Battle brews in Belgium over euthanasia
BELGIUM ONE OF TWO EUROPEAN COUNTRIES THAT ALLOW IT FOR MENTAL ILLNESS
After struggling with mental illness for years, Cornelia Geerts was so desperate to die that she asked her psychiatrist to kill her. Her sister worried that her judgment was compromised. The 59-year-old was taking more than 20 pills every day, including antidepressants, an opioid, a tranquilizer, and two medicines often used to treat bipolar disorder and schizophrenia.
But about a year later, on October 7, 2014, her doctor administered a lethal dose of drugs — a legal procedure in Belgium, which has among the world’s most permissive euthanasia laws.
“I know it was Cornelia’s wish, but I said to the psychiatrist that it was a shame that someone in treatment for years could just be brought to the other side with a simple injection,” said her sister, Adriana Geerts.
Belgium is one of five countries that allow doctors to kill patients at their request, and one of two, along with the Netherlands, that grant the procedure for people with mental illness. The idea is that those with a psychiatric illness should be afforded the same rights as those suffering from a physical one.
“I always regret that we couldn’t do something else,” said Dr. Lieve Thienpont, one of the doctors who signed off on Geerts’ death. “At the same time, I’m part of the relief for the patient.”
Like many in Belgium and elsewhere, Thienpont, a respected psychiatrist and prominent euthanasia advocate, believes that when medicine can’t relieve suffering, euthanasia — when doctors actively kill patients — should be an option. And because psychological suffering can be harder to detect, doctors must take patients at their word.
“You can’t see it on a scan,” she said. “But we have to listen to the patient. We have to believe them because we can’t see (the suffering) always.”
Cases like Geerts and others have shown, though, how difficult it can be to strike a balance between respecting personal freedom and ensuring that people requesting euthanasia have the mental capacity to make that decision. Many, including Geerts‘ sister Adriana, think society should try harder to help struggling people with issues they face in jobs and relationships.
Thienpont’s approach to managing euthanasia requests has raised concerns even among doctors who support the procedure for psychological suffering. According to copies of letters obtained by The Associated Press, those worries have led to a clash between Thienpont and Dr. Wim Distelmans, chairman of Belgium’s euthanasia review commission, that has not been publicly disclosed.
The documents do not include accusations that patients were killed who shouldn’t have been, but they suggest doctors may have failed to meet certain legal requirements in some cases. And they highlight how difficult it can be to judge whose pain should end in death.
Distelmans did not respond to requests by email and telephone for an interview. Thienpont described receiving Distelmans’ letter in February as “a very difficult moment” and said that she and members of Distelmans’ team were still working out how to resolve what she called “internal issues.”
In the countries where euthanasia is legal — Belgium, Canada, Colombia, Luxembourg and the Netherlands — the vast majority of cases are people with a fatal illness such as cancer who have only weeks or months to live.
To qualify for euthanasia in Belgium, people must meet a number of criteria, including proving they have “unbearable and untreatable” suffering. Among adults whose lives are ended for psychiatric reasons, the most common conditions are depression, personality disorder and Asperger’s syndrome, a mild form of autism. People diagnosed with early-stage dementia can also request euthanasia, including for the future.
As these procedures are slowly becoming more accepted, and in some places where they are already allowed, boundaries are being stretched even further.
In 2014, Belgium became the first country in the world to expand its original euthanasia law by explicitly allowing it for children, although this cannot be for psychological suffering. The Netherlands, the first country to legalize euthanasia, has proposed extending euthanasia to old, healthy people who feel they have “completed” their lives. Canada, which passed its euthanasia law last year, is facing legal challenges designed to expand access to the procedure.
The number of people killed for psychological suffering is small — about 40 cases among Belgium’s 2,000 yearly euthanasia deaths. But that’s more than some experts predicted. In 2008, when euthanasia for psychiatric disorders was first broken out, four people were euthanized for psychiatric disorders. By 2015, the latest year for which data are available, that figure was 43.
As more countries grapple with whether to legalize assisted dying, Thienpont argues they needn’t worry about setting limits on who should be eligible for euthanasia, because only the truly desperate will ask to die. “You don’t have to be afraid,” she said. One of Thienpont’s patients, Amy De Schutter, says approving euthanasia for psychiatric patients can save lives.
