Vernooij-Dassen, Wim Dekkers, Kris C. Vissers, and Chris van Wee. 2011. ‘Unbearable suffering’: A qualitative study on the perspectives of patients who request assistance in dying. Journal of Medical Ethics 37: 727–734.

    Article  Google Scholar 

  • Drion, Huib. 1991. Het zelfgewilde einde van oudere mensen. NRC Handelsblad, 19 October. http://retro.nrc.nl/W2/Tegenspraak/Drion/artikeldrion.html. Accessed 26 August 2014.

  • Greenberg, Gary. 2013. The book of woe: The DSM and the unmaking of psychiatry. New York: Blue Rider Press.

    Google Scholar 

  • Grisso, Thomas, and Paul S. Appelbaum. 1995. The MacArthur treatment competence study. III: Abilities of patients to consent to psychiatric and medical treatments. Law and Human Behavior 19: 149–174.

    Article  Google Scholar 

  • Gündel, Harald, Mary-Frances O’Connor, Lindsey Littrell, Carolyn Fort, and Richard D. Lane. 2003. Functional neuroanatomy of grief: An FMRI study. American Journal of Psychiatry 160: 1946–1953.

    Article  Google Scholar 

  • Hendin, Herbert. 1998. Seduced by death: Doctors, patients, and assisted suicide. New York: W.W. Norton & Company.

    Google Scholar 

  • Hirai, Kei, Tatsuya Morita, and Tetsua Kashiwagi. 2003. Professionally perceived effectiveness of psychosocial interventions for existential suffering of terminally ill cancer patients. Palliative Medicine 17: 688–694.

    Google Scholar 

  • Huxtable, Richard, and Maaike Möller. 2007. Setting a principled boundary”? Euthanasia as a response to ‘life fatigue. Bioethics 21: 117–126.

    Article  Google Scholar 

  • Inghelbrecht, Els, Johan Bilsen, Freddy Mortier, and Luc Deliens. 2009. Nurses’ attitudes towards end-of-life decisions in medical practice: A nationwide study in Flanders, Belgium. Palliative Medicine 23: 649–658.

    Article  Google Scholar 

  • Joffe, Walter G., and Joseph Sandler. 1967. On the concept of pain, with special reference to depression and psychogenic pain. Journal of Psychosomatic Research 11: 69–75.

    Article  Google Scholar 

  • Karine, Baumstarck, Laurent Boyer, Mohamed Boucekine, Valérie Aghababian, Nathalie Parola, Christophe Lançon, and Pascal Auquier. 2013. Self-reported quality of life measure is reliable and valid in adult patients suffering from schizophrenia with executive impairment. Schizophrenia Research 147: 58–67.

    Article  Google Scholar 

  • Kelly, Brendan D., and Declan M. McLoughlin. 2002. Euthanasia, assisted suicide and psychiatry: A Pandora’s box. The British Journal of Psychiatry 181: 278–279.

    Article  Google Scholar 

  • Kissane, David W. 2012. The relief of existential suffering. Archives of Internal Medicine 172: 1501–1505.

    Article  Google Scholar 

  • Kissane, David W., and Brian J. Kelly. 2000. Demoralisation, depression and desire for death: Problems with the Dutch guidelines for euthanasia of the mentally ill. Australian and New Zealand Journal of Psychiatry 34: 325–333.

    Article  Google Scholar 

  • Kouwenhoven, Pauline S.C., Natasja J.H. Raijmakers, Johannes J.M. van Delden, Judith A.C. Rietjens, Maartje H.N. Schermer, J.M.W. van Ghislaine, Margo J. Thiel, Suzanne Trappenburg, Bea J. van de Vathorst, Cristiano van der Vegt, Heleen Weyers Vezzoni, Donald G. van Tol, and Agnes van der Heide. 2012. Opinions of health care professionals and the public after eight years of euthanasia legislation in the Netherlands: A mixed methods approach. Palliative Medicine 27: 273–280.

    Article  Google Scholar 

  • Lamont, Scott, Yun-Hee Jeon, and Mary Chiarella. 2013. Assessing patient capacity to consent to treatment: An integrative review of instruments and tools. Journal of Clinical Nursing 22: 2387–2403.

    Article  Google Scholar 

  • Mee, Steven, Blynn G. Bunney, Christopher Reist, Steve G. Potkin, and William E. Bunney. 2006. Psychological pain: A review of evidence. Journal of Psychiatric Research 40: 680–690.

