If you were a psychiatrist and a chronically depressed patient told you he wanted to die, what would you do?
In Belgium, you might prescribe this vulnerable, desperate person a fatal dose of sodium thiopental.
Between October 2007 and December 2011, 100 people went to a clinic in Belgium’s Dutch-speaking region with depression, or schizophrenia, or, in several cases, Asperger’s syndrome, seeking euthanasia. The doctors, satisfied that 48 of the patients were in earnest, and that their conditions were “untreatable” and “unbearable,” offered them lethal injection; 35 went through with it.
These facts come not from a police report but an article by one of the clinic’s psychiatrists, Lieve Thienpont, in the British journal BMJ Open. All was perfectly legal under Belgium’s 2002 euthanasia statute, which applies not only to terminal physical illness, still the vast majority of cases, but also to an apparently growing minority of psychological ones. Official figures show nine cases of euthanasia due to “neuropsychiatric” disorders in the two-year period 2004-2005; in 2012-2013, the number had risen to 120, or 4 percent of the total.
Next door in the Netherlands, which decriminalized euthanasia in 2002, right-to-die activists opened a clinic in March 2012 to “help” people turned down for lethal injections by their regular physicians. In the next 12 months, the clinic approved euthanasia for six psychiatric patients, plus 11 people whose only recorded complaint was being “tired of living,” according to a report in the Aug. 10 issue of JAMA Internal Medicine.
If you find this sinister, I agree. Bioethicists Barron H. Lerner and Arthur L. Caplan, who reviewed the data from the Low Countries in JAMA Internal Medicine, observe that the reports “seem to validate concerns about where these practices might lead.”
That’s putting it mildly. Thienpont acknowledges that “the concept of ‘unbearable suffering’ has not yet been defined adequately” and that “there are no guidelines for the management of euthanasia requests on grounds of mental suffering in Belgium.”
Yet she and her colleagues continue to put the mentally ill to death, insisting that they are respecting their wishes — though, as she writes, “further studies are recommended.”
Thienpont’s co-author Wim Distelmans, a leading advocate of euthanasia, has ended the life of a 44-year-old who was anguished, but not terminally ill, due to a botched sex-change operation. Distelmans also put to death identical 45-year-old deaf twins who said they lost the will to live upon learning they would eventually go blind.
Frank van den Bleeken, imprisoned for 30 years for rape and murder, sought euthanasia from Distelmans, citing his incurable violent impulses and the misery of life behind bars. Belgian officials and Distelmans initially agreed; a lethal injection the murderer might have gotten as punishment in the United States would be supplied as therapy in anti-death penalty Europe.
In January, however, Distelmans backed out just before the scheduled procedure — there was still hope for van den Bleeken to get treatment at a facility in the Netherlands, he said.
Distelmans faced little accountability either way. The body empowered to scrutinize his actions, after the fact, was Belgium’s Euthanasia Control and Evaluation Commission — of which he is co-chairman. It has reviewed thousands of cases since 2002 but referred exactly none to law enforcement.
The “very worrisome” trends in Europe “should give us pause” about where the “assisted dying” movement might lead in this country, Lerner and Caplan write.
To be sure, by authorizing doctors to administer lethal drugs, in terminal and non-terminal cases, the Benelux countries go far beyond laws in Oregon and four other states, which permit physicians to prescribe, not administer, a fatal dose — and only in cases of terminal physical illness.
Those limitations, and their effectiveness since Oregon adopted its law in 1997, help explain why 24 states, and the District, are considering assisted-suicide legislation, which 68 percent of the public supports in some form, according to a Gallup poll.
What’s noteworthy about euthanasia in Europe, though, has been its tendency to expand, once the taboo against physician-aided death was breached in favor of more malleable concepts such as “patient autonomy.”
“What is presented at first as a right is going to become a kind of obligation,” Belgian law professor Étienne Montero has warned.
In 2013, euthanasia accounted for one of every 28 deaths in the Netherlands, three times the rate of 2002. In the Dutch-speaking part of Belgium, one of every 22 deaths was due to euthanasia in 2013, a 142 percent increase since 2007. Belgium has legalized euthanasia for children under 12, though only for terminal physical illness; no child has yet been put to death.
The United States, like Europe, is aging, with all that implies for the spread of Alzheimer’s and other cognitive disorders. If pressure rises for more doctor-assisted death, Lerner and Caplan insist, “physicians must remain primarily healers.”
“Part of the problem with the slippery slope,” they write, “is that you never know when you are on it.”
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