“We want to live,” said De Schutter, whose request for euthanasia was granted last year, though she didn’t set an immediate date to die.
De Schutter says she endured years of failed treatment at psychiatric institutions and spent months deliberating how to kill herself. A trained physicist, she calculated the time it would take for an overdose to kick in, considered which bridge she might jump from and listed ways to kill herself in PowerPoint presentations.
De Schutter had already picked the day of her suicide, but one month before her intended death last year, her euthanasia request was accepted. Once she had been given clearance to legally die at home, she was relieved she wouldn’t have to kill herself. That was comforting enough to her that she didn’t set an immediate date for her euthanasia and has even drawn up a list of things she’d like to do in the meantime.
“It felt like 10,000 kilos was just (lifted),” De Schutter said. She says if she hadn’t been in a country where euthanasia was legal, she would have resorted to suicide by now.
Pierre Pol Vincke wishes his daughter Edith could have gotten that same relief — and perhaps continued to live. “She said, ‘Dad, you understand science, what could help me to die?” said Vincke, a biologist and amateur beekeeper in his garden in Ramillies, Belgium. “I said, as a father, I can’t do that.”
Doctors refused her euthanasia request, despite years of psychiatric illness. On November 3, 2011, Edith slashed her throat.
Jean-Jacques De Gucht, a Belgian lawmaker who co-sponsored the amendment that made the procedure available to children, says the law enhances personal freedom and that criticism of the country’s euthanasia policies are misguided.
“I think one of the greatest gifts you can give to society is to give people the possibility to choose for themselves if they’re in a situation where they’re suffering every day, to choose for themselves how to cope with that pain,” he said.
Sophie Nys believes her sister’s euthanasia was granted far too easily. She acknowledges that her sister Tine had long struggled with mental health problems, but said it was unthinkable that those problems warranted her death.
Tine’s longtime psychiatrist rejected her request to die, but Tine soon found Thienpont.
Sophie Nys says that Thienpont diagnosed Tine with Asperger’s and approved her euthanasia request after two or three sessions with Thienpont. Because Asperger’s is “incurable and chronic,” it meets one of the legal requirements for euthanasia. Sophie said her sister was so intent on being euthanized she might have manipulated the test.
“She knew that if she wasn’t diagnosed with autism or Asperger’s that she would not have a chance (of being euthanized),” she said. Two months after her diagnosis with Asperger’s, Nys was killed, at age 38.
After Nys’ death, her sister Sophie filed a criminal complaint, alleging irregularities in her sister’s euthanasia procedure, including fumbling efforts to administer drugs and asking her family to confirm that Tine’s heart had stopped.
Nys later obtained access to her sister’s medical file and found emails between her sister’s doctors attempting to block the investigation into Tine’s death.
“We must try to stop these people,” Thienpont wrote in one email to her colleagues that was provided to the AP. “It is a seriously dysfunctional, wounded, traumatized family with very little empathy and respect for others,” the message read. “I am starting to better understand Tine’s suffering.”
The criminal complaint against Thienpont and the other doctors involved in Tine Nys’ death was dismissed last year. The Nys family is appealing the decision.
Thienpont’s readiness to grant euthanasia to mental health patients has made some of her own colleagues uncomfortable.
In 2015, Thienpont was the lead author of a paper published in the medical journal BMJ Open, tracking 100 of her patients who requested euthanasia between 2007 and 2011. Of those, 48 were granted.
Some doctors were stunned by the high number of requests Thienpont fielded and how many were approved. At some other major psychiatric centres in Belgium, doctors receive only a handful of such requests every year, of which perhaps about 10 to 30 per cent are accepted, according to several psychiatrists who deal with such requests.
“That one single psychiatrist in Belgium has had such a major impact on the practice of euthanasia in psychiatric patients is very alarming,” said Dr. Stephan Claes, a psychiatrist at the University of Leuven.
Thienpont disputed that characterization, adding that she was not the only psychiatrist signing off on patients’ requests and that her numbers were not unusual.
But some colleagues have refused to accept her patients.