The right to die : perspectives of mental health professionals in Malta

Abstract

Background: In their professional work, mental health professionals are continually working with individuals in distress, who at times may express a wish to end their lives. Aims: To understand the perspectives of mental health professionals towards a person's right to die. Methods: A mixed-method technique was employed. Stage 1 involved a validated online questionnaire that was sent to all professionals working within the Maltese public mental health service. Stage 2 involved a closed-group, multidisciplinary discussion between six professionals who were asked to manage the hypothetical case of a terminally-ill patient requesting physician-assisted suicide. Results: An acceptability score of 1.2 was obtained for suicide in general (where 0 indicates complete disagreement and 4 complete agreement), with similar scores for suicide in the specific scenarios of bankruptcy, overwhelming despair and family dishonour. Suicide in terminal illness elicited highly polarised and divergent views (score: 2.08; standard deviation: 1.23). Advanced age and belief in the afterlife were related to a lower acceptability of suicide. Male respondents agreed more with the hiding of suicidal behaviour. Older respondents were more likely to disagree with describing suicidal people as ‘mentally ill’. The discussion revealed that in terminal illness, professionals are willing to thoroughly assess those requesting physician-assisted suicide, treating any underlying mental illness and ultimately determining mental capacity, which is deemed the necessary prerequisite to individual autonomy. Conclusion: Mental health professionals in Malta consider autonomy as an absolute value when evaluating a person’s right to die; they adopt a relativistic and subjective paradigm when considering the value of life. After a comprehensive psychiatric assessment, they would choose not to impede the autonomous person from committing physician-assisted suicide, if legalised. However, the majority conscientiously object to actively assisting with the suicide, citing that it would go against the principle of non-maleficence and their duty as “good clinicians.”