La mort appréciée. L'assistance au suicide en Suisse

Ce livre propose une immersion dans les réalités de l’assistance au suicide. Il se fonde sur une étude ethnographique qui restitue le point de vue de personnes recourant à une telle assistance ainsi que celui des individus susceptibles de prendre part à un tel processus : personnes sollicitant une aide au suicide et leurs proches, accompagnateurs et accompagnatrices d’associations d’aide au suicide, médecins, psychiatres, personnels soignants, pharmacien·ne·s, agent·e·s de police, médecins légistes, procureur·e·s ou employé·e·s des pompes funèbres. Avec force et détail, il rend compte de toute la mise en place d’une assistance au suicide et documente de manière inédite – à partir d’observations directes – la réalisation même d’un suicide assisté et toute la procédure médicolégale qui la suit. Cet ouvrage fait le récit d’une série de cas, suivis parfois durant près de deux ans, pour tenter de saisir la façon dont l’idée consistant à vouloir donner une telle forme à la mort a émergé chez une personne – jusqu’à sa mise en oeuvre. L’ouvrage offre une compréhension aussi complète que possible du dispositif d’assistance au suicide en Suisse.

Le droit au suicide médicalement assisté

Cette contribution illustre le cadre légal suisse de l’aide médicale au suicide et des conditions d’octroi de Natrium Pentobarbital (NaP) notamment au regard du CP, de la LStup, de la LPTh et de la LPMéd, ainsi que le cadre réglementaire suisse actuel. Elle se penche aussi sur les traits saillants des systèmes du Benelux en matière de suicide assisté et de soins palliatifs dans le but d’examiner le potentiel de développement du système actuel en Suisse.

“Nothing Hurts Less Than Being Dead”: Psychological Pain in Case Descriptions of Psychiatric Euthanasia and Assisted Suicide from the Netherlands: « Rien ne fait moins mal qu’être mort »: La douleur psychologique dans les descriptions de cas d’euthanasie et de suicide assisté psychiatrique aux Pays-Bas

Objectives: Euthanasia and assisted suicide (EAS) of individuals with mental disorders is a growing practice in several countries, including the Netherlands. Here, we aimed to identify the most frequent dimensions of and associated factors to psychological pain, which has been associated with suicidality, in individuals undergoing psychiatric EAS. Methods: An exploratory retrospective content analysis of the English translation of 66 digital case records of individuals who died by EAS in the Netherlands between 2011 and 2014 was performed. Nine standard psychological pain dimensions (irreversibility, loss of control, emptiness, emotional flooding, freezing, social distancing, narcissistic wounds, confusion, and self-estrangement), illness, and sociodemographic variables were evaluated by 2 independent raters using a premade data abstraction form (Kohen κ > 0.8 in all cases). Results: The mean number of dimensions was 4.64 ± 1.20 (median = 5), out of 9. The most frequent dimensions were irreversibility, loss of control, emptiness, and emotional flooding, in decreasing order. Past treatment refusal and the mention of social connections in case descriptions were related to the higher number of psychological pain dimensions (4.89 ± 1.24 vs. 4.31 ± 1.07, P = 0.03 and 5.05 ± 1.17 vs. 4.43 ± 1.17, P = 0.03, respectively). Emotional flooding was the only dimension specifically associated with specific psychiatric conditions, namely posttraumatic phenomena and personality disorders. Conclusions: Numerous psychological pain dimensions were detected in case descriptions of individuals who underwent EAS before the procedure. Subjective nature of the study precludes definite conclusions but suggest that future studies should explore psychological pain and the role of interventions targeting it in patients requesting EAS.

Irremediable Psychiatric Suffering in the Context of Physician-assisted Death: A Scoping Review of Arguments: La souffrance psychiatrique irrémédiable dans le contexte du suicide assisté : Une revue étendue des arguments

Objectives: Physician-assisted death (PAD), also known as medical assistance in dying, of patients with a psychiatric disorder (PPD) is a global issue of debate. In most jurisdictions that allow PAD, irremediable suffering is a legal requirement, how to apply the concept of irremediability to PPD remains challenging. The aim of this article is to identify the main arguments concerning irremediability in the debate about PAD of PPD and give directions for further moral deliberation and empirical research. Methods: Systematic searches in MEDLINE, Embase, and PsycINFO were combined with 4 additional search strategies. All conceptual-ethical articles, quantitative and qualitative empirical studies, guidelines, case reports, and commentaries that met the inclusion criteria were included, and a qualitative data synthesis was used to identify recurring themes within the literature. The study protocol was preregistered at the Open Science Framework under registration code: thjg8. Results: A total of 50 articles met the inclusion criteria. Three main arguments concerning irremediability were found in the debate about PAD of PPD: uncertainty, hope, and treatment refusal. Conclusions: Uncertainty about irremediability is inevitable, so which level of certainty is morally required should be the subject of moral deliberation. Whether PAD induces or resolves hopelessness is an empirical claim that deserves clarification. Treatment refusal in search of PAD raises questions about treatment efficacy in this patient group and about decision-making in the context of the physician–patient relationship. Going forward, more attention should be given to epidemiological research and to specific challenges posed by different psychiatric disorders.