Euthanasia in psychiatric care: an ethical response to mental suffering

Euthanasia in mental health patients represents a unique and complex bioethical challenge due to the convergence of non-irreversibility, the possibility of a compromised competence and the intrinsic vulnerability associated with mental disorders. This article aims to offer a vision of euthanasia that accounts for the specific characteristics of the mental health field and understands its inherent difficulties. Given the limitations of an autonomy-based model in this context, a patient-centered approach is proposed — one that prioritizes genuine listening and empathy, placing the patient’s experience of suffering at the center of care. This approach emphasizes the need to address the unbearable suffering of the patient, interpreting death wishes as calls for help rather than mere symptoms of mental disorders. While acknowledging the autonomy-related problems associated with euthanasia for mental illness, this article suggests that such requests should be understood as part of a broader process of support, where the goal is to exhaust all treatment possibilities while recognizing that suffering may persist. Following such an approach, a model is proposed that balances patient autonomy with the ethical responsibility towards the patient’s mental suffering. Ultimately, euthanasia should only be offered as a last resort when all therapeutic options have failed to provide relief and the patient’s desire to die remains consistent over time.