The influence of cognitive distortions on decision-making capacity for physician aid in dying.

As international laws on physician aid in dying (PAD) evolve, the question of permitting PAD in non-terminal
illness, and in sole psychiatric illness, is under intense debate. In jurisdictions where PAD is permissible, certain
safeguards and eligibility requirements must be met for all patients making a PAD request, and one of these
requirements is that the patient have sound decision-making capacity with respect to the request. Legal criteria
already exist for the determination of capacity, and they are quite similar between different jurisdictions. In
current debates about the question of psychiatric PAD, one concern that has been raised is that cognitive distortions
in mental disorders may affect a patient's decision-making capacity. At the same time, it has been
established that all persons, with or without a mental disorder, experience cognitive distortions. If cognitive
distortions are ubiquitous, it is likely that the severity and frequency of cognitive distortions is dimensional
rather than categorical, between samples with and without mental illness. Furthermore, currently, there is no
requirement for a formalized evaluation of cognitive distortions as part of capacity assessment for any type of
medical decision, including PAD decisions. The current paper examines the literature related to cognitive distortions
in mental disorders and in healthy populations. It proposes that the existence of cognitive distortions,
alone, cannot be used as an argument for a blanket exclusion of psychiatric PAD. It therefore concludes that
further research and ethical analysis should be undertaken to examine the impact of cognitive distortions on
decision-making for consequential medical decisions, including PAD, in patients with and without mental disorders.