A Focus Group Study of the Views of Persons with a History of Psychiatric Illness about Psychiatric Medical Aid in Dying

Abstract

Background

Medical aid in dying (MAID) is legal in a number of countries, including some states in the U.S. While MAID is only permitted for terminal illnesses in the U.S., some other countries allow it for persons with psychiatric illness. Psychiatric MAID, however, raises unique ethical concerns, especially related to its effects on mental illness stigma and on how persons with psychiatric illnesses would come to feel about treatment and suicide. To explore those concerns, we conducted several focus groups with persons with lived experience of mental illness.

Methods

We conducted three video-conference-based focus groups involving adults residing in the U.S. who reported a prior diagnosis of any psychiatric illness. Only participants who reported thinking that MAID for terminal illness was morally acceptable were included. Focus group participants were asked to respond to a series of four questions. Groups were facilitated by a coordinator who was independent of the research team.

Results

A total of 22 persons participated in the focus groups. The majority of participants had depression and anxiety disorders; no participants had psychotic disorders such as schizophrenia. Many participants strongly favored permitting psychiatric MAID, generally on the basis of respect for autonomy, its effects on stigma, and the severe suffering caused by mental illness. Others expressed concerns, typically related to difficulties in ensuring decision-making capacity and to the risk that MAID would be used in lieu of suicide.

Conclusions

Persons with a history of psychiatric illness, as a group, have a diverse array of views about the permissibility of psychiatric MAID, reflecting nuanced consideration of how it relates to the public perception of mental illness, stigma, autonomy, and suicide risk.

Keywords:

• Medical aid in dying
• mental illness
• suicide
• euthanasia

Acknowledgements

This project was funded by a Faculty Scholarly Grant from the University of Utah Research Committee as well as by a Greenwall Foundation Faculty Scholars Fellowship awarded to BMK. Its contents are solely the responsibility of the authors, and do not necessarily represent the official views of the University of Utah, the Huntsman Mental Health Institute, or the Greenwall Foundation. The authors would also like to acknowledge Caleb Porter for assistance with the IRB submission.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

Greenwall Foundation.