A patient is depressed after receiving the diagnose of a serious illness and therefore wants to end it all. The doctor, who has known the patient for quite a long time, perceives the patient’s death wish as an indication of psychological stress, caused by the sense of hopelessness and fear of the future, and concludes that the patient, given the present depressive condition, is not capable to decide about such a final action. The doctor explains that the outcome is not absolutely certain, even though it looks serious, and seeks in this way to encourage the patient to take up the fight against the illness.
But the patient is not satisfied with this. He is afraid of the side-effects of an uncertain treatment and feels that his life is meaningless. And, once again he remembers his daughter’s silence when he talked about his thoughts about ending it all – no arguments, only silence.
Yes, he thinks to himself, this is the only decent thing I can do, and contacts another physician.
The patient meets his new doctor one Thursday morning, at 9 o’clock. This doctor makes a different judgement concerning the patient’s decisional capacity. He does not know the patient at all, but after an hour’s conversation he perceives that this is a decisive person who seems to be capable of logical reasoning. The patient backs up his decision with the sentiment that he wants to remain independent and does not wish to become reliant on others – no, there is no influence from family members.
The doctor notes that the patient is certainly not young anymore, and that he is already suffering from various ailments – the quality of life is obviously quite low, he thinks to himself. He looks at the printed 2-page form on the desk in front of him (we are now in Oregon) and quickly ticks the boxes in section C. The patient has a terminal illness – there are exceptions, but this is generally regarded as a deadly disease, ponders the doctor, and the patient has a maximum of six months left to live – this is a bit uncertain, of course, but really…….no one can say anything else with any certainty. And, then he comes to the third question.
Is the patient capable of making a decision?
The doctor leaves the box blank for a moment, and proceeds to section E, on the other side of the form, where the question of decisional capacity is more defined. He evaluates the information he has and finally makes his decision, based on his perception of the patient’s quality of life. Yes, thinks the doctor, it’s a rational decision, and without further ado he ticks the box in section E – I have determined that the patient is not suffering from any psychological or mental illness or depression that would cause any weakening of his decisional capacity. He completes his evaluation by turning the form over and ticking the third box in section C. Finally, he ticks all the remaining boxes and completes the form by filling in personal data and other formalities.
The doctor throws a glance at the clock, which shows 10:20. Late coffee break today, he registers, as he signs the form.
The end