Rapid-Response Treatments for Depression and Requests for Physician-Assisted Death: An Ethical Analysis.
American Journal of 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.
Comparable studies
Other narrative reviews on depression, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Synaptic Dysfunction in Depression: Potential Therapeutic Targets | 2012 | Review | |
| Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse | 2003 | Review | |
| Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation Adults with treatment-resistant depression | 2021 | Review | |
| Classic psychedelics: An integrative review of epidemiology, therapeutics, mystical experience, and brain network function. General population | 2019 | Integrative review | |
| Sudarshan Kriya Yogic Breathing in the Treatment of Stress, Anxiety, and Depression: Part II—Clinical Applications and Guidelines | 2005 | Review |
Citations in the library
Cited by 8
- Ethical Considerations at the Intersection Between Psychedelic-Assisted Psychotherapy and Medical Assistance in Dying AJOB Neuroscience April 3, 2023
- Ethical issues with psychedelic-assisted treatments in psychiatry: A systematic scoping review Psychological Medicine 2025
- Ethical Aspects of Psychedelic-Assisted Treatments: An Overview. Current Topics in Behavioral Neurosciences November 8, 2024
- Commentary: Access to Psychedelics for Psychological Suffering at the End of Life - Prioritizing Our Priorities. Healthcare policy = Politiques de sante May 1, 2023
- What do health professionals think about implementing psilocybin-assisted therapy in palliative care for existential distress? A World Café qualitative study. Palliative & Supportive Care October 1, 2024
and 3 more in the library
Cites 6
- Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial Journal of Psychopharmacology November 30, 2016
- Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder JAMA Psychiatry November 4, 2020
- Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation American Journal of Psychiatry March 17, 2021
- A Phase 2 Open Label Study of Efficacy, Safety, and Tolerability of SLS-002 (Intranasal Racemic Ketamine) in Adults with MDD at Imminent Risk of Suicide. Psychopharmacology Bulletin March 4, 2024
- Ketamine for the treatment of mental health and substance use disorders: comprehensive systematic review BJPsych Open December 23, 2021
and 1 more in the library