The role of psychiatrists and mental disorder in assisted dying practices around the world: a review of the legislation and official reports.

OBJECTIVE To establish the role of psychiatrists and mental disorder in assisted dying practices in countries and states where such practices are legal. METHODS The authors reviewed the Assisted Dying Acts and official statistical reports from Belgium, The Netherlands, Luxembourg, and the states of Washington and Oregon in the U.S.A. The data extracted related to the role of psychiatrists in assisted dying practices, and the relevance of capacity, 'suffering', and mental disorder. RESULTS A psychiatry referral is recommended or required by all countries and states in certain circumstances. These circumstances include mental disorder 'impairing judgement' in Oregon and Washington, and cases of exclusive mental disorder in European countries. 'Exclusive mental disorder' refers to those with a mental disorder (e.g., major depression) who apply for assisted dying in the absence of any terminal physical illness. Capacity/competence and necessary suffering must be present. On average, 5.4% (range 4.2%-6.7%) of applicants see a psychiatrist. Patients with exclusive mental disorder can apply for assisted dying in European countries but not in Oregon and Washington; actual figures are low. CONCLUSIONS No country has a blanket policy of mandatory psychiatric review but the specialty contributes in circumstances of exclusive mental disorder or when there is doubt regarding capacity and sound judgement. The absence of a mandatory role for psychiatrists means that reversible psychopathology may be missed. As a result, the patient's decision to end his/her life may be more informed by treatable mental disorder than by his/her lifelong preferences.