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Rapid-Response Treatments for Depression and Requests for Physician-Assisted Death: An Ethical Analysis

      Highlights

      • What is the primary question addressed by this study?
        What are the ethical implications of emerging rapid-response treatments for depression for depressed patients who request physician-assisted-death?
      • What is the main finding of this study?
        The development of rapid-response treatments could have an important role in clarifying the decision-making quality of depressed patients seeking PAD, raise potential dilemmas for clinicians assessing the PAD eligibility criterion of irremediability in some jurisdictions, and challenge society's obligations for making such treatments available for patients in particularly vulnerable situations.
      • What is the meaning of the finding?
        Although the emergence of rapid-response treatments for depression will likely have important benefits to depressed patients requesting PAD, they also raise ethical challenges for those jurisdictions in which the practice is legal.

      Abstract

      Depression is common at the end of life, and there is longstanding concern that it may affect terminally ill patients’ decisions to request physician-assisted death (PAD). However, it is difficult for clinicians to determine the role of depression in a patient's PAD request. A recent case series described rapid responses to intranasal ketamine in three patients with terminal illness and comorbid depression who had requested PAD. One patient withdrew her request (which, in retrospect, had been driven by her depression) while the others maintained their requests; in all three, the rapid relief clarified the role of depression in the patients’ decision-making. In addition to ketamine, there are other emerging rapid-response treatments for depression, including psilocybin with psychological support and functional connectivity-guided transcranial magnetic stimulation. We examine three key ethical implications of such treatments: their role in clarifying the decision-making capacity of depressed patients requesting PAD; the potential tension between the legal definition of irremediability in some jurisdictions and the ethical obligations of clinicians; and the likely obstacles to treatment access and their implications for equal respect for autonomy of patients.

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