A Conceptual Framework for Thinking About Physician-Assisted Death for Persons With a Mental Disorder

Physician-assisted death (PAD) has been enacted in a number of international jurisdictions, with several extending access to PAD for persons whose condition is not terminal, including those with a mental disorder.  We argue that based on the state of the literature, it is too early to make well-defined recommendations on how relevant fields can proceed legally, ethically, and clinically, particularly in regard to PAD for persons with a mental disorder.  The aim of this paper is to introduce a framework for further discussions on PAD for persons with a mental disorder to stimulate thoughtful and considered debate in our field.  We provide a brief discussion of the principles that guide regulatory frameworks on PAD practices worldwide, including a discussion of jurisdictions in Europe and North America that allow PAD for those suffering from an incurable non-terminal disease, illness, or disability.  Next, we present a conceptual framework as a series of questions that address legal, ethical, and clinical dilemmas arising from this trend.  We conclude with a summary of guidelines on the practice of PAD from international jurisdictions in order to assist in the development of potential legal and professional regulations