"Most jurisdictions are reluctant to authorise Physician Assisted Suicide (PAS) for patients with severe psychiatric illness in the absence of physical illness. None the less, the Dutch Supreme Court has ruled that PAS may be justifiable in certain cases in which there is unbearable mental suffering in the absence of physical illness. In 1994, the Court indicated that extreme care should be taken if PAS is considered in the absence of physical illness, and that the request should not be granted if the patient has deliberately refused a realistic alternative treatment. The advice of an independent expert is also required.

"In Dutch psychiatric practice only about 2% of requests for PAS are finally granted — compared with 37% of requests granted in Dutch medical practice as a whole (Groenewoud et al, 1997). In The Netherlands, PAS occurs in current psychiatric practice no more than five times per year, and most of these patients have both physical and mental illness. It could be argued that to deny a person PAS on the grounds that the illness is psychiatric rather than physical would be discriminatory. Is this the ‘slippery slope’ that opponents of PAS have always feared? Moreover, in an increasingly consumer-led society, could it become incumbent upon psychiatrists to provide such services?

"Requests for PAS on the basis of psychiatric illness alone stem from the provision of PAS for physical illness and from our growing understanding of the biological basis of certain mental illnesses. However, the similarities between physical and mental illness, though strong, are not complete. There is still a limited understanding of the underlying causes of common mental illnesses, including depression and schizophrenia. In the case of an individual patient, it remains extremely difficult to predict whether therapy will produce an early response, a delayed response or no response (Schoevers et al, 1998). It is impossible to predict which patients will undergo spontaneous remission and when this will happen. These uncertainties are far more pronounced in psychiatric practice than in medical practice, to the extent that it is essentially impossible to describe any psychiatric illness as incurable, with the exception of advanced brain damage as occurs in progressive neurodegenerative disorders such as Alzheimer's disease and Huntington's disease."

From: http://bjp.rcpsych.org/cgi/content/full/181/4/278