Death with Dignity and Mental Disorder

States and nations are grappling with physician-assisted dying and its boundaries. In the United States, euthanasia is universally prohibited, and a handful of states have sanctioned physician-assisted dying for competent adults with terminal illnesses. In Europe, access to physician-assisted dying is broader. The Netherlands, Belgium, and Switzerland permit physician-assisted dying for competent nonterminal patients, whether the cause of the patient’s suffering is psychological or somatic. Indeed, all three countries allow physician-assisted dying for psychiatric patients without an underlying somatic disorder.

Still, legal scholars and bioethicists are divided over whether someone with a mental disorder should have access to physician-assisted dying. Some object to physician-assisted dying itself, while others support a right to assisted dying for people with terminal illnesses, but are unwilling to extend that right to people with mental illnesses. In this Article, I argue that when a person requests the assistance of a physician to hasten her death, our only concern should be whether she is competent to consent to physician-assisted dying. A large empirical literature has shown that mental disorder is not synonymous with incompetence. A person can be depressed and form a desire to die that we are obligated to respect.