New APA Policy Prohibits Participation in Euthanasia of Non-Terminally Ill

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.

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.

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:

APA members can access the materials for the Assembly’s November meeting here. Archived summaries of Assembly actions can be accessed here.