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Competence for physician-assisted death of patients with mental disorders: theoretical and practical considerations
  1. Azgad Gold
  1. Forensic Psychiatry Unit, Beer Yaakov-Ness Ziona Mental Health Center, Beer Yaakov, Israel
  1. Correspondence to Dr Azgad Gold, Forensic Psychiatry Unit, Beer Yaakov-Ness Ziona Mental Health Center, Beer Yaakov, Israel; azgadgo{at}


Physician-assisted death (PAD) of patients whose suffering does not stem from terminal conditions has become more prevalent during the last few decades. This paper is focused on decision-making competence for PAD, specifically in situations in which PAD is related solely to psychiatric illness. First, a theoretical analysis presents the premises for the argument that competence for physician-assisted death for psychiatric patients (PADPP) should be determined based on a higher threshold in comparison to the required competence for conventional medical interventions. Second, the higher threshold for decision-making competence for PADPP is illustrated. Third, several real PADPP cases are critically discussed, as an illustration to decision-making competence evaluations that would not have met the higher standard. Finally, a short summary of practical suggestions regarding the assessment of decision-making competence for PADPP is presented. Psychiatrists are called to address the ethical, legal, societal and clinical challenges related to PADPP and should be prepared for its probable expansion.

  • Informed Consent
  • Mental Competency
  • Right to Die
  • Suicide
  • Mental Disorders

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  • Contributors AG is the sole author of this paper.

  • 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.

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