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Many people in favour of legalising euthanasia fail to consider its implications for those suffering from long term mental health conditions. Earlier this month, a woman in her 20s, suffering from several chronic psychiatric conditions, was helped to die by a doctor in Holland. The unnamed Dutch national was the victim of sexual and physical abuse, which spanned over 10 years; she was reported to have been suffering from anorexia nervosa, PTSD and chronic depression. Many who struggle with severe mental illness deal with unbearable pain, while also being subjected to futile treatments that only further diminish their quality of life. But can this ever justify medically ending their life?
In the UK, the idea of a young, physically healthy individual undergoing assisted suicide does not sit comfortably with most people. Yet last year, 56 people in the Netherlands suffering from mental illness received the lethal injection, increasing from just 11 in 2013. In 2015, 13 per cent of the Belgians who were euthanised did not have a terminal condition, and around three per cent suffered from psychiatric disorders.
Without medical intervention, it is certain many of these patients would have taken matters into their own hands: perhaps succeeding, leaving family and friends to deal with huge emotional trauma. Or perhaps failing, and possibly doing lasting physical damage which would only add to their misery.
An article in the New Yorker reported that Dirk De Wachter, an assistant professor of psychiatry at the University of Leuven, reconsidered his opposition to euthanasia after a patient whose request he had rejected set up a camera in front of an Antwerp newsagents and set herself on fire. In contrast to these disastrous outcomes, a formal process of medicalised euthanasia is not only safe but may help loved ones to understand, engage and prepare. The article went on to suggest that some physicians find euthanasia requests useful since they create an opportunity to make therapeutic interventions with patients who may not otherwise have sought medical help. And many, given time and treatment, may decide they want to live.
The interactions between autonomy, nonmaleficence and beneficence are both ancient and intricate. Discussion in the UK surrounding euthanasia for psychiatric conditions remains hypothetical – although there are stories of people in Britain receiving assessments by the Swiss clinic Dignitas, under such circumstances. This is an imaginably painful scenario for friends, family and the of course the patients themselves. And while capacious patients’ wishes are ultimately infallible, our thoughts should also go to who must carry them out. Ethics aside, any physician who approves or performs such a procedure will surely be left with lasting internal conflict – is it too much to ask of a single profession, that it both save, and take lives?
