Article Text

Download PDFPDF
Assessment of patient decision-making capacity in the context of voluntary euthanasia for psychic suffering caused by psychiatric disorders: a qualitative study of approaches among Belgian physicians
  1. Frank Schweitser1,
  2. Johan Stuy1,
  3. Wim Distelmans2,
  4. Adelheid Rigo3
  1. 1Philosophy and Moral Sciences, Vrije Universiteit Brussel, Brussel, Belgium
  2. 2Medicine, Vrije Universiteit Brussel, Brussel, Belgium
  3. 3Centre for Family Studies, University College Odisee, Schaarbeek, Belgium
  1. Correspondence to Drs Frank Schweitser, Philosophy and Moral Sciences, Vrije Universiteit Brussel, 1050 Ixelles, Belgium; frank.schweitser{at}


Objective In Belgium, people with an incurable psychiatric disorder can file a request for euthanasia claiming unbearable psychic suffering. For the request to be accepted, it has to meet stringent legal criteria. One of the requirements is that the patient possesses decision-making capacity. The patient’s decision-making capacity is assessed by physicians.

The objective of our study is to provide insight in the assessment of decision-making capacity in the context of euthanasia for patients with psychic suffering caused by a psychiatric disorder.

Method Twenty-two semistructured interviews with psychiatrists and neurologists were analysed with NVivo, a qualitative analysis software to code and organise transcribed data.

Results Different views and approaches regarding decision-making capacity in the context of euthanasia emerged from the data.

Most of the physicians have some knowledge of the cognitive ability approach on decision-making capacity. According to this approach, four abilities constitute decision-making capacity: communication, understanding, appreciation and reasoning. We observed differences in the way these abilities are valued in relation to competence. Some physicians take additional elements into consideration when assessing decision-making capacity.

Physicians acquired their knowledge on the subject in many different ways. Most of the physicians reported that decision-making capacity was not part of their training.

Conclusion We conclude that physicians assess decision-making capacity in different ways and that personal values and beliefs influence their approach. As such, a common approach in assessing the decision-making capacity of a patient among the interviewed physicians is lacking. Less arbitrariness could be obtained by consistently implementing the cognitive ability approach.

  • euthanasia
  • decision-making
  • psychiatry
  • competence/incompetence
  • end-of-life

Statistics from


  • Contributors FS wrote the manuscript, conducted the interviews and analysed the interviews with NVivo. JS and WD made substantial contributions to the conception of the article. AR contributed to the conception of the article and the analysing of the data. All authors reviewed the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.