Dr Mark Komrad: Why psychiatrists should oppose euthanasia.

The situation concerning euthanasia or assisted suicide for psychiatric reasons.

Since 2002, the Netherlands and Belgium (Luxembourg in 2009) legalized euthanasia without a distinction between terminal and non-terminal conditions. These laws allowed for euthanasia for physical and psychiatric reasons.

This has led to some patients receiving suicide assistance rather than suicide prevention.

As a psychiatrist, I disagree with these developments based on my Hippocratic tradition of medical ethics which is based on the value of not killing. The mighty tree of medicine grew from the Hippocratic tradition.

My concerns as a psychiatrist relate to the core values of psychiatry which focus on helping people in despair, helping people who are demoralized, helping people who cannot see their way cognitively and emotionally to a better future, helping to mitigate suffering, taking the journey of suffering with them, listening to them intently, to help find meaning in suffering and to fundamentally prevent suicide.

Preventing suicide is core to the individual and social mission of a psychiatrist.

• Mark Komrad: Psychiatrists prevent suicide not provide it.

Euthanasia takes this mission of ours and stands it on its head. To be involved with causing death is an anathema and inversion of the fundamental ethos of psychiatry.

Euthanasia affects mental health care since our patients generally experience a lack of access to resources. Once you begin to make euthanasia an alternate path my fear is that the advocacy to treatment may disappear.

All of the work we are doing to open access to mental health care is threatened when short circuited by euthanasia and assisted suicide.

Euthanasia affects attitudes towards life because once the concept takes hold the lives of people with disabilities or certain mental or medical conditions are seen as somehow not as worth living.

I have a colleague in Belgium, whose father has a chronic condition and has chosen not to have euthanasia. I am told, when his father complains about his symptoms that some of his friends will say – you chose not to have euthanasia.

The sympathy that normally people would have had, now they are explicit that he doesn’t deserve their sympathy.

The subtle changes to the collective psyche as we begin to open to these things leads us to accelerate down the slippery slope to the point where the train ends up going off the rails.

• American Psychiatric Association position on euthanasia.