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Perspectives on the eligibility criteria for euthanasia for mental suffering caused by psychiatric disorder under the Belgian Euthanasia Law : a qualitative interview study among mental healthcare workers

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Abstract
Introduction Euthanasia in adults with psychiatric conditions (APC) is allowed in Belgium and impacts a variety of workers in this field, including psychiatrists, psychiatric nurses, psychologists, and support “buddies”. This study examines their perspectives on the appropriateness of the current legal criteria for, and practice of, euthanasia in the context of psychiatry, and their suggestions to properly implement or amend these criteria. Methods Semi-structured interviews were conducted with 30 Dutch-speaking mental healthcare workers who had at least one experience with an APC requesting euthanasia, in Flanders and Brussels (Belgium), between August 2019 and August 2020. Interview transcripts were analyzed through qualitative content analysis. Findings Our study shows that, for these mental healthcare workers, only one of the legal eligibility criteria to assess euthanasia requests by APC (i.e., unbearable suffering) is rather straightforward to interpret. In addition, there was a lack of consensus on what aspects of the Euthanasia Law should be modified and in what way. Conclusions Many mental healthcare workers do not well understand or misinterpret the legal criteria for euthanasia involving APC. Criteria are sometimes defined so narrowly that euthanasia requests by APC are generally deemed ineligible or, alternatively, are stretched to allow for inclusion of cases that go beyond what the Law intended. Our study indicates the need for an authoritative professional code of conduct offering clear advice for Belgian euthanasia practice in the context of psychiatry. It is also recommended that future trainings are standardized, supported by the most important professional associations in the field, and freely available to all who are confronted with euthanasia requests from APC or who offer support to APC who consider euthanasia.
Keywords
Law, Psychiatry and Mental health, Pathology and Forensic Medicine, Psychiatry, Mental disorders, Assisted dying, Euthanasia

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MLA
Verhofstadt, Monica, et al. “Perspectives on the Eligibility Criteria for Euthanasia for Mental Suffering Caused by Psychiatric Disorder under the Belgian Euthanasia Law : A Qualitative Interview Study among Mental Healthcare Workers.” INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY, vol. 93, 2024, doi:10.1016/j.ijlp.2024.101961.
APA
Verhofstadt, M., Van Assche, K., Pardon, K., Gleydura, M., Titeca, K., & Chambaere, K. (2024). Perspectives on the eligibility criteria for euthanasia for mental suffering caused by psychiatric disorder under the Belgian Euthanasia Law : a qualitative interview study among mental healthcare workers. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY, 93. https://doi.org/10.1016/j.ijlp.2024.101961
Chicago author-date
Verhofstadt, Monica, Kristof Van Assche, Koen Pardon, M. Gleydura, K. Titeca, and Kenneth Chambaere. 2024. “Perspectives on the Eligibility Criteria for Euthanasia for Mental Suffering Caused by Psychiatric Disorder under the Belgian Euthanasia Law : A Qualitative Interview Study among Mental Healthcare Workers.” INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 93. https://doi.org/10.1016/j.ijlp.2024.101961.
Chicago author-date (all authors)
Verhofstadt, Monica, Kristof Van Assche, Koen Pardon, M. Gleydura, K. Titeca, and Kenneth Chambaere. 2024. “Perspectives on the Eligibility Criteria for Euthanasia for Mental Suffering Caused by Psychiatric Disorder under the Belgian Euthanasia Law : A Qualitative Interview Study among Mental Healthcare Workers.” INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 93. doi:10.1016/j.ijlp.2024.101961.
Vancouver
1.
Verhofstadt M, Van Assche K, Pardon K, Gleydura M, Titeca K, Chambaere K. Perspectives on the eligibility criteria for euthanasia for mental suffering caused by psychiatric disorder under the Belgian Euthanasia Law : a qualitative interview study among mental healthcare workers. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY. 2024;93.
IEEE
[1]
M. Verhofstadt, K. Van Assche, K. Pardon, M. Gleydura, K. Titeca, and K. Chambaere, “Perspectives on the eligibility criteria for euthanasia for mental suffering caused by psychiatric disorder under the Belgian Euthanasia Law : a qualitative interview study among mental healthcare workers,” INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY, vol. 93, 2024.
@article{01HQ7XRT2C1AZHTACQSKF7YMVQ,
  abstract     = {{Introduction
Euthanasia in adults with psychiatric conditions (APC) is allowed in Belgium and impacts a variety of workers in this field, including psychiatrists, psychiatric nurses, psychologists, and support “buddies”. This study examines their perspectives on the appropriateness of the current legal criteria for, and practice of, euthanasia in the context of psychiatry, and their suggestions to properly implement or amend these criteria.

Methods
Semi-structured interviews were conducted with 30 Dutch-speaking mental healthcare workers who had at least one experience with an APC requesting euthanasia, in Flanders and Brussels (Belgium), between August 2019 and August 2020. Interview transcripts were analyzed through qualitative content analysis.

Findings
Our study shows that, for these mental healthcare workers, only one of the legal eligibility criteria to assess euthanasia requests by APC (i.e., unbearable suffering) is rather straightforward to interpret. In addition, there was a lack of consensus on what aspects of the Euthanasia Law should be modified and in what way.

Conclusions
Many mental healthcare workers do not well understand or misinterpret the legal criteria for euthanasia involving APC. Criteria are sometimes defined so narrowly that euthanasia requests by APC are generally deemed ineligible or, alternatively, are stretched to allow for inclusion of cases that go beyond what the Law intended. Our study indicates the need for an authoritative professional code of conduct offering clear advice for Belgian euthanasia practice in the context of psychiatry. It is also recommended that future trainings are standardized, supported by the most important professional associations in the field, and freely available to all who are confronted with euthanasia requests from APC or who offer support to APC who consider euthanasia.}},
  articleno    = {{101961}},
  author       = {{Verhofstadt, Monica and Van Assche, Kristof and Pardon, Koen and Gleydura, M. and Titeca, K. and Chambaere, Kenneth}},
  issn         = {{0160-2527}},
  journal      = {{INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY}},
  keywords     = {{Law,Psychiatry and Mental health,Pathology and Forensic Medicine,Psychiatry,Mental disorders,Assisted dying,Euthanasia}},
  language     = {{eng}},
  pages        = {{18}},
  title        = {{Perspectives on the eligibility criteria for euthanasia for mental suffering caused by psychiatric disorder under the Belgian Euthanasia Law : a qualitative interview study among mental healthcare workers}},
  url          = {{http://doi.org/10.1016/j.ijlp.2024.101961}},
  volume       = {{93}},
  year         = {{2024}},
}

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