Depression as a terminal illness - Is there a place for palliative care?

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Minna Chang

Imperial College London, UK

: Int J Ment Health Psychiatry

Abstract

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In 2020, there were 5,224 deaths due to suicide registered in England and Wales. The Mental Health Foundation has reported that ~70% are in patients with depression. The number of attempted suicides is much higher – South West London and St George’s mental health trust estimates that at least 140,000 people attempt suicide in England and Wales every year. In suicidal depression, the psychological pain is often unbearable and feels overwhelmingly incompatible with life. One is no longer living, they are merely surviving and eventually, the exhaustion will lead to decompensation. This is marked by suicide. The goal is to end the suffering permanently and this is achieved through death. Depression, like all other physical and mental illnesses, runs a course. This is highly variable between individuals and can be the case even between separate relapse episodes in the same patient. Like many diagnoses, depression is known to lead to death in a significant number of people. Many suicidal depressed patients feel that death will be an inevitable result of the illness. Suicide is often viewed as a symptom of severe depression, but would it be justifiable to consider death as part of the disease process itself? Consequently, would it be justifiable to consider depression in these patients as a form of terminal illness? Since without treatment, the condition would lead to death? Accordingly, could there be a place for palliative care in a small minority of suicidal depressed patients? This would mean that instead of placing the focus on the prevention of deaths and prolonging lifespan, the focus would be on making the patient comfortable as the disease progresses, maintaining their dignity and promoting autonomy. In this essay, I discuss the ethical and moral implications of suicidal depression from a doctor’s and patient’s perspectives. I also discuss the implications of depression on capacity and decision-making. Lastly, I discuss the ethical dilemmas surrounding assisted suicide and euthanasia for severe suicidal treatment resistant depression. Could there be considered a means of treatment in certain cases?

Biography

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Minna Chang graduated from Imperial College London and has a special interest in medical ethics, particularly psychiatric medical ethics. She is passionate about teaching and research outside of her clinical duties.