In Reply: Dr. Berghmans rightly draws attention to the differences between the evaluation of a request for physician assisted suicide by a suffering psychiatric patient and the judicial process leading to the death penalty for persons who have committed criminal offenses, in countries where this sentence exists.
The analogy with the death sentence was used in the context of a discussion of the incurability of psychiatric disorders, in which we asked whether psychiatrists can provide sufficient certainty on the treatment prognosis of their patients to warrant assisting a suicide. The analogy was not based on a literal interpretation, but rather on the fact that decisions on life and death are final and should be carried out only when there is certainty that the decision is right. The need for certainty places a heavy responsibility on those who have to make such decisions, whether judges or physicians, and on the evaluation procedure that is to be followed.
In our paper we underlined the uncertainties and complexities of such an evaluation procedure, applicable to psychiatric patients with a death wish who turn to their psychiatrist for help. We hope we made clear what those complexities are, and how a policy favoring physician-assisted suicide may fundamentally affect clinical practice. By focusing on a "new treatment that may eventually be developed," Dr. Berghmans failed to address some of the key issues we raised.