title: Assisted dying in liberalised jurisdictions and the role of psychiatry: a clinician's view.
abstract: OBJECTIVE
  Assisted dying is a contentious and topical issue. Mental disorder is a relevant influence on requests of hastened death. The psychiatry of dying is not a prominent component in the assessment of euthanasia and physician-assisted suicide (PAS) in jurisdictions with liberalised assisted dying laws. The literature on the assessment processes, with particular reference to mental status, involved in euthanasia requests is considered.
  
  
  METHODS
  An experienced palliative medicine specialist and psychiatrist selectively reviewed the recent literature published about the mental health issues involved in euthanasia and PAS.
  
  
  RESULTS
  Assessments of competency, sustained wish to die prematurely, depressive disorder, demoralisation and 'unbearable suffering' in the terminally ill are clinically uncertain and difficult tasks. There is a growing psychiatric and psychological literature on the mental status of the terminally ill. As yet psychiatry does not have the expertise to 'select' those whose wish for hastened death is rational, humane and 'healthy'. Rarely in those societies with liberalised assisted dying laws are psychiatrists involved in the decision-making for individuals requesting early death. This role is fulfilled by non-specialists.
  
  
  CONCLUSIONS
  There remain significant concerns about the accuracy of psychiatric assessment in the terminally ill. Mental processes are more relevant influences on a hastened wish to die than are the physical symptoms of terminal malignant disease. Psychiatric review of persons requesting euthanasia is relevant. It is not obligatory or emphasised in those legislations allowing assisted dying. Psychiatry needs to play a greater role in the assessment processes of euthanasia and PAS.
authors.affiliation: Health Sciences Centre, University of Canterbury, Christchurch, New Zealand. ad.macleod@cdhb.govt.nz
authors.forename: Sandy
authors.initials: S
authors.lastname: Macleod
mesh_terms: D001315:Australia; D028601:Euthanasia, Active / Q000331:legislation & jurisprudence / Q000523:psychology; D006801:Humans; D016743:Mental Competency / Q000331:legislation & jurisprudence / Q000523:psychology; D009426:Netherlands; D009922:Oregon; D010819:Physician's Role; D011570:Psychiatry; D017236:Suicide, Assisted / Q000331:legislation & jurisprudence / Q000523:psychology; D013727:Terminal Care / Q000331:legislation & jurisprudence / Q000523:psychology