Choosing to Die with the Help or by the Hand of a Doctor (Medically-Assisted Death): Limitations and Safety Profiles
Cembrani F. 1, De Leo D. 2
  
1 University of Verona, Italy
2 Griffith University, Australia
 

Abstract

Background and Aim of Study: Depression severity can be profoundly impacting the life of individuals, while its persistence can provoke the conviction that recovery is unattainable. One of the extreme consequences is the request for euthanasia. However, during major depression cognition can be significantly impaired. In this study, we comment on the exemplar case of a Belgian lady, Mrs. Godelieva de Troyer, who made that request and obtained the desired outcome.
The aim of the study: to consider a specific case of a patient with major depressive disorder and the role of doctors in informing the decision about medically assisted death.
Material and Methods:
The history of the request made by Mrs. Godelieva is described. The procedure was followed by the reactive initiatives of the son of the lady, who made a formal complaint against the procedure that brought his mother to death and appealed the European Court of Justice.
Results:
A description of what happened is briefly reported, including considerations on the clinical treatments received by Mrs. Godelieva, the roles interpreted by the doctors she consulted and, finally, the appropriateness of the decision taken.
Conclusions:
In revisiting this case, the decision-making process during major depression episodes and the authenticity and robustness of end-of-life choices in similar cases are critically examined. Comments are made on the frequency of cognitive impairments during major depressive episodes and the need to provide depressed people the necessary support during their important choices.

 
 
 

Keywords

Major depression, chronic persistent depression, euthanasia, medically assisted suicide, care for depressed people, psychological support, European Court of Justice

 
 
  

References

American Psychiatric Association (2012). Guidelines for assessing decision-making capacities of cognitively impaired elderly persons. American Journal of Geriatric Psychiatry, 10(2), 151–165. https://doi.org/10.1176/appi.ajgp.10.2.151

Appelbaum, P. S. (2007). Assessment of patient’s competence to consent to treatment. The New England Journal of Medicine, 357, 1834–1840. https://doi.org/10.1056/NEJMcp074045

Bedaso, A., Mekonnen, N., & Duko, B. (2022). Estimate of the prevalence of depression among older people in Africa: Review and meta-analysis. Aging & Mental Health, 26(6), 1095–1105. https://doi.org/10.1080/13607863.2021.1932740

Beevers, C. G. (2005). Cognitive vulnerability to depression: A dual process model. Clinical Psychology Review, 25(7), 975–1002. https://doi.org/10.1016/j.cpr.2005.03.003

Bersani, G., Rinaldi, R. & Iannitelli, A. (2020). Psichiatria e bioetica: Un rapporto critico, uno stimolo alla riflessione [Psychiatry and bioethics: A critical relationship, a stimulus to reflection]. Rivista di Psichiatria, 55(2), 57–58. https://doi.org/10.1708/3333.33019

Bucalo, M. E. (2023). Il caso Mortier c. Belgique. La Corte Europea dei diritti dell’uomo verso l’elaborazione del diritto all’eutanasia? Differenze e similitudini tra Roma e Strasburgo [The case Mortier v. Belgium. The European Court of Human Rights towards the development of the right to euthanasia? Differences and similarities between Rome and Strasbourg]. Gruppo di Pisa, 1, 19–36. https://iris.unipa.it/handle/10447/582090

Butturini, D. (2011). Note a margine di corte E.D.U. HAAS contro Svizzera [Marginal notes from the E.D.U. HAAS court against Switzerland]. Rivista AIC, 3. https://www.rivistaaic.it/images/rivista/pdf/Butturini.pdf

Cappelli, V. (2021, April 30). La nozione di “trattamenti di sostegno vitale” dopo la sentenza 242/2019 della Corte Costituzionale: Il caso Trentini [The notion of “life-sustaining treatments” after ruling 242/2019 of the Constitutional Court: The Trentini case]. Giustizia Civile.com. https://giustiziacivile.com/soggetti-e-nuove-tecnologie/note/la-nozione-di-trattamenti-di-sostegno-vitale-dopo-la-sentenza

