Last resort: the ethical obligation to offer ketamine in psychiatric euthanasia and assisted suicide

Intravenous ketamine and intranasal esketamine have shown rapid effects in reversing suicidality and improving depressive symptoms. In countries that allow psychiatric euthanasia and/or assisted suicide (EAS), we argue that potentially effective treatments for suicidal ideation and behaviour, such as ketamine, should be required before allowing patients to access psychiatric EAS. Ketamine can both help clarify patients’ decision-making capacity and serve as a reasonable therapeutic alternative when determining irremediability. For patients who refuse potentially effective treatments such as ketamine, oversight bodies should establish a formal process through which they can petition for review of their EAS request—protecting their legal right to die while guarding against potentially preventable death.