Euthanasia is itself not without controversy; the euthanasia or assisted suicide (EAS) of the mentally ill even more so. It's an infrequent practice but one on the rise in the Netherlands, which is thought to have seen no more than five such cases in 1997 but 42 in 2013. Still, "little is known" about these cases, write researchers in a report published Wednesday in JAMA Psychiatry. And so they reviewed the particulars of 66 patients who opted for EAS in the country from 2011 to 2014. Depression was the most common psychiatric disorder, but there was also psychosis, PTSD, and anxiety and long-term eating disorders (most had more than one condition). About half had attempted suicide; almost all had a comorbidity (ranging from cancer to arthritis), though the study calls out one healthy 70-year-old woman who simply found her life a "living hell" in the year after her husband's death.
As for how they came to end their lives, "the reality of implementing such programs is messy," Reuters notes. In 32% of the cases, the patient had been refused EAS. The physicians for three of those 21 patients ultimately reversed their decisions; the other 18 got approval from a new physician. In 24% of the cases, there was physician disagreement, per a press release, and the New York Times points out that while most patients had long treatment histories, 56% had turned down at least some treatment. In an accompanying editorial, Dr. Paul S. Applebaum sees further "red flags," among them the 20% who had never been hospitalized for psychiatric reasons, the "ratio of women to men (2.3 to 1), and the 56% of cases in which social isolation or loneliness was important enough to be mentioned," raising "the concern that physician-assisted death served as a substitute for effective psychosocial intervention." (Belgium granted a depressed 24-year-old the right to die.)