In order to show the different perspectives with which society and thus also the medical profession view assisted suicide, we asked two doctors to explain their position. Some questions in the two interviews are identical in order to be able to compare the answers well with one another. A link to the interview with the internist Wolfgang Oblinger can be found at the end.
Eve sleeper
Editor in the “Life” department of the Frankfurter Allgemeine Sunday newspaper.
Mr. Reif, what is your experience with assisted suicide?
It happens that in a psychiatric context, too, patients ask that suicide be made possible for them or that they even want to be killed. With sufficient specialist knowledge, however, this can be assessed relatively quickly as a symptom of the mental illness. Again and again, for example, I see patients, especially those with depression, who have informed themselves about assisted suicide before the psychiatric treatment or have become a member of one of the euthanasia associations. For someone with expertise it is actually clear that the suicidal idea here was caused by the mental illness; without a specialist medical assessment, however, this does not seem to have been noticed.
They fear that the more liberal draft will not adequately protect mentally ill people who are in a particularly difficult phase of their illness and are not capable of forming an autonomous free will. What do you specifically criticize?
Two things. On the one hand, that there is only one single examination of the formation of free will and that the durability of the decision is therefore not sufficiently examined. Especially in the context of mental illness, suicidal thoughts sometimes fluctuate considerably. Above all, however, I criticize the fact that no qualification whatsoever is required for the review of free decision-making. However, this check is anything but trivial; this requires expertise and experience. It’s absurd that special qualifications are needed to check whether someone can drive a car again after having their license revoked, but anyone should be able to take the test of free will, whether they have experience with mental illness or not. This entails a high and dangerous risk that a mental illness will be overlooked, which leads to the desire to commit suicide – but which at the same time is easily treatable.
Prof. Andreas Reif is a specialist in psychiatry and director of the Clinic for Psychiatry, Psychosomatics and Psychotherapy at the University Hospital in Frankfurt. He is also a board member of the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN). : Image: private
Aren’t the mentally ill capable of free will?
But. Mental illness per se is not associated with the suspension of free will. You have to find the causal connection: Is the patient actually no longer able to form a free will regarding suicidal tendencies due to the mental illness? Exactly these subtleties can only be recognized if you actually have experience in this field. To give a vivid example: A patient with a panic disorder, who at the same time suffers from a severe, incurable cancer with pain, is of course not at all restricted in the formation of the free will with regard to suicide by the panic disorder. Mental illnesses come in many different forms, and it is not permissible to automatically infer one from the other.
Can there also be the opposite example?