Table 2.

Survey items

I: Questions on the treatment of patients with severe and persistent mental illness (SPMI)

In the treatment of patients with severe and persistent mental illness (SPMI), how important is:

A) curing the illness

B) reduction of suffering

C) the patient’s ability to function in daily life

D) the patient remaining autonomous in their decision making

E) impeding suicide

According to the World Health Organization (WHO), palliative care ‘is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual’.

How strongly do you agree or disagree with the following.

F) For me, the term ‘palliative’ relates directly to end of life.

G) For some SPMI patients, palliative care is indicated.

H) In psychiatry, applying a palliative care model is important in providing optimal support for certain patients without a life-limiting medical illness.

I) In severe, chronic and therapy-refractory anorexia nervosa, a palliative approach would be suitable.

J) In severe, chronic and therapy-refractory schizophrenia, a palliative approach would be suitable.

K) In severe, chronic and therapy-refractory depression, a palliative approach would be suitable.

L) In severe, chronic and therapy-refractory bipolar disorder, a palliative approach would be suitable.

M) In severe, chronic and therapy-refractory substance disorder, a palliative approach would be suitable.

How strongly do you agree or disagree with the following.

N) SPMI can be a terminal illness.

O) Sedation for the reduction of unbearable refractory psychological symptoms is justifiable in certain cases of SPMI.

P) I would generally be willing to perform sedation as mentioned above in ‘O’.

Q) I generally advocate access to assisted suicide for patients with SPMI.

R) If physician-assisted suicide was legally permitted for SPMI, I would support my patients in seeking this intervention as the physician of record or by referring them to another physician.

II: Questions about the three case vignettesa

Please evaluate the case vignettes as below.

S) I would not be surprised if this patient died within the next 6 months.

T) For this patient, further interventions to cure the anorexia would most likely be futile.

U) In this case, I would be comfortable with a reduction of life expectancy in order to increase or maintain quality of life if consistent with the patient’s goals.

V) In this case, I would accept a temporary decrease in quality of life due to coercive measures.

W) In this case, I would not proceed against the patient’s wishes.

X) In this case, sedation to reduce an unbearable refractory symptom is reasonable.

Y) If physician-assisted suicide was legally permitted, I would support this patient if this was her explicit and enduring wish, referring her to appropriate care.

^aNote: Questions S–Y applied to all three case vignettes in Table 1