Switzerland has the longest history of nonmedicalized assistance in dying, which is considered a civil right even in non-pathological situations. Public debate in Switzerland about the issue of suffering in the context of medical assistance in dying is current and ongoing.
We hold that intolerable suffering is a necessary but insufficient condition for assistance in dying, and criteria should also include decision-making capacity and refractoriness of suffering. We further contend that suffering is a subjective experience that can only be quantified by the patient and cannot be objectively compared across different individuals. On this view, some patients with severe and persistent mental illness, refractory suffering, and preserved decision-making capacity will meet the criteria for medical assistance in dying, and we advocate palliative psychiatric care that includes as much relief of suffering as possible while accepting assistance in dying following conscientious assessment of the criteria.
Manuel Trachsel and Ralf J. Jox are proud of having been awarded with the 2020 Mark S. Ehrenreich Global Prize in Healthcare Ethics Research by the Pacific Center for Health Policy and Ethics, University of Southern California.
Trachsel, M., & Jox R. J. (submitted). Suffering is not enough: The ethics of medical assistance in dying for patients with severe and persistent mental illness.
Stoll, J., Ryan, C. J., & Trachsel, M. (2021). Perceived burdensomeness and the wish for hastened death in persons with severe and persistent mental illness, Frontiers in Psychiatry, 11:532817.
Gloeckler, S., & Trachsel, M. (2020). Acceptability of Assisted Suicide in Patients With Severe and Persistent Mental Illness: A Pilot Study on Attitudes Among Nurses in Switzerland. GeroPsych: The Journal of Gerontopsychology and Geriatric Psychiatry. Online first. https://doi.org/10.1024/1662-9647/a000248
Hodel, M. A., Hoff, P., Irwin, S. A., Biller-Andorno, N., Riese, F, & Trachsel, M. (2019). Attitudes toward assisted suicide requests in the context of severe and persistent mental illness: A survey of psychiatrists in Switzerland. Palliative and Supportive Care, 1–7.
Shaw, D., Trachsel, M., & Elger, B. (2018). Assessment of decision-making capacity in patients requesting assisted suicide. The British Journal of Psychiatry, 213, (1), 393–395, 2018.
Hodel, M. A., & Trachsel, M. (2016). Euthanasia or assisted suicide in patients with psychiatric illness. JAMA, 316(20), 2153-2154.