Losing Your Mind: Do You Lose Your ‘Right to Die’ too?
Since the age of 5, she has been sexually abused. She was rescued ten years later, but the events scarred her with Post-Traumatic Stress Disorder (PTSD). Psychiatrists were unable to relieve her suffering despite various treatment modalities have been attempted. Ten years have passed, yet she incessantly conveyed the will to die. According to the Independent, her wish of euthanasia was granted in 2015.
Rising numbers
This was one of the many psychiatric cases that met criterias for euthanasia in the Netherlands. The Netherlands is the first country to legalise both euthanasia and assisted suicide (EAS), and its practice is regulated under the “Termination of Life on Request and Assisted Suicide Act”. Since its legalisation in 2002, the number of deaths by Euthanasia or Assisted Suicide (EAS) tripled to 6,091 in 2016, with about 70% of them due to incurable cancer. It is reasonable to expect a rising trend for euthanasia, since its provision is a relatively new end-of-life service. As with other new services, we can speculate it to trend with an initial rise followed by a plateau.
Nature of Conditions for cases that
complied with EAS criteria in 2016
Data from Regional Euthanasia Review Committees,
Annual Report 2016, the Netherlands
Generally speaking, the prerequisites permitting euthanasia among legislated countries include:
The patient is chronically ill with unbearable suffering
No improvement of health can be foreseen
The patient is capable in making the decision
The request is made repeatedly and voluntarily
The law did not specify the nature of “unbearable suffering”, hence it is legal to provide EAS as long as the patient met the aforementioned criteria. The first two conditions implied that it is acceptable to give up the fight once you know for sure nothing else can be done. In most circumstances, these are people whose lives are going to end soon anyway. The next condition highlights another assumption: that if you have lost decision-making capacity, you will lose the right to decide what is the best for you. It is these values, upon which the prerequisite conditions are based on, that raise concerns on permitting patients with mental health disorders for euthanasia.
According to the Dutch Regional Euthanasia Review Committee’s annual report, the number of deaths by euthanasia due to mental health disorders has climbed from 2 in 2010 to 60 in 2016 in the Netherlands. Among those applicants, 55% of them were suffering from depressive disorders- an alarming call for some. Perhaps the thirty-fold rise of EAS over only the course of six years is not solely due to the increasing use of a ‘new service’. Rather, it can signify the increasing recognition of psychiatric patients’ requests as being no different from that of other health conditions. Although this can be true, it is actually much trickier and requires delicate considerations by the physicians.
The law did not specify the nature of “unbearable suffering”, hence it is legal to provide EAS as long as the patient met the aforementioned criteria. The first two conditions implied that it is acceptable to give up the fight once you know for sure nothing else can be done. In most circumstances, these are people whose lives are going to end soon anyway. The next condition highlights another assumption: that if you have lost decision-making capacity, you will lose the right to decide what is the best for you. It is these values, upon which the prerequisite conditions are based on, that raise concerns on permitting patients with mental health disorders for euthanasia.
According to the Dutch Regional Euthanasia Review Committee’s annual report, the number of deaths by euthanasia due to mental health disorders has climbed from 2 in 2010 to 60 in 2016 in the Netherlands. Among those applicants, 55% of them were suffering from depressive disorders- an alarming call for some. Perhaps the thirty-fold rise of EAS over only the course of six years is not solely due to the increasing use of a ‘new service’. Rather, it can signify the increasing recognition of psychiatric patients’ requests as being no different from that of other health conditions. Although this can be true, it is actually much trickier and requires delicate considerations by the physicians.
Respecting decisions
As a medical student, I believe it would be dangerously easy to discriminate against psychiatric patients, due to our lack of understanding of the disease itself and lack of perspective from not having personally experienced the disease.
The fundamental duty of a physician is to do no harm, a professional legacy of the Hippocratic Oath since the times of ancient Greek.
Who has the right to decide which does more harm: administering the patient life-ending medication, or letting the patient suffer for the rest of his/her lifetime?
After all, the goal of euthanasia is to provide an option to terminate one’s life in a peaceful way. To the family and partners, it is also an opportunity for “healing”, and a time for well-prepared farewell, which often is what hurts most from sudden deaths- words left unsaid, relationships unfixed, and regrets.
Explanatory notes:
[1] In medicine, ‘capacity’ is “the ability to use and understand information to make a decision, and communicate any decision made”, as defined by the National Health Service, UK. This corresponds to the legal terminology, ‘competence’, which refers to “the mental ability and cognitive capabilities required to execute a legally recognized act rationally”, according to the American College of Legal Medicine.
[2] Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness. It involves treatment of pain and other distressing symptoms, and intends neither to hasten or postpone death. Definition retrieved from World Health Organisation.
Author’s note:
For discussion sake, all mental health disorders discussed are referring to treatment-resistant states only, given the current limitations on medical sciences as inadequate in providing effective treatment. The overwhelming majority of patients improve with medication, psychotherapy and/or social therapy.
Medical professionals do not see death as a solution to problems; even in treatment-refractory cases, death is not an alternative to living.