Treatment-resistant major depressive disorder and assisted dying: response to comments
Bibliographic record
Abstract
The commentaries responding to our article on treatment-resistant depression and assisted dying focus on the following issues: epistemological questions about death, patient competence, the role of doctors, the moral basis of the right to an assisted death, safety and security of patients, and questions about various cases that occurred in the Netherlands. We will address in our response each of these concerns, beginning with the last issue first. Dr den Hartogh mentions a case in the Netherlands where the Dutch review committee deemed ‘the doctor … not careful’.1 This case was published after we submitted our paper. The case was judged ‘not careful’ because no psychiatrist had been consulted to consider the competence of the patient, and to review whether the patient's situation was truly of a hopelessness nature. In this case, the doctor who performed the euthanasia and the consultant were general practitioners. This case does not undermine our argument. The review committee did not suggest that the patient was incompetent. In our paper, we are careful to consider only treatment-resistant competent patients. Dr Cowley mentions the so-called Chabot case and the Brongersma case.2 In the Netherlands, the Brongersma case is not discussed under the label ‘depression’, but as a case of a patient who was ‘tired of life’.3 Eighty-six-year-old former politician Edward Brongersma did not suffer from a mental or other illness. It deserves a separate discussion and is outside the scope of our paper. The Chabot case was extraordinary because the patient had no wish to be cured from her depression because she felt depression to be an appropriate state to be in after the premature deaths of her two sons.4 This case also falls outside the scope of our paper. Drs Broome and de Cates begin their discussion with an epistemological argument …
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.023 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.003 | 0.006 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".