Physician-Assisted Suicide

摘要

To the Editor: Studies support that psychiatrists' ethical views on physician-assisted suicide clearly affect their clinical understanding of this practice (1). This bias is demonstrated in both the manner in which N. Gregory Hamilton, M.D., and Catherine A. Hamilton, M.A. (2) described cases of physician-assisted suicide and the Journal editors' choice to publish the case report. Dr. and Ms. Hamilton stated that the law failed to protect "Kate Cheney, an 85-year-old cancer patient with growing dementia, whose psychiatrist believed she was being pressured by her family. Nevertheless, she was approved for an overdose by a psychologist" (p. 1061). I was the psychiatrist who determined that Ms. Cheney did not meet the requirements of the law, but concern regarding coercion was not the primary basis. This woman had mild, potentially reversible cognitive deficits that interfered with her ability to understand her options. I agreed with the need for a second opinion and assisted in finding a qualified mentalhealth professional to give one. As noted by Grisso and Appelbaum (3), "A key element in attempting to maximize patient performance is delaying the final decision about their capacities.. .repeat evaluations are often helpful in distinguishing between time-limited and permanent impairments" (p. 92).