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 DOI: 10.1016/j.jagp.2022.07.003 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Case report Peer reviewed |
|---|---|
| Sample size | 3 |
| Population | Terminally ill patients with comorbid depression who had requested physician-assisted death |
| Intervention | Intranasal ketamine |
| Topics | Depression |
| Keywords | Physician-assisted death Decision-making capacity Ethics |
| Citations | 12 |
| Key findings | Rapid-acting antidepressants like ketamine can help clarify whether depression is driving a terminally ill patient's request for physician-assisted death, but their use raises ethical concerns about decision-making capacity, irremediability, and equitable access. |
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.