By Benedict Carey | New York Times

A new study of doctor-assisted death for people with mental disorders raises questions about the practice, finding that in more than half of approved cases, people declined treatment that could have helped, and that many cited loneliness as an important reason for wanting to die. The study, of cases in the Netherlands, should raise concerns for other countries debating where to draw the line when it comes to people’s right to die, experts said.

At least three countries — the Netherlands, Belgium and Switzerland — allow assisted suicides for people who have severe psychiatric problems and others, like Canada, are debating such measures, citing the rights of people with untreatable mental illness. Laws in the United States, passed in five states, restrict doctor-assisted suicide to mentally competent adults with terminal illnesses only, not for disorders like depression and schizophrenia.

The study, published Wednesday in the journal JAMA Psychiatry, finds that cases of doctor-assisted death for psychiatric reasons were not at all clear-cut, even in the Netherlands, the country with the longest tradition of carefully evaluating such end-of-life choices. People who got assistance to die often sought help from doctors they had not seen before, and many used what the study called a “mobile end-of-life clinic” — a nurse and a doctor, funded by a local euthanasia advocacy organization.

“The criteria in the Netherlands essentially require that the person’s disorder be intractable and untreatable, and this study shows that evaluating each of those elements turns out to be problematic,” said Dr. Paul S. Appelbaum, a professor of psychiatry, medicine and law at Columbia University.

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