News/Recent Publications

  • Two articles on euthanasia/assisted suicide and dementia may be of interest for readers. The first is an analysis of published cases in the Netherlands. The second is a survey of public attitudes toward the practice.
  • Noa Pothoven was a 17 year-old young woman with several psychiatric conditions from the Netherlands who died recently by self-starvation. Her death was initially reported in English speaking media as a euthanasia. I comment on her death and put it in the context of Dutch practice of psychiatric euthanasia here.
  • We and others have reported that personality disorders are quite common in persons requesting and receiving psychiatric euthanasia. We recently analyzed the Dutch psychiatric euthanasia cases involving persons with prominent personality difficulties (as described in their case reports published by the review committees). 
  • My colleagues from King's College London (Alex Ruck-Keene, Nuala Kane, and Gareth Owen) and I just published a paper that will be of value to those working on the increasingly studied and debated topic of decision-making capacity. The paper (open access!) is a unique combination of an exposition of how Mental Capacity Act (England and Wales) works in the court system and an empirical review of that court system's experience over its 10 years of using the MCA.  
  • Is 'physician-assisted death' (PAD) distinct from 'suicide in the traditional sense'?  Does it make sense to advocate for PAD and also be committed to the prevention of suicide? The American Association of Suicidology published a statement arguing that it does, mainly by contrasting PAD for terminal illness with what they call suicide in the 'ordinary' or 'traditional' sense. Eric Caine, Yeates Conwell (two eminent suicidologists) and I recently published a commentary on the AAS Statement.
  • My fellow David Miller, bioethicist Rebecca Dresser, and I recently analyzed a controversial Dutch case of euthanasia of an elderly woman with dementia based on an advance directive, and during which the physician asked the family to hold down the resisting patient.
  • My colleagues Neal Dickert, Dave Wendler and I organized a workshop on a new way of looking at informed consent for research--what we call a 'function-based approach'--and the resulting paper is now in print at AJOB, with commentaries by various authors and an editorial by Tom Beauchamp.
  • Our analysis of euthanasia cases in the Netherlands that their review committees deemed as "due care not met" (i.e., according to their euthanasia law's requirements) was just published on BMJ Open.  
  • Mental Health and Justice, a project based at King's College London with Gareth Owen as the principal investigator, has now been launched. I am a core member of the research team. It is funded by the Wellcome Trust and addresses a central ethical question in mental health law: how do we balance the protection of decisionally impaired persons with the need to promote their autonomy?  This is a large, multi-year, multi-disciplinary project.
  • If a person cannot understand the facts relevant to a medical decision, or is too confused to use the information, or has a delusion that misinterprets the actual facts, then we usually say that the person lacks decision-making capacity for that medical decision.  But what if a person's disorder does not impeded factual comprehension or does not involve a delusion about the facts but instead distorts the ability to appropriately value something--like a severely depressed person or a person with a brain tumor who develops a completely new desire contrary to everything he holds valuable?  My co-author Lisa Eckstein and I explore the role of this 'ability to value' in capacity assessments in a new article. (Unfortunately not available online but available upon request).
  • Can neuroscience help us think about how to apply the criteria for assessing someone's decision-making capacity?  This and many other questions that deal with the relationship between law and neuroscience were discussed at a recent conference sponsored by UCSF/Hastings School of Law.  My panel talk and discussion can be found on the Talks Online page.
  • Do persons with severe mental disorders requesting euthanasia and assisted suicide (EAS) retain their capacity to make decisions? We recently published an analysis of how Dutch doctors and euthanasia review committees discuss this issue in the published case reports of psychiatric EAS.
  • Suppose a clinical trial is comparing two treatments that are already widely in use for a condition because it is not known which is better.  Some doctors like one, others like the other treatment--but there is no rigorous evidence-base for the choice.  Do such clinical trials involve research risks for participants? Do participants (patients in clinics, for example) need to know they are in the study? We recently published a framework for figuring out the research risks and its implications for informed consent.
  • Several new online videos have been added to the Talks Online page.


Mangino DR, Bernhard T, Wakim P, Kim SY. Assessing public's attitudes towards euthanasia and assisted suicide of persons with dementia based on their advance request: an experimental survey of US public. The American Journal of Geriatric Psychiatry. 2020.

