JAMA Psychiatry誌にオランダの精神障害者への安楽死実態

過去数日間にたくさん報道されている話題２つのうちの１。

JAMA Psychiatry誌に、オリジナル調査の論文、
“Euthanasia and Assisted Suicide of Patients With Psychiatric Disorders in the Netherlands 2011 to 2014”

著者はScott Y. Kim, Raymond G. De Bries, John R. Peteet.

無料で全文を読めます　↓
http://archpsyc.jamanetwork.com/article.aspx?articleid=2491354

アブストラクトは以下。

Importance Euthanasia or assisted suicide (EAS) of psychiatric patients is increasing in some jurisdictions such as Belgium and the Netherlands. However, little is known about the practice, and it remains controversial.

Objectives To describe the characteristics of patients receiving EAS for psychiatric conditions and how the practice is regulated in the Netherlands.

Design, Setting, and Participants This investigation reviewed psychiatric EAS case summaries made available online by the Dutch regional euthanasia review committees as of June 1, 2015. Two senior psychiatrists used directed content analysis to review and code the reports. In total, 66 cases from 2011 to 2014 were reviewed.

Main Outcomes and Measures Clinical and social characteristics of patients, physician review process of the patients’ requests, and the euthanasia review committees’ assessments of the physicians’ actions.

Results Of the 66 cases reviewed, 70% (n = 46) were women. In total, 32% (n = 21) were 70 years or older, 44% (n = 29) were 50 to 70 years old, and 24% (n = 16) were 30 to 50 years old. Most had chronic, severe conditions, with histories of attempted suicides and psychiatric hospitalizations. Most had personality disorders and were described as socially isolated or lonely. Depressive disorders were the primary psychiatric issue in 55% (n = 36) of cases. Other conditions represented were psychotic, posttraumatic stress or anxiety, somatoform, neurocognitive, and eating disorders, as well as prolonged grief and autism. Comorbidities with functional impairments were common. Forty-one percent (n = 27) of physicians performing EAS were psychiatrists. Twenty-seven percent (n = 18) of patients received the procedure from physicians new to them, 14 of whom were physicians from the End-of-Life Clinic, a mobile euthanasia clinic. Consultation with other physicians was extensive, but 11% (n = 7) of cases had no independent psychiatric input, and 24% (n = 16) of cases involved disagreement among consultants. The euthanasia review committees found that one case failed to meet legal due care criteria.

Conclusions and Relevance Persons receiving EAS for psychiatric disorders in the Netherlands are mostly women and of diverse ages, with complex and chronic psychiatric, medical, and psychosocial histories. The granting of their EAS requests appears to involve considerable physician judgment, usually involving multiple physicians who do not always agree (sometimes without independent psychiatric input), but the euthanasia review committees generally defer to the judgments of the physicians performing the EAS.

まず、最初に思うのは、安楽死（euthanasia）と医師幇助自殺（assisted suicide）とを
合わせて表現するのにEASと称するのが、やっぱり学問的誠実というものだなぁ、と。
死における援助（AID: assistance in dying）とかその他さまざまな文言の操作で
概念を勝手に広げて、この2つを緩和ケアや消極的安楽死と勝手にひっくるめるようなことは
やっぱり誠実な議論ではないなぁ、ということ。

それはともかく、

著者らはオランダ、ベルギーで行われている精神障害者への安楽死の
実態がほとんど知られていないことから、

オンラインで入手可能なオランダ地域安楽死審査委員会のケースサマリー
2011年から2014年の66件を検証。

7割が女性。
32％が70歳以上。
30－50歳が24％。

55％のケースで主要な問題はうつ病。

ほとんどの人で重度の障害があり、複数の症状や障害を合併。
自殺未遂の既往歴あり、精神科への入院あり、社会的にも孤立。

実施した医師の41％は精神科医。

27％（18ケース）では患者と面識のない内科医が実施しており、
そのうち14ケースは終末クリニック（機動安楽死チーム）の医師によるものだった。

実施した医師以外へのコンサルテーションは広く行われていたが、
11％では独立した精神科医の関与はなく、
24％ではコンサルテーション医から異論が出ていた。

安楽死委員会がしかるべきケアの基準を満たしていないと認定したのは１ケースのみ。

NYTが主著者のKim医師に取材して記事を書いています。
http://www.nytimes.com/2016/02/11/health/assisted-suicide-mental-disorders.html?_r=0

“The Dutch system is really the idealized setting in which to try something like this,” said Dr. Kim, in an interview. “But still, you can see that there are many cases that make us question whether this is the right practice.”

“The criteria in the Netherlands essentially require that the person’s disorder be intractable and untreatable, and this study shows that evaluating each of those elements turns out to be problematic,” said Dr. Paul S. Appelbaum, a professor of psychiatry, medicine and law at Columbia University.

その他の報道。
http://www.medscape.com/viewarticle/858786
http://www.reuters.com/article/uk-health-psychiatry-euthanasia-idUSKCN0VJ2K0
http://www.jwatch.org/fw111164/2016/02/11/physician-assisted-suicide-psychiatric-disorders-examined
http://newsdaily.com/2016/02/study-finds-concerning-trends-among-dutch-assisted-suicide-cases/