Cembrani, F., Cingolani, M., & Fedeli, P. (2022). L’autonomia decisionale della persona nelle situazioni di vulnerabilità, di debolezza e di razionalità limitata: Iniziali riflessioni a margine della sentenza n. 50 del 15 febbraio 2022 della Corte costituzionale [The decision-making autonomy of the person in situations of vulnerability, weakness and limited rationality: Initial reflections on the sidelines of sentence no. 50 of 15 February 2022 of the Constitutional Court]. Stato, Chiese e Pluralismo Confessionale, 8, 1-17. https://doi.org/10.54103/1971-8543/17766

Cembrani, F., Asioli F., Bianchetti A., Ferranini L., Mossello E., Scapati F., & Trabucchi, M. (2019). La pianificazione condivisa della cura e l’autodeterminazione della persona anziana affetta da patologie psicogeriatriche [Shared care planning and self-determination of elderly people suffering from psychogeriatric pathologies]. Psicogeriatria, 1(suppl. 1). https://www.quotidianosanita.it/allegati/allegato4296861.pdf

Cembrani, F., Castellani, M., & Ciraolo, G. (2014). Sulla legge belga che ha esteso anche ai minori (che si trovano in particolari condizioni) il diritto di morire [On the Belgian law which also extended the right to die to minors (who find themselves in particular conditions)]. BioLaw Journal – Rivista Di BioDiritto, 2, 227–237. https://doi.org/10.15168/2284-4503-41

Commission Fédérale de Contrôle et D’évaluation de L’euthanasie (2023). CFCEE Rapport Euthanasie 2022 [CFCEE Euthanasia Report 2022]. https://organesdeconcertation.sante.belgique.be/fr/documents/cfcee-rapport-euthanasie-2022

Council of Europe. (2002). Convenzione Europea dei Diritti dell’Uomo [European Convention on Human Rights]. https://www.echr.coe.int/documents/d/echr/convention_ita

Cupelli, C. (2013). La responsabilità penale dello psichiatra. Sui rapporti tra obblighi impeditivi, consenso e regole cautelari [The criminal responsibility of the psychiatrist. On the relationships between preventive obligations, consent and precautionary rules]. E.S.I. https://art.torvergata.it/handle/2108/119775?mode=full.70

De Girolamo, G., Polidori, G., Morosini, P., Mazzi, F., Serra, G., Scarpino, V., Reda, V., Visonà, G., Falsirollo, F., & Rossi, A. (2005). Prevalenza dei disturbi mentali comuni in Italia, fattori di rischio, stato di salute ed uso dei servizi sanitari: Il progetto ESEMeD-WMH [Prevalence of common mental disorders in Italy, risk factors, health status, and utilization of health services: the ESEMeD-WMH project]. Epidemiologia e Psichiatria Sociale, 14(4 Suppl), 1–100. https://pubmed.ncbi.nlm.nih.gov/16447815/

Dentamaro, B. (2019, January 22). Il Belgio: Caso più unico e raro [Belgium: The most unique and rare case]. Giurisprudenza Penale Web, 1-Bis. https://www.giurisprudenzapenale.com/2019/01/22/belgio-caso-piu-unico-raro/

Dotson, V. M., McClintock, S. M., Verhaeghen, P., Kim, J. U., Draheim, A. A., Syzmkowicz, S. M., Gradone, A. M., Bogoian, H. R., & de Wit, L. (2020). Depression and cognitive control across the lifespan: A systematic review and meta-analysis. Neuropsychology Review, 30, 461–476. https://doi.org/10.1007/s11065-020-09436-6  

Douglas, K. M., & Porter, R. J. (2009). Longitudinal assessment of neuropsychological function in major depression. Australian & New Zealand Journal of Psychiatry, 43(12), 1105–1117. https://doi.org/10.3109/00048670903279887

