[Request for assisted suicide in older people with depressive disorders : Expression of a mental disorder or free and independent structuring of the end of life?]

Abstract

Depressive disorders in older people are often accompanied by thoughts of their own death and the specific wish to die. Therefore, it can be assumed that depressive older people will express the wish for assisted suicide more frequently if legal provisions have been made. The following aspects must be taken into account when examining the decision-making capacity of those affected: depressive disorders can be reversible. Severe depressive disorders can be accompanied by an impaired capacity for judgment and making decisions, which rules out the possibility of making decisions of one's own free will. Particularly in old age, somatic comorbidities and an increased risk of loneliness are often found, which can additionally promote suicidal ideation. Without comprehensive assessments it will not be possible to clarify the actual autonomy of the will and it will be difficult to assess the permanence of the decisions made. It is also conceivable that the legal expert opinion could come to a different conclusion than the treating physician, who has followed the course of the illness during various phases of the patient's life and observed many changes in the patients will. In summary, it is currently not clearly recognizable in what form the assessment of free will could be organized in connection with possible legal regulations on assisted suicide, as long observation periods would be required for an adequate assessment.