BioEdge, 9 October, 2019
Reproduced under Creative Commons Licence
Xavier Symons*
A new edition of the American Journal of Bioethics explores the theme of euthanasia for mentally ill persons. Several well-known commentators on euthanasia argue that, in principle, euthanasia should not be prohibited for people suffering from severe psychiatric disorders.
The journal discussion is built around a target article by Brent Kious and Marget Battin from the University of Utah. Battin is a long-time proponent of voluntary euthanasia, while Kious is a psychiatrist who specialises in severe and persistent mental illness. The authors argue that euthanasia for the mentally ill is morally indistinct from euthanasia for physical terminal illness:
“We think it is clear that the suffering associated with mental illnesses can sometimes be as severe, intractable, and prolonged as the suffering due to physical illnesses. Accordingly, it seems to us that if severe suffering can justify [physician assisted dying] for some persons with terminal physical illnesses, it should justify [physician assisted dying] for some persons with mental illnesses, too. Call this the parity argument.”
To resist the parity argument, some scholars claim that terminality (i.e., the presence of a terminal illness) is morally relevant as patients who request euthanasia are dying already. Yet Kious and Battin argue that suffering, not terminality, is the ultimate justification that motives lawmakers to legalise euthanasia: “Terminality is...merely a safeguard, and not a rationale, for [physician assisted dying]”.
Other scholars argue that persons with mental illness lack the capacity to make decisions about ending their own life. Kious and Battin acknowledge that severe mental illness can greatly affect capacity, but they suggest that this does not rule out the possibility that some persons with severe psychiatric disorders are capable of making an autonomous decision to end their life. Indeed, in some cases we may be denying competent persons the right to a humane death:
“by forbidding [physician assisted death] in [cases of] mental illness we could [be denying] much-needed succor to a person who is suffering severely and whose request for death is reasonable and made with full capacity”.
While several of the open peer commentaries are supportive of Kious and Battin’s basic proposal, a commentary by Charles Foster (University of Oxford) takes the parity argument in the opposite direction. Foster argues that the parity argument is in fact a reason to prohibit euthanasia altogether:
“Kiou"s and Battin are right to assert that there is no distinction of substance between physical and psychiatric suffering, and that the presence of psychiatric suffering does not necessarily connote incapacity (although in practice it often will)...[yet the authors] have reached precisely the wrong conclusion using, in part, precisely the right reasoning. The right conclusion is not that the ambit of legally sanctioned physician-assisted suicide (PAS) should be widened, but that it should be narrowed: Indeed, PAS should be unlawful”.
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