Psychiatrie, soins palliatifs et de fin de vie : des univers (ir)réconciliables? Le cas de madame Sanchez

  • Marie-Eve Bouthillier Centre d’éthique du Centre intégré de santé et de services sociaux (CISSS) de Laval, Laval; Faculté de médecine, Université de Montréal, Montréal, Canada https://orcid.org/0000-0002-7156-057X
  • Hugues Vaillancourt Centre d’éthique du Centre intégré de santé et de services sociaux (CISSS) de Laval, Laval, Canada
Keywords: psychiatry, palliative and end-of-life care, refusal to drink and eat, treatment refusal, ethics, suicidal ideation, wish to die, elderly

Abstract

Background: In psychiatry, the issue of providing palliative and end-of-life care for what would be a “terminal psychiatric condition” or considering a palliative approach to severe and persistent mental health problems is still a taboo. Methodology: This question is addressed through an analysis of a case arising during a clinical ethics consultation, using Hubert Doucet’s scenario method. It is about Mrs. Sanchez, a patient over 90 years of age with a psychiatric profile, expressing the desire to die by suicidal gestures, refusing the proposed treatments, and refusing as well to drink and eat. Her clinical history is told through the filter of reflexive support offered in clinical ethics to the various stakeholders. Results: The case analysis, far from responding to the challenges posed by the concept of palliative and end-of-life care in a psychiatric context, nevertheless presents an opportunity to name its main ethical issues: psychic suffering, refusal to eat and drinking as well as refusal of treatment, palliative sedation and medical assistance in dying, wishes and advanced medical directives and clinical-organizational challenges for geriatric psychiatry clients. Conclusion: There are still many challenges for professionals and decision-makers to meet the needs of older mental health clients. We call for further development of knowledge on this specific topic.

Published
2020-10-30
How to Cite
[1]
Bouthillier M-E, Vaillancourt H. Psychiatrie, soins palliatifs et de fin de vie : des univers (ir)réconciliables? Le cas de madame Sanchez. Can. J. Bioeth. 2020;3:43-5. https://doi.org/10.7202/1073546ar.