    Article  Google Scholar 

  • Merskey, Harold, and Nikolai Bogduk (eds.). 1994. Classification of chronic pain, 2nd ed. Seattle: IASP Press.

    Google Scholar 

  • Merskey, Harold, and Frank G. Spear. 1967. The concept of pain. Journal of Psychosomatic Research 11: 59–67.

    Article  Google Scholar 

  • Mitchell, Alex J., Amol Vaze, and Sanjay Rao. 2009. Clinical diagnosis of depression in primary care: A meta-analysis. The Lancet 374: 609–619.

    Article  Google Scholar 

  • Murata, Hisayuki, and Tatsuya Morita. 2006. Conceptualization of psycho-existential suffering by the Japanese Task Force: The first step of a nationwide project. Palliative and Supportive Care 4: 279–285.

    Article  Google Scholar 

  • Nederlandse Vereniging voor Psychiatrie. 2009. Richtlijn omgaan met het verzoek om hulp bij zelfdoding door patiënten met een psychiatrische stoornis. Utrecht: de Tijdstroom.

    Google Scholar 

  • Onwuteaka-Philipsen, Bregje D., Arianne Brinkman-Stoppelenburg, Corine Penning, Gwen J.F. de Jong-Krul, Johannes J.M. van Delden, and Agnes van der Heide. 2012. Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: A repeated cross-sectional survey. The Lancet 380: 908–915.

    Article  Google Scholar 

  • Rietjens, Judith A.C., Johannes J.M. van Delden, Agnes van der Heide, Astrid M. Vrakking, Bregje D. Onwuteaka-Philipsen, Paul J. van der Maas, and Gerrit van der Wal. 2006. Terminal sedation and euthanasia. Archives of Internal Medicine 166: 749–753.

    Article  Google Scholar 

  • Rurup, Mette L., Martien T. Muller, Bregje D. Onwuteaka-Philipsen, Agnes van der Heide, Gerrit van der Wal, and Paul J. van der Maas. 2005. Requests for euthanasia or physician-assisted suicide from older persons who do not have a severe disease: An interview study. Psychological Medicine 35: 665–671.

    Article  Google Scholar 

  • Saunders, Cicely. 1964. The symptomatic treatment of incurable malignant disease. Prescribers 4: 68–73.

    Google Scholar 

  • Saunders, Cicely. 2001. The evolution of palliative care. Journal of the Royal Society of Medicine 94: 430–432.

    Google Scholar 

  • Savulescu, Julian. 2014. A simple solution to the puzzles of end of life? Voluntary palliated starvation. Journal of Medical Ethics 40: 110–113.

    Article  Google Scholar 

  • Szasz, Thomas. 2007. The medicalization of everyday life: Selected essays. Syracuse, New York: Syracuse University Press.

    Google Scholar 

  • Varelius, Jukka. 2007. Illness, suffering and voluntary euthanasia. Bioethics 21: 75–83.

    Article  Google Scholar 

  • Varelius, Jukka. 2014. On the relevance of an argument as regards the role of existential suffering in the end-of-life context. Journal of Medical Ethics 40: 114–116.

    Article  Google Scholar 

  • Wager, Tor D., Lauren Y. Atlas, Martin A. Lindquist, Mathieu Roy, Choong-Wan Woo, and Ethan Kross. 2013. An fMRI-based neurologic signature of physical pain. New England Journal of Medicine 368: 1388–1397.

    Article  Google Scholar 

Court Cases And Rulings

Laws and Legislation

Download references

Author information

Authors and Affiliations

  1. Bioethics Institute Ghent, Ghent University, Ghent, Belgium

    Kasper Raus & Sigrid Sterckx

Authors
  1. Kasper Raus
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sigrid Sterckx
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kasper Raus .

Editor information

Editors and Affiliations

  1. Department of Philosophy, California State Polytechnic University, Pomona, California, USA

    Michael Cholbi

  2. Dept. of Behavioural Sciences and Philos, University of Turku, Turku, Finland

    Jukka Varelius

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Raus, K., Sterckx, S. (2015). Euthanasia for Mental Suffering. In: Cholbi, M., Varelius, J. (eds) New Directions in the Ethics of Assisted Suicide and Euthanasia. International Library of Ethics, Law, and the New Medicine, vol 64. Springer, Cham. https://doi.org/10.1007/978-3-319-22050-5_6

Download citation

Publish with us

Policies and ethics

Search

Navigation