Enlightened Compassion

"...The concept of 'unbearable suffering' has not yet been defined adequately. There are no guidelines for the management of euthanasia requests on grounds of mental suffering in Belgium."
Lieve Thienpont Belgian psychiatrist

"What is presented at first as a right is going to become a kind of obligation."
Belgian law professor Etienne Montero

"...Physicians must remain primary healers."
"Part of the problem with the slippery slope is that you never know when you are on it."
"[Reports published in JAMA Internal Medicine] seem to validate concerns about where these practices [approving euthanasia for psychiatric patients] might lead."
Bioethicists Barron Lerner and Arthur Caplan

Belgian law allows euthanasia for patients who suffer from severe and incurable distress, including psychological disorders. Credit Photograph Courtesy Tom Mortier

The growing clamour in the public arena taking place in Canada and the United States for people suffering from incurable chronic illness diminishing the quality of their lives, or those facing certain death after diagnoses of incurable conditions like metastasized cancer or Lou Gehrig's disease is steadily bringing those countries toward the legalization of assisted suicide. Canada's Supreme Court has come down in favour of assisted suicide.

And the medical profession finds itself facing a situation where the healing profession becomes the enabling profession and many physicians struggle with their moral conscience and the pledge taken when they hung out their professional medical shingle to 'do no harm'. Those who believe in the right to die, feel that a medical professional giving them assistance to leave life behind is doing no harm, but rather obliging their wishes.

Many in the medical profession, however, having dedicated their professional lives to improving the quality of life for patients, envision that to be achieving success in mitigating the ill effects of disease or chronic conditions, as much as is medically feasible. Their black bag stuffed with protocols and pharmaceuticals doesn't include drugs to stop the heart and give surcease to suffering patients.

There is suspicion from within the medical community and from the public at large as well, who don't subscribe to the positive aspects of deliberately aiding someone to die, that society, once accustomed to helping people in end-stage medical conditions to take leave of their miserable lives prematurely, will become desensitized to the issue and begin the process of extending the 'right' to people merely dissatisfied with their lives.

A clinic in Belgium served people with depression or schizophrenia and in a few instances Asperger's syndrome, who sought the solution to their problems in euthanasia. One hundred people between 2007 and 2011 reached out to doctors at the clinic for "help". The doctors in their wisdom chose to agree with 48 of that one hundred and agreed to end their "untreatable", "unbearable" conditions by lethal injection.

One of the doctors working at the clinic wrote of her experience, in a BMJ Open journal article. The clinic's operation was legal under the country's 2002 euthanasia statute which includes terminal physical illness and a growing minority of psychological issues. Nine cases of euthanasia resulting from "neuropsychiatric" disorders took place in 2004-05, and the figure rose to 120 in 2012-13.

The Netherlands decriminalized euthanasia in 2002 and right-to-die activists opened a clinic to "help" people whom their family physician refused to "help". In the year that followed euthanasia was approved for six psychiatric patients and another eleven whose complaint was that they were "tired of living".

Dr. Thienpont, working out of her Belgian clinic insisted the clinic respects patients' wishes, while stating that "further studies are recommended". The co-author of the article which was critiqued by Drs. Lerner and Caplan in JAMA Internal Medicine is an advocate of  euthanasia, Wim Distelmans. Dr. Distelmans saw nothing amiss in ending a 44-year-old's life. who was upset over a botched sex-change operation.

Nor did he see anything immoral when he put to death identical 45-year-old deaf twins who claimed to have lost the will to live when they were informed they would eventually lose their eyesight. Another man, given a 30-year prison sentence for rape and murder claimed his incurable impulses to violence and the anguish he felt behind bars qualified him for assisted death.

The irony is that in Belgium there is no death sentence for murder. Dr. Distelmans had second thoughts and decided against acting on his original acquiescence in this instance. In any event Dr. Distelmans is unlikely to face professional chastising since Belgium's Euthanasia Control and Evaluation Commission which reviews cases is co-chaired by himself. And of thousands of cases reviewed since 2002, none were referred to law enforcement.

In the socially and medically enlightened Netherlands, euthanasia accounted for one of every 28 deaths in 2013, three times the figures of 2002. In Belgium's Dutch-speaking area one of every 22 deaths was due to euthanasia in 2013 representing an increase of 142 percent since 2007. Euthanasia for children under 12 has been legalised for terminal physical illness in Belgium.

Julien Warnand—EPA Activists of the collective Yellow Safety Jacket protest against the proposed statutory amendment legalizing the euthanasia of young children, in Brussels, Feb. 11, 2014.