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.
Thirty-five of the 100 patients 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 number of psychological ones.
Official figures show nine cases of euthanasia due to “neuropsychiatric” disorders during 2004-2005. In 2012-2013, the number rose 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 2012 to “help” people turned down for lethal injections by their 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. Barron Lerner and Arthur Caplan — bioethicists 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.
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 the United States, Lerner and Caplan write.
To be sure, the Benelux countries go far beyond laws in Oregon and four other U.S. states that 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 of Columbia, 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 its use once the taboo against physician-aided death is breached.
“What is presented at first as a right is going to become a kind of obligation,” Belgian law professor Étienne Montero has warned.
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.”