Fornaro, M., Solmi, M., Stubbs, B., Veronese, N., Stubbs, B., Monaco, F., Novello, S., Fusco, A., Anastasia, A., De Berardis, D., & Carvalho, A. F. (2020). Prevalence and correlates of major depressive disorder, bipolar disorder and schizophrenia among nursing home residents without dementia: Systematic review and meta-analysis. British Journal of Psychiatry, 216(1), 6–15. https://doi.org/10.1192/bjp.2019.5

Foucault, M. (2020). Io Pierre Rivière, avendo sgozzato mia madre, mia sorella e mio fratello...Un caso di parricidio nel XIX secolo [I Pierre Rivière, having slaughtered my mother, my sister and my brother...A case of parricide in the 19th century]. Einaudi. https://www.illibraio.it/libri/io-pierre-riviere-avendo-sgozzato-mia-madre-mia-sorella-e-mio-fratello-un-caso-di-parricidio-del-xix-secolo-9788806244750/

GBD 2019 Diseases and Injuries Collaborators. (2020). Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 396(10258), 1204–1222. https://doi.org/10.1016/S0140-6736(20)30925-9

Grahek, I., Everaert, J., Krebs, R. M., & Koster, E. H. W. (2018). Cognitive control in depression: toward clinical models informed by cognitive neuroscience. Clinical Psychological Science, 6(4), 464–480. https://doi.org/10.1177/216770261875896
Hartlage, S., Alloy, L.B., Vasquez, C., & Dykman, B. (2018). Automatic and effortful processing in depression. Psychological Bulletin, 113(2), 247–278. https://doi.org/10.1037/0033-2909.113.2.247  

Istituto Superiore di Sanita’ (2020, August 6). Raccomandazioni per la governance e la clinica nel settore delle demenze [Recommendations for governance and clinical practice in the dementia sector]. Ministero della Salute della Repubblica Italiana. https://www.salute.gov.it/imgs/C_17_pubblicazioni_3360_allegato.pdf

Jeste, D. V., Palmer, B. W., Appelbaum, P. S., Golshan, S., Glorioso, D., Dunn, L. B., Kim, K., Meeks, T., & Kraemer, H. C. (2007). A new brief instrument for assessing decisional capacity for clinical research. Archives of General Psychiatry, 64(8), 966–974. https://doi.org/10.1001/archpsyc.64.8.966

Joorman, N., & Stanton, C. H. (2016). Examining emotion regulation in depression: A review and future directions. Behaviour Research and Therapy, 86(November), 35–49. https://doi.org/10.1016/j.brat.2016.07.007 
Kriesche, D., Woll, C. F. J., Tschentscher, N., Engel, R. R., & Karch, S. (2023). Neurocognitive deficits in depression: A systematic review of cognitive impairment in the acute and remitted state. European Archives of Psychiatry and Clinical Neuroscience, 273, 1105–1128. https://doi.org/10.1007/s00406-022-01479-5  

Li, C.-T., Lin, C.-P., Chou, K.-H., Chen, I.-Y., Hsieh, J.-C., Wu, C.-L., Lin, W.-C., & Su, T.-P. (2010). Structural and cognitive deficits in remitting and non-remitting recurrent depression: A voxel-based morphometric study. NeuroImage 50(1), 347–356. https://doi.org/10.1016/j.neuroimage.2009.11.021

Marazziti, D., Consoli, G., Picchetti, M., Carlini, M., & Favarelli, L. (2010). Cognitive impairment in major depression. European Journal of Pharmacology, 626(1), 83–86. https://doi.org/10.1016/j.ejphar.2009.08.046  

