It is commonly accepted that voluntary active euthanasia and physician-assisted suicide can be allowed, if at all, only in the cases of patients whose conditions are incurable. Yet, there are different understandings of when a patient’s condition is incurable. In this article, I consider two understandings of the notion of an incurable condition that can be found in the recent debate on physician-assisted dying. According to one of them, a condition is incurable when it is known that there is no (...) cure for it. According to the other, a condition is incurable when no cure is known to exist for it. I propose two criteria for assessing the conceptions and maintain that, in light of the criteria, the latter is more plausible than the former. (shrink)

By issuing an advance treatment directive, an autonomous person can formally express what kinds of treatment she wishes and does not wish to receive in case she becomes ill or injured and unable to autonomously decide about her treatment. While many jurisdictions and medical associations endorse them, advance treatment directives have also been criticized. According to an important criticism, when a person irreversibly loses her autonomy what she formerly autonomously desired ceases to be of importance in deciding about her treatment. (...) The medical ethical debate regarding different possible ways of solving the problem on which the criticism is based has grown exceedingly intricate. Instead of assessing the developments made in the debate so far, I present a thought experiment—built around a suicide case—which suggests that the problem is not as intractable as it has generally been deemed to be. (shrink)

Treatment-resistant depression (TRD) holds centrality in many debates regarding psychiatric euthanasia. Among the strongest reasons cited by opponents of psychiatric euthanasia is the uncertainty behind the irremediability of psychiatric illnesses. According to this argument, conditions that cannot be considered irremediable imply that there are possible remedies that remain for the condition. If there are possible remedies that remain for the condition, then patients with that condition cannot be considered for access to euthanasia. I call this the irremediability requirement (IR). I (...) argue that patients with TRD can, indeed, meet the operationalisation of irremediability in the IR. This is because the irremediability it asks for is not some global or absolute irremediability, but rather a present irremediability based on the current state of medical science. I show this by considering irremediability relating to (1) possible future treatments and (2) not trying presently available alternative treatments. I extend Schuklenk nd van de Vathorst’s argument from parity to terminal malignancies, to show that (1) is an unreasonable expectation for all cases of euthanasia. Taking (2) as a more serious opponent to psychiatric euthanasia, I show how the IR, based on how it is presently operationalised, can be realistically applied to cases of TRD. I do this by further developing Tully’s argument on broad-sense treatment resistance with the robust empirical data from the STAR*D trials. If my argument from Tully’s is valid, then we have reasons to, again, seek parity between the operationalisations of irremediability in terminal malignancies and TRD. (shrink)

Should people suffering from untreatable psychiatric conditions be eligible for physician-assisted death? This is possible in Belgium and the Netherlands, where PAD for psychiatric conditions is permitted, though rare, so long as the criteria of due care are met. Those opposed to all instances of PAD point to Belgium and the Netherlands as a dark warning that once PAD is legalized, restricting it will prove impossible because safeguards, such as the requirement that a patient be terminally ill, will inevitably be (...) eroded or discarded. However, some supporters respond that limiting PAD to those suffering from terminal illness, or physical illnesses generally, is arbitrary and illogical. In addition, precisely because such patients are not terminally ill, their suffering may last for years, even the rest of their lives. Finally, severe depression may not be treatable. If PAD is justifiable under some conditions—as I shall assume in this article—then why wouldn't it be justifiable for these patients? Why shouldn't psychiatrists who have nothing else to offer their suffering patients be able to help them to die, if that is what they want? (shrink)

Volume 19, Issue 10, October 2019, Page 3-7.

Melancholia is an attunement of despair and despondency that can involve radical disruptions to temporal experience. In this article, I extrapolate from the existing analyses of melancholic time to examine some of the important existential implications of these temporal disruptions. In particular, I focus on the way in which the desynchronization of melancholic time can complicate the melancholic’s relation to death and, consequently, to the meaning and significance of their life. Drawing on Heidegger’s distinction between death and demise, I argue (...) that melancholic time leaves the melancholic in an impossible state of existing, where they are both unable to live and unable to die. Turning to the role of the physician, I consider the significant role that clinical interventions might have in resynchronizing the melancholic with time and examine these ideas further through a case study on physician-assisted suicide. In so doing, I demonstrate that the desynchronization of melancholic time should indeed be understood as a matter of life and death. (shrink)