Physician Aid-in-Dying for Individuals With Serious Mental Illness: Clarifying Decision-Making Capacity and Psychiatric Futility

Kious and Battin (2019) describe a pressing and profound ethical dilemma in psychiatry. This dilemma is rooted in conceptual parity—the view that psychiatric illness and somatic illnesses exist within the same ontological realm, that the suffering caused by the one and that caused by the other are commensurable, and that consequently psychiatric and somatic illnesses entail equal consideration for physician aid-in-dying (PAD) (Kious and Battin 2019; Sisti and Ramamurthy 2016). In individuals with serious mental illness, how might we ascertain capacitated, rational requests for self-killing versus suicides that are the sequelae of an incapacitating illness?

The authors correctly recognize the aporetic moment in which American psychiatry currently finds itself, and they offer several ways forward. We wish to append these recommendations by briefly suggesting ways that capacity evaluation might be retooled for this problem and how a more robust concept of psychiatric futility is critical to resolving this dilemma. Ultimately, we believe it is premature to extend PAD to individuals requesting it for relief from serious mental illness.