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Schuklenk and van de Vathorst (henceforth “the authors”) make the following starting assumption, which I will accept: that it is ethically permissible for doctors to assist suicide and it is permissible for those competent patients with terminal somatic diseases (such as inoperable stage IV cancer) or non-terminal but untreatable debilitating diseases (such as motor neuron disease, MND) to be assisted in their suicide.1 Given these assumptions, there is a question about whether treatment-resistant major depressive disorder (henceforth ‘clinical depression’) is sufficiently similar to MND to qualify for assisted suicide: the authors think yes, I think no.
The first and most obvious problem concerns competence. With cancer and MND that do not affect the brain, the disease does not directly undermine competence. With depression, there is always an initial question about competence and about authenticity. Does the disease distort their judgement about the world, about the future and about themselves in that world? Are the depressed person's wishes authentic in expressing their long and deeply-held beliefs and desires about the world and about themselves? The authors claim that the data is ambiguous, and therefore, clinically depressed patients should be presumed competent and their suicidal request should be granted. I would draw exactly the opposite conclusion: …