Mehlum, L., Schmahl, C., Barens, A., Doering, S., Hutsebaut, J., Kaera, A., Kramer, U., Moran, P. A., Renneberg, B., Ribaudi, J. S., Simonsen, S., Swales, M., Taubner, S., & di Giacomo, E. (2020). Euthanasia and assisted suicide in patients with personality disorders: A review of current practice and challenges. Borderline Personality Disorder and Emotion Dysregulation, 7, Article 15. https://doi.org/10.1186/s40479-020-00131-9

Pilania, M., Yadav, V., Bairwa, M., Behera, P., Gupta, S. D., Khurana, H., Mohan, V., Baniya, G., & Poongothai, S. (2019). Prevalence of depression among the elderly (60 years and above) population in India, 1997-2016: A systematic review and meta-analysis. BMC Public Health, 19, Article 832. https://doi.org/10.1186/s12889-019-7136-z

Rosenberg, P. B., Mielke, M. M., Appleby, B. S., Oh, E. S., Geda, Y. E., & Lyketsos, C. G. (2013). The association of neuropsychiatric symptoms in MCI with incident dementia and Alzheimer disease. The American Journal of Geriatric Psychiatry, 21(7), 685–695. https://doi.org/10.1016/j.jagp.2013.01.006

Semkovska, M., Quinlivan, L., O’Grady, T., Johnson, R., Collins, A., O’Connor, J., Knittle, H., Ahern, E., & Gload, T. (2019). Cognitive function following a major depressive episode: A systematic review and meta-analysis. The Lancet Psychiatry, 6(10), 851–861. https://doi.org/10.1016/S2215-0366(19)30291-3

Vazquez, C., & Hernangómez, L. (2009). Automatic and controlled processing in depression. In R. Ingram (Ed.), The International Encyclopedia of Depression (pp. 48–51). Springer. https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=f9eb47f63f6f0885fb4b57264ec8c8a4b3b1e7ba

World Health Organization (2022). World mental health report: Transforming mental health for all. https://www.who.int/publications/i/item/9789240049338

Zenebe, Y., Akele, B., W/Selassie, M., & Necho, M. (2021). Prevalence and determinants of depression among old age: A systematic review and meta-analysis. Annals of General Psychiatry, 20, Article 55. https://doi.org/10.1186/s12991-021-00375-x

 

 

 

  
 

 

Information about the authors:

Cembrani Fabio (Corresponding Author)https://orcid.org/0009-0007-6214-6557; This email address is being protected from spambots. You need JavaScript enabled to view it.; Coroner, Contract Professor, University of Verona, Verona, Italy 
 
De Leo Diegohttps://orcid.org/0000-0001-8255-6480; Doctor of Medical Sciences, MD, Emeritus Professor of Psychiatry, Griffith University, Brisbane, Australia.
 
 
 
Cite this article as:

APA


Cembrani, F., & De Leo, D. (2024). Choosing to die with the help or by the hand of a doctor (medically-assisted death): Limitations and safety profiles. International Journal of Science Annals, 7(1), 1–9. https://doi.org/10.26697/ijsa.2024.1.1

Harvard


Cembrani, F., & De Leo, D. (2024). "Choosing to die with the help or by the hand of a doctor (medically-assisted death): Limitations and safety profiles". International Journal of Science Annals, [online] 7(1), pp. 1–9. viewed 30 June 2024, https://culturehealth.org/ijsa_archive/ijsa.2024.1.1.pdf

Vancouver


Cembrani F., & De Leo D. (2024). Choosing to die with the help or by the hand of a doctor (medically-assisted death): Limitations and safety profiles. International Journal of Science Annals [Internet]. 2024 [cited 30 June 2024]; 7(1): 1–9. Available from: https://culturehealth.org/ijsa_archive/ijsa.2024.1.1.pdf https://doi.org/10.26697/ijsa.2024.1.1

Copyright © 2018 – 2024 International Journal of Science Annals, its licensors, and contributors.
All Rights Reserved DOI: https://doi.org/10.26697/ijsa