Introduction:
Upon legislation allowing medical assistance in dying (MAID) for patients with unbearable and irremediable suffering, the Netherlands has seen a surge of requests for MAID by patients with psychiatric suffering. Among those are a substantial number of young patients (age <24). Little is known about this group, or about the outcomes of the MAID assessment procedure.
Methods:
The majority of patients requesting MAID for psychiatric suffering are referred to the Dutch national expertise center for euthanasia (ECE). ECE-applications were included if (1) the applicant requested MAID based primarily on psychiatric suffering; (2) the applicant was aged <24 years or younger; (3) the application occurred between 1-1-2012 and 30-6-2021; and (4) the application had been closed at 1-12-2022. Outcome of the application was defined as either patient discontinued (including cases of suicide), patient was rejected, or MAID. First, we assessed which outcomes occurred and when these outcomes occurred (e.g. after initial application but before full assessment). Second, we assessed characteristics of patients who died by either MAID or suicide.
Results:
N=401 applications by N=357 unique patients were included (75.1% female, age range 16.2-24.0), showing an increase in the number of applications in recent years. N=188 (49.4%) were discontinued by the patient, mostly before the application was completed. N=178 applications (44.8%) were rejected, almost exclusively after eligibility screening. N=19 applications (4.8%) were halted because the applicant had died by suicide. N=12 applications (3.0%) resulted in MAID. Almost all patients who died had a history of multiple suicide attempts and involuntary inpatient treatment. Other common characteristics were diagnoses of depression and autism spectrum disorder and a history of childhood trauma, the latter especially among those who died by suicide.
Discussion:
This is the first study to date to provide numbers on MAID for psychiatric suffering among young people. Our findings show that although a large and growing number of MAID applications are made by young people with psychiatric suffering, MAID among young people remains rare. The most likely outcome of a MAID-procedure by a young psychiatric patient is discontinuation of the application, followed by rejection. Among fatal outcomes, suicides is more common than MAID.