85 Depression as a terminal illness – could there be a place for palliative care?

<h3>Background</h3> Suicide is often viewed as a symptom of severe depression, but in this paper, I propose a question: what if we considered death as part of the disease process? Consequently, could we consider depression in some patients as a form of terminal illness? Could there be a place for palliative care in a small minority of suicidally-depressed patients? Thus, instead of placing the focus on the prevention of deaths with highly restrictive/traumatising measures, we would focus on ensuring comfort/maintaining dignity/promoting autonomy. This would allow patients to have more say, more rights and more options pertaining to their care and their own lives. <h3>Methods</h3> To view severe treatment-resistant depression as a terminal illness is a highly provocative concept, rarely openly discussed within societies. I believe that we need to provide opportunnities to open these conversations to patients/loved ones/healthcare givers/society. I discuss: ethical principles of euthanasia/assisted suicide for suicidal, treatment-resistant depression potential advantages/challenges for the treating team/the patient/their loved ones current laws/principles underlying ethical care provision how these precipitate ethico-legal conflicts <h3>Results</h3> Patients with psychiatric conditions are generally not given the same rights to make decisions regarding their mental health and treatment, particularly if they wish to decline treatment. In the case of severe suicidal depression, the treatment may help them in the short-term, but are we doing more harm by forcing them to stay alive against their will? Beneficence is the moral duty to promote the action that is in the patient’s best interest and doctors play a central role in the duty of care. But care does not always mean active treatment. <h3>Conclusion</h3> The moral stance would be to help those who are suffering. But what exactly constitutes ‘help’? Are euthanasia and assisted suicide helping or harming? Likewise, is keeping a patient with capacity alive against their wishes helping or harming?