Euthanasia for the Mentally Ill

Who are we to judge people’s actions based on our brief fifteen-minute glimpses during our consultations? We do not live with them day in and day out. We do not sit with them upon the sofa as their mind squirms and bolsters, trying to tear apart its loves and dreams until what is left is a shell of self-loathing, despair and disgust. One argument is the fact that suffering from mental disorders can be just as distressing as suffering from the physical illness that can lead people towards assisted suicide. The argument follows that if a person is able to make a decision autonomously, with a clear understanding of both the nature of the decision and its consequences, then their choice should be taken into consideration3.

Assisted suicide for psychiatric disorders is legal in Europe in only Belgium, Luxembourg and the Netherlands, (4) where the patient is needs to fit the criteria to have an unbearable and untreatable psychiatric disorder. One study in Belgium found that out of a sample of 100 patients seeking assisted suicide for psychological problems, the majority of patients (8) suffered from a treatment-resistant mood disorder. Both patients and relatives reported that they found euthanasia to be more humane than suicide, with a less difficult period of mourning (4).  There has been much controversy over the dramatic increase in the number of people who have chosen euthanasia due to a mental illness within the Netherlands over the past few years, rising from just 2 people in 2010 to 56 people in 2015 (5). 

One clear difficulty from this comes from the subjective terms of ‘untreatable’ and ‘unbearable.’ Can we ever be certain that a mental illness is untreatable? Many people who go through acute crisis get better, and are often relieved that they did not succeed in killing themselves in the first place (4). Indeed, the term unbearable can be described as even more subjective; what is bearable for myself may be torture for someone else. 

Yet we must also admit that despite the advances that Psychiatry has made in the last century there are people who do not respond to medications and can find such interventions to be intrusive. Furthermore, quality of life studies have shown that serious mental illnesses lead to impairments across social relationships, occupations and physical and cognitive functioning; reflecting upon our own lives, how different would we be if these things were taken away from us? It has further been argued that a clinicians’ view of quality of life can often be very different from their patients, with a greater focus on the illness and absence symptoms in comparison to a patients’ perspective of a standard of living. Some patients have described their experience of chronic mental illness as a rollercoaster of repeated relapses, psychiatric surveillance, unwanted interventions and the associated stigma (8).

Watching the video, I was struck by Sanne’s awareness of the impact such a decision would have on those closest to her. Often we are taught that one of the first sentences we should say to someone who is suicidal is ‘How do you think your family would feel?’ The thoughts that are reflected from such a question can bring someone back from the depths of utter darkness. Sanne’s words illustrate the amount of time she must have spent upon this very question: