Evaluation of competence to consent to assisted suicide: Views of forensic psychiatrists

Linda Ganzini, Gregory B. Leong, Darien S. Fenn, J. Arturo Silva, Robert Weinstock

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Objective: Mental health evaluation of competence to consent has been proposed as an important safeguard for patients requesting assisted suicide, yet mental health professionals have not developed guidelines or standards to aid in such evaluations. The authors surveyed a national sample of forensic psychiatrists in the United States regarding the process, thresholds, and standards that should be used to determine competence to consent to assisted suicide. Method: An anonymous questionnaire was sent to board-certified forensic psychiatrists between August and October 1997. Results: Of the 456 forensic psychiatrists who were sent the questionnaire, 290 (64%) responded. Sixty-six percent believed that assisted suicide was ethical in at least some circumstances, and 63% thought that it should be legalized for some competent persons. Twenty-four percent indicated that it was unethical for psychiatrists to determine competence; however, 61% thought such an evaluation should be required in some or all cases. Seventy-eight percent recommended a very stringent standard of competence. Seventy-three percent believed that at least two independent examiners were needed to determine competence, and 44% favored requiring judicial review of a decision. Fifty- eight percent believed that the presence of major depressive disorder should result in an automatic finding of incompetence. Psychiatrists with ethical objections to assisted suicide advocated a higher threshold for competence and more extensive review of a decision. Conclusions: The ethical views of psychiatrists may influence their clinical opinions regarding patient competence to consent to assisted suicide. The extensive evaluation recommended by forensic psychiatrists would likely both minimize this bias and assure that only competent patients have access to assisted suicide, but the process might burden terminally ill patients.

Original languageEnglish (US)
Pages (from-to)595-600
Number of pages6
JournalAmerican Journal of Psychiatry
Volume157
Issue number4
DOIs
StatePublished - Apr 2000
Externally publishedYes

Fingerprint

Assisted Suicide
Mental Competency
Psychiatry
Mental Health
Terminally Ill
Major Depressive Disorder
Guidelines

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Evaluation of competence to consent to assisted suicide : Views of forensic psychiatrists. / Ganzini, Linda; Leong, Gregory B.; Fenn, Darien S.; Arturo Silva, J.; Weinstock, Robert.

In: American Journal of Psychiatry, Vol. 157, No. 4, 04.2000, p. 595-600.

Research output: Contribution to journalArticle

Ganzini, Linda ; Leong, Gregory B. ; Fenn, Darien S. ; Arturo Silva, J. ; Weinstock, Robert. / Evaluation of competence to consent to assisted suicide : Views of forensic psychiatrists. In: American Journal of Psychiatry. 2000 ; Vol. 157, No. 4. pp. 595-600.
@article{9ece2172dc494e29afd62ceb7a4a43e0,
title = "Evaluation of competence to consent to assisted suicide: Views of forensic psychiatrists",
abstract = "Objective: Mental health evaluation of competence to consent has been proposed as an important safeguard for patients requesting assisted suicide, yet mental health professionals have not developed guidelines or standards to aid in such evaluations. The authors surveyed a national sample of forensic psychiatrists in the United States regarding the process, thresholds, and standards that should be used to determine competence to consent to assisted suicide. Method: An anonymous questionnaire was sent to board-certified forensic psychiatrists between August and October 1997. Results: Of the 456 forensic psychiatrists who were sent the questionnaire, 290 (64{\%}) responded. Sixty-six percent believed that assisted suicide was ethical in at least some circumstances, and 63{\%} thought that it should be legalized for some competent persons. Twenty-four percent indicated that it was unethical for psychiatrists to determine competence; however, 61{\%} thought such an evaluation should be required in some or all cases. Seventy-eight percent recommended a very stringent standard of competence. Seventy-three percent believed that at least two independent examiners were needed to determine competence, and 44{\%} favored requiring judicial review of a decision. Fifty- eight percent believed that the presence of major depressive disorder should result in an automatic finding of incompetence. Psychiatrists with ethical objections to assisted suicide advocated a higher threshold for competence and more extensive review of a decision. Conclusions: The ethical views of psychiatrists may influence their clinical opinions regarding patient competence to consent to assisted suicide. The extensive evaluation recommended by forensic psychiatrists would likely both minimize this bias and assure that only competent patients have access to assisted suicide, but the process might burden terminally ill patients.",
author = "Linda Ganzini and Leong, {Gregory B.} and Fenn, {Darien S.} and {Arturo Silva}, J. and Robert Weinstock",
year = "2000",
month = "4",
doi = "10.1176/appi.ajp.157.4.595",
language = "English (US)",
volume = "157",
pages = "595--600",
journal = "American Journal of Psychiatry",
issn = "0002-953X",
publisher = "American Psychiatric Association",
number = "4",

}

TY - JOUR

T1 - Evaluation of competence to consent to assisted suicide

T2 - Views of forensic psychiatrists

AU - Ganzini, Linda

AU - Leong, Gregory B.

AU - Fenn, Darien S.

AU - Arturo Silva, J.

AU - Weinstock, Robert

PY - 2000/4

Y1 - 2000/4

N2 - Objective: Mental health evaluation of competence to consent has been proposed as an important safeguard for patients requesting assisted suicide, yet mental health professionals have not developed guidelines or standards to aid in such evaluations. The authors surveyed a national sample of forensic psychiatrists in the United States regarding the process, thresholds, and standards that should be used to determine competence to consent to assisted suicide. Method: An anonymous questionnaire was sent to board-certified forensic psychiatrists between August and October 1997. Results: Of the 456 forensic psychiatrists who were sent the questionnaire, 290 (64%) responded. Sixty-six percent believed that assisted suicide was ethical in at least some circumstances, and 63% thought that it should be legalized for some competent persons. Twenty-four percent indicated that it was unethical for psychiatrists to determine competence; however, 61% thought such an evaluation should be required in some or all cases. Seventy-eight percent recommended a very stringent standard of competence. Seventy-three percent believed that at least two independent examiners were needed to determine competence, and 44% favored requiring judicial review of a decision. Fifty- eight percent believed that the presence of major depressive disorder should result in an automatic finding of incompetence. Psychiatrists with ethical objections to assisted suicide advocated a higher threshold for competence and more extensive review of a decision. Conclusions: The ethical views of psychiatrists may influence their clinical opinions regarding patient competence to consent to assisted suicide. The extensive evaluation recommended by forensic psychiatrists would likely both minimize this bias and assure that only competent patients have access to assisted suicide, but the process might burden terminally ill patients.

AB - Objective: Mental health evaluation of competence to consent has been proposed as an important safeguard for patients requesting assisted suicide, yet mental health professionals have not developed guidelines or standards to aid in such evaluations. The authors surveyed a national sample of forensic psychiatrists in the United States regarding the process, thresholds, and standards that should be used to determine competence to consent to assisted suicide. Method: An anonymous questionnaire was sent to board-certified forensic psychiatrists between August and October 1997. Results: Of the 456 forensic psychiatrists who were sent the questionnaire, 290 (64%) responded. Sixty-six percent believed that assisted suicide was ethical in at least some circumstances, and 63% thought that it should be legalized for some competent persons. Twenty-four percent indicated that it was unethical for psychiatrists to determine competence; however, 61% thought such an evaluation should be required in some or all cases. Seventy-eight percent recommended a very stringent standard of competence. Seventy-three percent believed that at least two independent examiners were needed to determine competence, and 44% favored requiring judicial review of a decision. Fifty- eight percent believed that the presence of major depressive disorder should result in an automatic finding of incompetence. Psychiatrists with ethical objections to assisted suicide advocated a higher threshold for competence and more extensive review of a decision. Conclusions: The ethical views of psychiatrists may influence their clinical opinions regarding patient competence to consent to assisted suicide. The extensive evaluation recommended by forensic psychiatrists would likely both minimize this bias and assure that only competent patients have access to assisted suicide, but the process might burden terminally ill patients.

UR - http://www.scopus.com/inward/record.url?scp=0034080812&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034080812&partnerID=8YFLogxK

U2 - 10.1176/appi.ajp.157.4.595

DO - 10.1176/appi.ajp.157.4.595

M3 - Article

C2 - 10739419

AN - SCOPUS:0034080812

VL - 157

SP - 595

EP - 600

JO - American Journal of Psychiatry

JF - American Journal of Psychiatry

SN - 0002-953X

IS - 4

ER -