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Jeanne Smits, Paris correspondent

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Study lays out complications of ‘death with dignity’ in Belgium

Jeanne Smits, Paris correspondent

August 18, 2015 (LifeSiteNews) -- A study published recently in the British Medical Journal sheds light on the practice of euthanasia of patients with psychiatric disorders in Belgium, as seen by medical specialists who intervene in the process. The findings are chilling: of the 100 cases studied – all mentally ill patients who requested euthanasia in recent years – 48 led to acceptance of the requests, and "mercy killing" took place for 35 patients in total. In all cases, the patients were not otherwise gravely ill, and they were certainly not in a terminal condition.

The study's main author, Lieve Thienpont, had a key role insofar as she was personally responsible for conducting interviews with the 100 psychiatric patients in Flanders who had already made their death wish known, in order to confirm their diagnosis and to evaluate their degree of suffering, which under Belgian law must be "unbearable" and "untreatable." She is the author of a book aimed at the general public, Libera me, about psychiatric suffering and euthanasia published earlier this year; she is also the psychiatrist who gave Laura, 24, a healthy woman with suicidal thoughts, a positive opinion for euthanasia. Her case was discussed here by LifeSiteNews.

As a "LEIF" doctor, Lieve Thienpont is part of a Life End Information Forum, which trains doctors with regard to the Belgian euthanasia law, palliative care, and end-of-life decisions in Flemish Belgium and Brussels. She has been practicing in this capacity since 2007.

Other authors of the BMJ study include pro-euthanasia law practitioner Tony Van Loon, who is Thienpont's life partner, as well as Professor Wim Distelmans, who has been actively involved in Belgium's most controversial euthanasia cases.

This explains that the study is in no way critical of the practice of accepting euthanasia for mentally ill patients so long as they are deemed capable of making an independent and fully informed decision.

Roughly 3 percent of all euthanasia requests over the period covered by the study – from October 2007 to December 2011 – emanated from patients with psychiatric disorders. The BMJ study followed the first 100 consecutive requests over that period: be it for implementation of euthanasia, suicide, death by other means, or the decision to shelve the request, they were followed up on only to the end of 2012. Seventy-seven of the cases were women, and the mean age of the patients was 47, in contrast with "ordinary" euthanasia cases that concern about as many men as woman at a mean age of 60. Belgian law explicitly allows euthanasia to be performed on the mentally ill as long as the "substantive and procedural criteria" are met.

These include informing the patient about palliative care, which is of little use to psychiatric sufferers, and judging whether an effectual treatment can be found. Typically, almost half (48%) of the requests were accepted. In all these cases, Lieve Thienpont, "in discussion with the patients' other practitioners and families, considered the requests to be based on reasons that were sufficiently tangible and reasonable, and because all legal requirements had been fulfilled," says the article in the British Medical Journal.

Of the patients thus encouraged to die, most suffered from a "treatment-resistant mood disorder" (58 percent), including 48 with "major depressive disorder." This clearly indicates that they were suicidal because of their depression; obtaining euthanasia in their case would simply mean that their illness served as an excuse for ending their lives, and that doctors had found no way of alleviating their despair. This is profoundly disturbing: did not the patients really need spiritual guidance, medication, or life-orientated counseling that was not forthcoming?

Other mental illnesses – any one patient could receive up to three diagnoses – included bipolar disorder (10 percent), a personality disorder (50 percent), post-traumatic stress disorder (13 percent), schizophrenia and other psychotic disorders (14 percent), anxiety, eating disorders, Asperger syndrome (12 percent, often not diagnosed before the euthanasia request was assessed), autism, and even substance use disorders (10 percent).

The study's authors underscore that while 48 requests were accepted, only 35 led to euthanasia over the considered period: 2 of the 48 patients committed suicide because of the lengthiness of the procedure. A further 8 decided to postpone or cancel the euthanasia procedure because, they said, "knowing they had the option to proceed with euthanasia gave them sufficient peace of mind to continue their lives," a fact that, according to the study's authors, argues in favor of accepting euthanasia requests.

But the majority did choose to die. Of the remaining three, 2 chose to withdraw their request because of "strong family resistance," and in one case the patient was imprisoned and euthanasia could not take place for that reason.

The percentage of acceptance could have been higher. "Among the 52 patients whose requests were not accepted, 38 withdrew their requests before a decision was reached," says the study. Eight continued to pursue their requests; 2 "died spontaneously." The case of a woman who died after "palliative sedation in a psychiatric hospital" is included in these "spontaneous deaths."

At the end of the period under scrutiny, 57 patients (12 men and 45 women) were still alive. Nine of the requests were still in process. But "in 48 cases, their requests were on hold because they were managing with regular, occasional or no therapy," the study points out. This means that these mentally ill patients who at one point in their lives were seeking to die could live on without their death wish with therapy, and in some cases even with little or no therapy. How many of the patients who did obtain euthanasia might have lived on in the same way?

The conclusions reached by the authors are no less significant. The authors mainly regret that "the concept of 'unbearable suffering' has not yet been defined adequately, and that views on this concept are in a state of flux." While the concept of "unbearable suffering" is "considered to be subjective, dependent on personal values, and … must be determined in the first place by the patient," psychiatrists involved with euthanasia requests are asking for "guidelines" that will help them through "ongoing fierce ethical debates." It is more a question of moving responsibility on to official authorities than of finding ways and means to avoid mentally ill patients to be rushed to their deaths, often at an early age and otherwise healthy.

The study also underscores the "serene and positive" atmosphere in which the majority of euthanized patients died, mostly in their own homes (28), sometimes in a "clinical setting," and "with family and/or friends present" in 30 cases. In a few cases, tension grew because the patient's family had problems with the situation, and in one case, the doctor was "inexperienced and became overwhelmed and stressed by the situation."

Overall, euthanasia is presented as a "more humane death than suicide," in an atmosphere of serenity that "would have been impossible to attain in the case of unassisted, traumatic suicide."

The argument for euthanasia of the mentally ill as a clean or sanitized alternative to ugly, dramatic, dirty, disruptive suicide has been put forward both in Belgium and the Netherlands, where it is legal. The logic behind the argument is much the same as that which tries to justify legal abortion as opposed to unsafe backroom abortion. It deliberately misses the point: is it acceptable to kill a human being, all the more so because he or she is fragile and suffering, in order to hide the pain?

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