Assisted suicide availed of solely related to eating disorders – study

Image credit: Diana Polekhina via Unsplash

Assisted suicide for reasons solely related to an eating disorder (ED) has occurred in multiple countries, including those which restrict the practice to individuals with a terminal condition, according to a recent systematic review published in the Frontiers in Psychiatry journal.

The review aimed to identify all known cases of assisted suicides among patients with EDs and to describe the clinical rationales used to grant patients’ requests for assisted suicide.

It identified at least 60 cases of patients in the US, the Netherlands and Belgium who availed of assisted suicide because they suffered with an eating disorder. Of the 60+ cases identified across 10 peer-reviewed articles and 20 government reports, 19 included descriptive case summaries with information about the patients and the clinical rationales that were used to justify assisted suicide. 

All 19 patients were women, with six under the age of 30, seven between the ages of 30 and 50, and another six over 50 years old. Eleven of the women (61%) had been diagnosed with anorexia, while one person was described as obese (but her ED was not specified), and five had EDs but without specific diagnoses provided.

The study defines so-called ‘assisted dying’ as “the practice of healthcare professionals prescribing or administering lethal drugs to end a patient’s life at their voluntary request, subject to eligibility criteria and safeguarding measures”. 

Assisted dying, it notes, is often used to broadly encompass ‘assisted suicide’ and euthanasia, the former involving patients self-ingesting lethal medications provided to them, while euthanasia sees a healthcare provider directly administering lethal medications.

Assisted suicide and/or euthanasia are currently available in 33 jurisdictions across the world, including Switzerland, the Netherlands, Belgium, Luxembourg, Colombia, Canada, Germany, Spain, Portugal, New Zealand, Austria, Ecuador, all six states of Australia, and in ten states and one district in the United States.

While most of these require that a person have a terminal illness to undergo assisted suicide/euthanasia, the Netherlands, Belgium, Luxembourg and Switzerland are exceptions. In Canada, legislation initially required a terminal condition for eligibility for either assisted suicide or euthanasia, but the study notes that laws were later amended after court challenges to remove these criteria.

The clinical rationales provided were categorised into three domains: irremediability, terminality, and voluntary request. The study found that in 95% of cases, patients who underwent assisted suicide were described as having irremediable, incurable, or untreatable EDs and that in all cases reviewed, reports indicated that patients had voluntarily chosen to die.

Terminality was complicated by the fact that among the confirmed nations in which assisted suicide for EDs had been carried out, only the United States required a terminal condition as a legal criterion. In both cases in the United States, the patient’s ED was described as a terminal condition, and death was deemed imminent. These cases also suggested the patients were at a terminal stage of anorexia. There were no mentions of terminality in the Dutch case reports (where 16 of the patients resided).

However, the report stated that the conception of terminality employed in the US cases “deviates from medical definitions of a terminal condition, by describing reversible cognitive behaviors (thoughts, thinking patterns, cognitive distortions) as indicators of a terminal illness”.

The authors stated that the results of their review “underscore considerable gaps in the reporting of assisted death in patients with psychiatric conditions, posing substantial concerns about oversight, patient safety, and the ability of researchers to assess the effectiveness of safeguards across different jurisdictions”.

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Jason Osborne

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This article was first published on Gript and is printed here with permission

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