Rapid-Response Treatments for Depression and Requests for Physician-Assisted Death: An Ethical Analysis.
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry November 1, 2022 Peer reviewed DOI: 10.1016/j.jagp.2022.07.003 via PubMed
Summary
Depression can influence terminally ill patients' requests for physician-assisted death (PAD). In a case series of three patients with terminal illness and depression who requested PAD, one patient retracted her request after receiving intranasal ketamine, which alleviated her depressive symptoms. The other two patients continued to seek PAD. The findings highlight the need to consider how emerging treatments for depression may affect decision-making capacity in such cases.
Study at a glance
| Design | case series |
|---|---|
| Sample size | 3 |
| Population | terminally ill patients with comorbid depression who requested physician-assisted death |
| Key finding | One patient withdrew her request for physician-assisted death after rapid relief from depression due to ketamine treatment, while two others maintained their requests. |
Abstract
Depression is common at the end of life, and there is longstanding concern that it may affect terminally ill patients' decisions to request physician-assisted death (PAD). However, it is difficult for clinicians to determine the role of depression in a patient's PAD request. A recent case series described rapid responses to intranasal ketamine in three patients with terminal illness and comorbid depression who had requested PAD. One patient withdrew her request (which, in retrospect, had been driven by her depression) while the others maintained their requests; in all three, the rapid relief clarified the role of depression in the patients' decision-making. In addition to ketamine, there are other emerging rapid-response treatments for depression, including psilocybin with psychological support and functional connectivity-guided transcranial magnetic stimulation. We examine three key ethical implications of such treatments: their role in clarifying the decision-making capacity of depressed patients requesting PAD; the potential tension between the legal definition of irremediability in some jurisdictions and the ethical obligations of clinicians; and the likely obstacles to treatment access and their implications for equal respect for autonomy of patients.