Mangino DR, Nicolini ME, De Vries RG, Kim SYH. Euthanasia and Assisted Suicide of Persons With Dementia in the Netherlands. Am J Geriatr Psychiatry. 2020;28(4):466-477.

Kim, S. How Dutch Law Got a Little Too Comfortable With Euthanasia. The Atlantic. June 8, 2019.

Nicolini, M. E., Peteet, J. R., Donovan, G. K., & Kim, S. Y. H. Euthanasia and assisted suicide of persons with psychiatric disorders: the challenge of personality disorders. Psychological Medicine, 1-8. doi:10.1017/S0033291719000333

Miller, D. G., Kim, S. Y. H., Li, X., Dickert, N. W., Flory, J., Runge, C. P., & Relton, C. (2018). Ethical Acceptability of Postrandomization Consent in Pragmatic Clinical Trials. JAMA Network Open, 1(8), e186149. doi:10.1001/jamanetworkopen.2018.6149

Ruck Keene, A., Kane, N. B., Kim, S. Y. H., & Owen, G. S. (2019). Taking capacity seriously? Ten years of mental capacity disputes before England's Court of Protection. International Journal of Law and Psychiatry, 62, 56-76. Open Access.

Kim SYH, Conwell Y, Caine ED. Suicide and physician-assisted death for persons with psychiatric disorders: How much overlap? JAMA Psychiatry. 2018.

Miller DG, Dresser R, Kim SYH. Advance euthanasia directives: a controversial case and its ethical implications. J Med Ethics. 2018.

Dickert NW, Wendler D, Devireddy CM, et al. Consent for Pragmatic Trials in Acute Myocardial Infarction. Journal of the American College of Cardiology. 2018;71(9):1051-1053.

Dickert NW, Eyal N, Goldkind SF, Grady C, Joffe S, Lo B, Miller F, Pentz R, Silbergleit R, Weinfurt K, Wendler D, Kim SYH.Reframing Consent for Clinical Research: A Function-Based Approach. The American Journal of Bioethics. 2017;17(12):3-11.

Miller DGKim SYH. 
BMJ Open 2017;7:e017628. doi: 10.1136/bmjopen-2017-017628

Eckstein L, Kim SYH. Criteria for Decision-Making Capacity: Between Understanding and Evidencing a Choice. Journal of Law and Medicine. 2017; 24: 678-694.

Doernberg SN, Peteet JR, Kim SYH. Capacity Evaluations of Psychiatric Patients Requesting Assisted Death in theNetherlands. Psychosomatics. 2016. DOI: 10.1016/j.psym.2016.06.005.

Chen S, Kim SYHA Framework for Analysis of Research Risksand Benefits to Participants in Standard of Care Pragmatic Clinical Trials. Clinical Trials. doi: 10.1177/1740774516656945

Kim, S. Y. H., & Lemmens, T. (2016). Should assisted dying for psychiatric disorders be legalized in Canada? Canadian Medical Association Journal.

Kim SYH, Wilson R, De Vries R, Kim HM, Holloway RG, Kieburtz K. “It is not guaranteed that you will benefit”: True but misleading?  Clinical Trials. doi: 10.1177/1740774515585120.

Kim SYH, Miller FG.  Ethical Complexities in Standard of Care Randomized Trials: A Case Study of Morning Versus Nighttime Dosing of Blood Pressure Drugs. Clinical Trials. 2015 doi: 10.1177/1740774515607213

    see also:  Kim SY, Miller FG. Response to Magnus and Wilfond. Clin Trials. Apr 2016;13(2):244-245.

Nayak RK, Wendler D, Miller FG, Kim SYHPragmatic Randomized Trials Without Standard Informed Consent?: A National Survey.  Annals of Internal Medicine. 2015;163(5):356.

Kim SYH, Miller FG.  Waivers and Alterations to Consent in Pragmatic Clinical Trials: Respecting the Principle of Respect for PersonsIRB: Ethics & Human Research. 2016; 38(1): 1-5.

Kim SYH, Wilson R, De Vries R, Ryan KA, Holloway RG, Kieburtz K. Are patients with amyotrophic lateral sclerosis at risk of a therapeutic misconception? Journal of Medical Ethics. March 10, 2016.