Santosh Patel is a neuropsychologist affiliated with a hospital located in a state with a voter-approved Death With Dignity Act. Under this law, the hospital may approve a dying patient’s wish to receive a lethal prescription if a physician corroborates a 6-month terminal diagnosis. If the physician believes competence to be an issue, a psychologist or psychiatrist evaluates the patient to determine competence to make the decision to end life.
A physician requests a psychological evaluation for a 62-year-old Jewish woman with 6-month terminal cancer who has requested the lethal prescription. The physician questions the patient’s competence because it appears that her decision to end her life now is motivated by the fact that her health care benefits have run out and her adult children have been complaining about the financial burden of providing the potent pain medications and hospice care she needs.
Dr. Patel administers standard tests for mental health disorders (the Minnesota Multiphasic Personality Inventory) and cognitive functioning (the Wechsler Adult Intelligence Scale). The patient’s scores do not meet clinical cutoffs for any mental disorder, and her cognitive scores are in the normal range. During the clinical interview, the patient states that her primary reason for seeking the lethal prescription is to ease the financial burden and conflict among her children. Her reasoning process flows logically, and she understands and appreciates the personal implications of the procedure and her own medical condition. She has spoken to her rabbi and believes God will forgive her for this decision. Although the standardized assessment does not provide evidence of mental impairment, the psychologist believes that while the patient’s decision may be rational, it is not truly voluntary but a result of pressure from the patient’s children. The psychologist knows that in general, this type of end-of-life decision-making process is emotionally taxing for the patient, the patient’s family members, and the health care team. He also realizes that whatever his assessment, it may be challenged in court by the patient’s or family’s legal representative.
Ethical Dilemma:
Dr. Patel does not know whether or not he should place a constraint on the patient’s decision by recommending a waiting period for psychotherapeutic intervention in the hope that treatment may shift the patient’s concerns from her children’s welfare to her own.
Why is this an ethical dilemma? What APA Ethical principle(s) are relevant in this matter?
Is it “irrational” for terminally ill patients to be concerned about the financial burden of their care on their family members? Can Dr. Patel obtain a valid assessment of whether family members’ financial concerns are or are not “coercive”?
What are the social and cultural issues (age, gender, race, religion etc.) that should be taken into consideration in this dilemma?