The 'end of the therapeutic path': supporting suicide in disguise

by Paul RussellThe relationship between suicide and the double sided spectre of euthanasia and assisted suicide is complex. Though complex, it is paradoxically easily understood at first glance given that all three relate to a wish to die and given that some of the most prominent advocates for the latter also involve themselves in the former.Though advocates for both euthanasia and assisted suicide have tried to soften and obscure this reality by the use of slogans such as 'assisted dying' and 'dignity in dying', I expect that most people understand the correct terminology. At the very least, people understand that both euthanasia and assisted suicide include an active decision by a third party or parties to take part in an action that has as its goal making someone dead.There is little substantive difference between the hopelessness experienced by the 'person on the ledge' who acts alone and the person who either asks for a lethal substance to take themselves or asks for a medical professional to deliver the dose. All three are about hopelessness.Few suicide prevention organisations have actively engaged with this relationship. The promotion of personal autonomy as the highest ideal added to a difficult prognosis colours both euthanasia and assisted suicide drawing the false conclusion that prevention is applicable to some and not to others. That some seeking an early demise should have their desire accepted. Accepted under the cloak of medicine that somehow sanitizes the grizzly behaviour.But in Belgium, that medical cloak has been extended in recent years to the suicidal but otherwise not dying. Between 50 and 60 cases of euthanasia were recorded in 2013 and 2014 where the overwhelming reason for the euthanasia request was recorded as psychological.The Belgian act of 2002 states that: 

The patient is in a medically futile condition of constant and unbearable physical or mental suffering that can not be alleviated, resulting from a serious and incurable disorder caused by illness of accident.

Mental suffering, or what we would call psychological suffering is clearly included here. The phrase: The patient is in a medically futile condition of constant and unbearable physical or mental suffering is entirely subjective. It is somewhat modified by the criteria: that can not be alleviated; a caveat that, one would have thought, would have excluded those for whom treatment had not been yet exhausted.

That seems to be the opinion of 38 Belgian psychiatrists and medical staff who recently gathered to pen an open letter to the Belgian people questioning the rise in euthanasia for psychiatric reasons. (De Standard) Prompted by the widely publicised euthanasia death of the 24 year old "Laura" who did not want to continue living these medical professionals insist that those involved in the euthanasia request should provide proof that the constant and unbearable physical or mental suffering cannot be alleviated. Otherwise, as they say, the act of euthanasia would be illegal.

They cite Co-Chair of the Belgian Euthanasia Evaluation Commission, Dr Wim Distelmans and his observations that two criteria must be satisfied: that the patient has suffered for a long time and is 'at the end of the therapeutic path'. They observe that often, given the opportunity, such people go on to 'develop a satisfying life' and observe that it is the nature of mental suffering of 'not seeing prospects' noting that, 'the impression of lack of outlook teaches nothing about the prognosis of mental suffering'. An unambiguous reference to the pathology of mental illness and suicide.

Distelmans' assertion that the criteria that the person be 'at the end of the therapeutic path' appears disingenuous.

In the case of Tom Mortier's mother, Godelieve De Troyer, she has been suffering clinical depression for years, was under good care but was suffering following a relationship break up. Distelmans could have insisted that she talk to Tom and his sister; a clear therapeutic option. He did not.

Dr Marc van Hoey could have likewise withheld the euthanasia of Simona de Moor who was grieving at her favourite daughter's untimely death until such time as she reconciled with her other daughter or until her grieving had passed. He did not.

"Laura" was clearly in the grip of suicidal ideation following the death of a friend. Though she appears to have had a history of mental illness, her request for euthanasia was triggered by her loss.

The 38 medical professionals also observe that Distelmans' supposed twofold criteria will also have a perverse effect upon the work of psychiatric clinicians. They suggest that such clinicians may begin to question just how far they might be prepared to go in treating a patient who is asking to die.

Distelmans is exposed further in the letter by the attribution of a quote wherein he observes that euthanasia for psychological distress is a necessary option 'as long as there are people who go throw herself (sic) under a train or from the top of an apartment building' adding that, 'euthanasia is still too taboo'.

And there you have it: my opening point reinforced in a chilling fashion. Rather than actually helping the person 'on the ledge', Distelmans would rather simply change the method. And we've heard this many times before; the false reasoning that because desperate people choose to suicide we need to change the law. Where is due care in that equation?

The Belgians are reinforcing any sense of hopelessness and adding into the mix nihilistic abandonment.

A link to the Statement by the 38 Belgian specialists (in French) can be found HERE.

Note: If anything in this article causes you difficulties, please phone:

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