The Role of the Psychologist in Determining Competence for Assisted Suicide/euthanasia in the Terminally Ill

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Abstract

This paper discusses the history of assisted suicide/euthanasia and public attitudes in Canada; discusses depression in the terminally ill and the potential role of the psychologist in the assisted suicide/euthanasia process; and specifically addresses the importance of determining competence in terminally ill patients. One area in which the services of psychologists have not been used to their fullest potential is in the care of the terminally ill, particularly in helping them make end-of-life decisions. It is very important that individuals making end-of-life decisions be assessed for mental disorders in order to ensure they are able to make competent decisions. If assisted suicide and euthanasia were to become legalized, psychologists should be involved in the assessment process in order to determine competency.

During the last few decades, psychologists1 have become integrally involved in health care settings. As the profession of psychology grew over the years, the role of psychologists in health care began to include multiple functions such as clinical services, consulting, teaching and research. A recent analysis of registered psychologists across Canada estimated an average of 17% were employed by health care facilities (Hearn & Evans, 1993). An area in health care in which the services of psychologists have not been utilized to their fullest potential is in the care of the terminally ill, particularly in helping them deal with end-of-life decisions (Farberman, 1997). Traditionally, when patients make decisions they tend to include their family members and their physician.

As stated by Farberman (1997), psychologists have conducted a large portion of the research on issues related to end-of-life decisions such as coping, pain management and depression (Farberman, 1997). Consequently, their knowledge, combined with their clinical experience on these issues, is a significant resource, particularly for determining whether a patient is competent to make critical end-of-life decisions. These decisions traditionally involve deciding whether to withdraw or withhold life-sustaining treatment; however, attention has increasingly focused on alternatives such as assisted suicide and euthanasia (Ericksen, Rodney, & Starzomski, 1995). Assisted suicide and euthanasia are not legal in Canada; however, their possible decriminalization has been the subject of many debates, with strong arguments for and against legalization.

First, we briefly discuss the history of assisted suicide and euthanasia and public attitudes towards both in Canada. Next, we discuss depression in the terminally ill and the potential role of psychologists in the assisted suicide/euthanasia process. Lastly, we address the importance of determining competence in terminally ill patients.

The History of Assisted Suicide and Euthanasia

The concept of euthanasia has existed for thousands of years; however, our current conceptualizations of euthanasia and subsequent controversies stem from the early part of the 20th century (Pappas, 1996). The advances in medical technology throughout this century have played a key role in the development of the euthanasia debate. Although medical technology has eliminated many acute illnesses, degenerative illnesses with a much later onset have increased (Pappas, 1996). Although medical technology has extended lifespans, the quality of the prolonged life remains questionable for those suffering from chronic debilitating, painful illnesses.

The word "euthanasia" is Greek for "good or pleasant death" (Ericksen et al., 1995, p. 30). Unfortunately, the term became tainted through association with the Nazi experiments during the 1930s. Consequently, the public remains confused with regard to the meaning of euthanasia (Nadeau, 1995). There are two types of euthanasia. Passive euthanasia is the removal of life-support (e.g., respirators); active euthanasia is the involvement of a physician in performing an action that directly and immediately results in the patient's death. …