Assisted Suicide for Mental Disorders: A Critical Review of the State-of the Art in Europe and Experts’ Opinions

Abstract

Background:

Medical assistance in dying (MAiD), encompassing euthanasia and assisted suicide, has expanded from its original focus on terminal somatic illness to include, in some jurisdictions, individuals with psychiatric disorders. This shift has raised major ethical, legal, and clinical concerns. While proponents argue for respecting autonomy and recognizing the severity of psychological suffering, opponents highlight diagnostic uncertainty, fluctuating decision-making capacity, and the risk of extending MAiD to vulnerable individuals.

Aims:

This narrative review provides a comprehensive overview of the legal frameworks, ethical debates, and clinical patterns surrounding assisted suicide and euthanasia for psychiatric disorders across Europe. It further examines expert concerns, the characteristics of patients requesting MAiD, and unresolved challenges related to competence, irremediability, and the potential overlap with suicidal behavior.

Results:

Across Europe, MAiD for psychiatric disorders remains ethically contested and inconsistently regulated. The growing number of requests underscores the need for clearer diagnostic standards, structured safeguards, and parallel treatment pathways to ensure that decisions are autonomous, informed, and not driven by potentially reversible psychopathology.

Conclusions:

The current landscape of MAiD for psychiatric disorders in Europe is marked by legal variability, ethical tension, and clinical uncertainty. Clarifying assessment standards, strengthening safeguards, and improving access to evidence-based treatments are essential to ensure that decisions are both ethically sound and clinically justified. Ongoing debate highlights the need for careful, evolving regulation in this highly sensitive area.