Department of Psychosomatic Medicine and Psychotherapy, Otto von Guericke University Magdeburg, University Hospital Magdeburg, Magdeburg, Germany; and German Center for Mental Health, Magdeburg, Germany
Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, University of Tuebingen, Tuebingen, Germany; and German Center for Mental Health, Tuebingen, Germany
Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, University of Tuebingen, Tuebingen, Germany; and German Center for Mental Health, Tuebingen, Germany
Background Physician-assisted suicide (PAS) is typically associated with serious physical illnesses that are prevalent in palliative care. However, individuals with mental illnesses may also experience such severity that life becomes intolerable. In February 2020, the previous German law prohibiting PAS was repealed. Patients with severe mental illnesses are increasingly likely to approach physicians with requests for PAS. Aims To explore the ethical and moral perspectives of medical students and physicians when making individual decisions regarding PAS. Method An anonymised digital survey was conducted among medical students and physicians in Germany. Participants were presented with a case vignette of a chronically depressed patient requesting PAS. Participants decided on PAS provision and assessed theoretical arguments. We employed generalised ordinal regression and qualitative analysis for data interpretation. Results A total of N = 1478 participants completed the survey. Of these, n = 470 (32%) stated that they would refuse the request, whereas n = 582 (39%) would probably refuse, n = 375 (25%) would probably agree and n = 57 (4%) would definitely agree. Patient-centred arguments such as the right to self-determination increased the likelihood of consent. Concerns that PAS for chronically depressed patients might erode trust in the medical profession resulted in a decreased willingness to provide PAS. Conclusions Participants displayed relatively low willingness to consider PAS in the case of a chronically depressed patient. This study highlights the substantial influence of theoretical medical-ethical arguments and the broader public discourse, underscoring the necessity of an ethical discussion on PAS for mental illnesses.
