Treatment-resistant depression and physician-assisted death

Franklin G MIller

doi:10.1136/medethics-2015-103060

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Treatment-resistant depression and physician-assisted death

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Dr. Miller disagrees but does not overcome the facts and logic
Henry C Bissel
Published on: 26 January 2016

Published on: 26 January 2016
Dr. Miller disagrees but does not overcome the facts and logic
- Henry C Bissel, Counselor, Professional Advisor
Dr. Miller cites the "professional integrity of physicians" and the uncertainty of whether additional interventions will restore a patient's desire to live.
Does Dr. Miller's professional integrity include honesty, truthfulness, and sincerity when speaking to severely treatment-resistant patients? Particularly with respect to the efficacy of treatments that will provide rapid response and prolonged remission? D...
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Dr. Miller cites the "professional integrity of physicians" and the uncertainty of whether additional interventions will restore a patient's desire to live.
Does Dr. Miller's professional integrity include honesty, truthfulness, and sincerity when speaking to severely treatment-resistant patients? Particularly with respect to the efficacy of treatments that will provide rapid response and prolonged remission? Does that integrity extend to honestly communicating with these patients regarding scientific data on the likelihood, severity, and duration of relapse or recurrence?
Or is Dr. Miller referring to the integrity that embodies a physician's personal ethics, morality and righteousness? Given Dr. Miller's emphasis of the uncertainty about whether additional interventions with the patient can improve quality of life, it appears the physician's beliefs should trump the ability of informed patients to decide.
As Drs. Schuklenk and van de Vathorst stated, "if the pace of developments leading to therapeutic success in major depressive disorder is anything to go by, many people suffering from TRD would have reason to be sceptical about the odds of such a treatment regimen coming about within a timeframe that they would consider acceptable."
Patients suffering from treatment-resistant major depression have likely undergone extensive long-term professional psychiatric care. "Typically they would have tried a fairly significant number of antidepressants, psychotherapy, probably electroconvulsive therapy, and they would have experienced the failure of these varied therapeutic approaches."
Dr. Miller places considerable weight on the "uncertainty of whether additional interventions will restore a patient's desire to live." As Dr. Schuklenk points out, this argument unjustly ignores "the high burden that is paid by patients who happen to wait unsuccessfully for a successful treatment that may not come about at all or that may come about too late."
Drs. Schuklenk and van de Vathorst provided sound recommendations in their article. Dr. Miller appears to personally disagree.
Conflict of Interest:
None declared
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Conflict of Interest:
None declared.
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