Table 3 Impact of the euthanasia procedure on Adults with Psychiatric Conditions’ state of mind, including death ideation, in the context of the euthanasia request being neglected (N), rejected (R), under review/being assessed (A), granted (G) or put on hold (P)
MENTAL STATE | ||
Favourable outcome | Unfavourable outcome | |
Feeling heard | Feeling recognised/heard/understood - Relief of being enrolled for future euthanasia assessment (A, P) - Being recognised/heard as regards the burden of suffering/problems in life (A, G) - Being seen as a whole (not only sick) person (G, P) Immediate impact at having request granted (G) - “euphoria”, “intense happiness”, “contentment” | Not feeling recognised/heard/understood - Being fended off (N, R) - Not being taken seriously/heard (N) - Being misunderstood as regards the burden of (invisible) suffering/problems in life (N, R) |
Fear for adverse events | Less fearful of unwanted events (A, G) - No (more) fear for involuntary admissions to a psychiatric ward - Less burdened with ‘self-destructive ideation and behaviors’ - Increased ability/willingness to suppress suicidality Relief for loved ones when no formal advice on the request has been obtained - not to have burdened loved ones (N, R, A) - not to have burdened one self with further discussions on the subject (N, R) | More fears/thoughts regarding death and dying - Fearful of new (failed) suicide attempts (N, R, A) - Ambiguity about dying (fear of dying, afterlife) (A) - Time-consuming ruminations regarding *(unregulated) suicide (N, R, A) vs *euthanasia (A) - Time-consuming practical preparations for euthanasia (A,G) Distress about consequences of having request granted - stigma/labelling if APC does meet the legal criteria (A) eg. jeopardise potential opportunities in life - ambiguity about dying (fear of dying, afterlife) (A) - Uncertainty < probability of the window of opportunity narrowing/closing: (A,G) *professional backing out * legislation change *validity period of obtained positive advices (eg. physician’s retirement) |
Creating Perspective, empathy | Better understanding of/empathy toward others’ perspectives *Towards physicians - Understanding/empathy towards rejection *from treating psychiatrist (R, A) *from performing physician (A, G, P) - Understanding/empathy towards physicians as regards the difficulties faced and the necessity of building sufficient reflection time (A, G, P) - Understanding/empathy towards physicians entrusted with euthanasia assessment (A, G, P) *Towards the social inner circle - Understanding/empathy: regained ability to take important others’ perspective into account (A) - Regained ability to deal with different perspectives and reactions (A, G, P) | |
Perceived control | Ability to plan a good death - eg. planning and exchanging goodbyes, memorial celebration (G) - Reframing the death wish (A, G, P) eg. ‘euthanasia’ as potential safety net > < acute death request | Feelings of powerlessness, having no control (A, G) - Burden of pleading tribunal hearings’ (A, G) (pleas instead of requests for euthanasia) - Perception of being given the runaround (A, G) - Experiences of broken promises/physicians getting cold feet (A) - Distress about the uncertainty of the outcome (A) *the probability of broken promises, tightening of the law (A) (Di)stress when the outcome turns out negative - despair, hopelessness (N, R) - indignation (R) - Feeling left in the dark/to their fate to find new physicians (N) Burden of the quest in finding physicians open to euthanasia (N, R) |
Fairness | Feelings of injustice, unfairness (A, G, P) - Unprofessional behaviour of physicians involved *violation of medical secrecy/confidentiality * poor communication skills (induced false hope, lack/little transparent communication between physicians involved) - Inequality of the euthanasia procedure and outcomes associated with *patient characteristics ie. the highly intelligent, verbally skilled APC and those who have important other’s approval are in the advantage * the absence of one single standard protocol approach ie. law versus a variety of guidelines | |
Emotional drain | Procedure itself is emotionally draining - Reluctance/burden of (repeated) self-disclosures (A, G, P) - Assessment procedure is hard/too time-consuming/over-burdening (while being exhausted) (A, G) - Being the victim of dissensions between EOL centres/played out by the dissensions between strong opponents and proponents (A) | |
Distress about loved ones | Relief not (yet) to burden loved ones (N, R) | Distress about consequences of the euthanasia procedure on loved ones - Burdening loved ones (A,G) - Concerns about bottled up emotions inside loved ones (N, R, A, G, P) |