by Alex Schadenberg, Executive Director - Euthanasia Prevention Coalition. With Paul Russell
The 2015 Netherlands euthanasia report that was recently released states that there were 5561 reported euthanasia deaths in 2015, up from 5306 in 2014, there were 109 reported euthanasia deaths for dementia, up from 81 in 2014, and there were 56 reported euthanasia deaths for psychiatric reasons, up from 41 in 2014.
Shockingly, a woman who died by euthanasia for psychiatric reasons in 2015 was in her 20's and had been sexually abused.
The Daily Mail news reported:
The woman, in her twenties, was given a lethal injection after doctors and psychiatrists decided that her post-traumatic stress disorder and other conditions were incurable.
It went ahead despite improvements in the woman's psychological condition after 'intensive therapy' two years ago, and even though doctors in the Netherlands accept that a demand for death from a psychiatric patient may be no more than a cry for help.
The woman, who has not been named, began to suffer from mental disorders 15 years ago following sexual abuse, according to the papers released by the Dutch Euthanasia Commission.
The Daily Mail reported that the Netherlands government released information about the case to prove that the case fulfilled the requirements of the law. According to the Daily Mail report:
the woman had post-traumatic stress disorder that was resistant to treatment. Her condition included severe anorexia, chronic depression and suicidal mood swings, tendencies to self-harm, hallucinations, obsessions and compulsions.
She also had physical difficulties and was almost entirely bedridden. Her psychiatrist said 'there was no prospect or hope for her. The patient experienced her suffering as unbearable'.
However, the papers also disclosed that two years before her death the woman's doctors called for a second opinion, and on the advice of the new doctors she had an intensive course of trauma therapy. 'This treatment was temporarily partially successful,' the documents said.
The patient, they said, was 'totally competent' and there was 'no major depression or other mood disorder which affected her thinking'. A final GP's report approved the 'termination of life' order and the woman was killed by an injection of lethal drugs, the report said.
Australian psychiatrist and mental health campaigner Professor Ian Hickie echoed these sentiments at News.com.au, labelling the girl's euthanasia "entirely inappropriate".
"It makes all sorts of poorly substantiated assumptions about causation, available treatments, supportive care and prognosis.
"It really demonstrates how the current concepts around euthanasia cannot be applied to mental illness".
The Dutch law says that 'a patient's suffering was unbearable, and that there was no prospect of improvement' and that 'there is no reasonable alternative.' Whether or not the suffering is 'unbearable' is entirely subjective; 'prospects of improvement' are less problematic and 'no reasonable alternative'- while it may seem objective is entirely up to what the patient sees as 'reasonable'. Even so, in cases of severe illness the medical literature may be a reasonable guide to such matters even if some of it remains guess work.
Not so for psychiatric cases. In December 2015, 65 Belgian professors, psychologists and psychiatrists signed an open letter called: Death as therapy? They sought the removal of euthanasia on the ground of purely psychological suffering from the law. The signatories were critical of the decision to decide that some psychiatric cases offered 'no prospects of improvement' or, in other words, were incurable:
"In contrast to illnesses that are the consequence of tissue damage, mental suffering is associated with a change in functioning - not a deterioration of tissue. This difference is essential, because such dynamic changes, by definition, can revert and do so sometimes quite suddenly. Thus we see that some who are at first declared incurably ill and granted permission to receive euthanasia on that basis, decide they don't want euthanasia anymore because new - albeit fragile - (other) perspectives have appeared.
"In a paradoxical way, this proves that the illness cannot be called incurable. The subjective assessment of one's own perspective with regards to mental suffering is therefore no reliable ground for making an "incurable" verdict."
Nor indeed is the judgement that the person is 'of sound mind'. As described above, perspectives can and do change. Unlike a terminal illness, restoration to full health remains a possibility. While it is possible that a person with a psychiatric illness could make a so-called 'rational' decision to be made dead, it is entirely irrational that a medical professional should agree.
In 2010 there were 2 reported cases of euthanasia for psychiatric reasons in the Netherlands and in 2015 there were 56 reported cases.
A recent study examined 66 cases of euthanasia for psychiatric reasons between 2011 and 2014 in the Netherlands.
One of the cases was a healthy woman who decided that she could not live without her husband. After her husband died, she wanted to die by euthanasia. She was lethally injected, even though one of the consultants reported that she:
"did not feel depressed at all. She ate, drank and slept well. She followed the news and undertook activities."
Lead researcher, Dr Scott Kim was reported by CTV news as stating:
"There is no evidence base to operationalize 'unbearable suffering,' there are no prospective studies of decision-making capacity in persons seeking EAS for psychiatric reasons, and the prognosis of patients labeled as 'treatment-resistant depression' varies considerably, depending on the population and the kind of treatments they receive."
Canada's Bill C-14, that is being debated in parliament, would legalize euthanasia for physical and psychological suffering. The concept of euthanasia should be disturbing, but the concept of euthanasia for psychiatric reasons should be considered unthinkable.
The bill currently before the South Australian Parliament has provisions that could be used to accept euthanasia for psychiatric reasons.