Severe and persistent mental illness can cause profound suffering. For some people, that suffering continues despite years of treatment, medication, hospitalization, therapy, and other interventions.

How society should respond to individuals who describe their psychiatric suffering as unbearable and enduring raises difficult questions involving patient autonomy, medical ethics, disability rights, suicide prevention, access to treatment, and the responsibility of healthcare professionals.

These questions deserve rigorous public examination rather than dismissal or oversimplification.

Medical aid in dying is permitted under limited circumstances in a number of jurisdictions, while extending eligibility to people whose sole underlying condition is psychiatric remains particularly controversial. Determining whether psychiatric suffering can ever reliably be considered irremediable presents substantial medical and ethical challenges.

This petition calls for a comprehensive national review of this issue rather than immediate legalization.

We ask appropriate federal health agencies, medical researchers, bioethicists, disability advocates, mental-health professionals, people with lived experience of severe mental illness, and other stakeholders to examine:

The available international evidence concerning medical aid in dying when psychiatric illness is the sole underlying condition.
Whether medicine can reliably determine that a psychiatric condition is irremediable, and what level of uncertainty remains in long-term psychiatric prognosis.
How clinicians can distinguish a persistent, informed request concerning end-of-life autonomy from suicidal thinking or impaired decision-making associated with a treatable psychiatric condition.
What safeguards would be necessary to protect people from coercion, discrimination, inadequate healthcare, poverty, housing instability, social isolation, or lack of access to effective treatment.
How disability rights and concerns about discrimination should inform any future policy.
Whether existing mental-health systems provide people experiencing severe and persistent psychiatric suffering with adequate access to evidence-based treatment, long-term care, supportive housing, and other resources before their condition is characterized as having exhausted reasonable alternatives.
The experiences and outcomes of jurisdictions outside the United States that have adopted different approaches to this issue.
Any examination of medical aid in dying for psychiatric suffering must recognize two important principles: people experiencing mental illness deserve autonomy and dignity, and society has a responsibility to protect vulnerable individuals and provide meaningful opportunities for treatment and recovery.

Neither principle should simply erase the other.

The United States should approach this question through evidence, medical ethics, transparent public discussion, and careful consideration of the experiences of people directly affected by severe psychiatric illness.

We therefore call for a comprehensive national review and public report examining severe, persistent psychiatric suffering, medical aid in dying, patient autonomy, available treatments, appropriate safeguards, and the consequences of potential policy options.

Whatever conclusions ultimately emerge, people experiencing profound psychiatric suffering deserve to have their experiences taken seriously—and public policy concerning life and death deserves an exceptionally high standard of evidence and care.