Assisted Death and Mental Health – An Unnamed Woman’s Story

The Dutch Euthanasia Commission recently revealed that last year, in the Netherlands, an unnamed woman was granted a death by euthanasia because of suffering brought on by a mental health condition. For people outside the Netherlands, where the debate about assisted death for people with mental conditions is just beginning, it’s a controversial story.

Content Warning: Suicide, sexual abuse, assisted suicide, euthanasia

Yellow caution tape against a black background. Keyword: assisted death

Image Description: Yellow caution tape against a black background.

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The young lady in question was 22 years old. She’d been sexually abused from age 5 to 15. Metro UK reports that she had “Post Traumatic Stress Disorder, chronic depression and severe anorexia” and “hallucinations and compulsions.”

Doctors declared her mental health conditions “incurable”, and the suffering that they caused her “unbearable”, and on this basis she was granted the right to the death by euthanasia that she requested.

There’s a lot to unpack here. I understand why, in light of what we know about this young woman’s condition, suicide looked like an option for her. I don’t understand why she was granted an assisted death and I’m not sure that I agree, based on the information that I’ve been able to find, that she should have gotten one.

“Assisted Death”, “Assisted Suicide”, and “Euthanasia”

Let’s get a matter of terminology out of the way. I will use “assisted death” in my discussion in this piece because while we tend to use “assisted suicide” as a catch-all for several types of death in which a doctor is involved, in the Netherlands “assisted death” has a particular meaning and isn’t interchangeable with “euthanasia”.  In Dutch law, a physician prepares a lethal injection for an “assisted suicide” but does not administer it.  The physician administers the injection during “euthanasia”. Media sources are quite clear that that this young woman was euthanized.  I think it’s important, for clarity, to use a third term to speak generally about the assisted death debate…on the one hand.

On the other hand, for the purposes of this discussion, the distinction doesn’t really matter: the fact that any kind of assisted death was approved for a chronic psychiatric condition is dicey even in the Netherlands. It requires evaluation by two specialists, one of whom must be a psychiatrist, and both of whom must agree that the applicant is “incurable” and experiencing “unbearable suffering.” Dutch doctors are somewhat reluctant to make these declarations about mental conditions. (Pg 14)

So there’s *that*.

Thoughts on Suicide Generally and Assisted Death Particularly

I don’t like the idea of people committing suicide, of course, but, bodily autonomy – you have a right to do what you want to your body, regardless of how I feel about it. I’ve been suicidal. I don’t think that I truly wanted to die, just as I think that most people considering suicide don’t truly want to die. I think that they’re people in tremendous pain that want it to stop and that suicide sometimes looks like the only option. That’s part of what makes suicide so sad – if you take that option, not aware that there are there are others or that you can access others, or lacking confidence in the efficacy of other options or your ability to use them effectively, or simply to worn out to give a damn, you can’t change your mind.

But I also think that there’s a very small number of people who have truly decided that they want to die, who have thought it through with a clear head and who fully understand the consequences, and whose unclouded reasoning shows when evaluated by professionals. They want a dignified death that’s under their control, perhaps with loved ones around them, where they don’t have worry about something going wrong and traumatizing loved ones being beyond the grief of the death itself. I can respect that. I support that. I think that there needs to be safeguards around the right to access it, but I think that the access should be there.

People who request an assisted death are generally terminally ill, but not always.

They don’t have to be in the Netherlands.

They won’t have to be in Canada, if the legislation proposed in 2015 is passed as presented.

This woman wasn’t, although she may have died eventually if she’d not found a way to manage her anorexia.

Cause for Caution

There are good reasons to consider assisted death legislation that doesn’t have terminal illness as a criteria, but these are good reasons to  approach it cautiously, too.  Three major concerns come out of this story for me:

  1. Granting assisted death on these declarations sets a dangerous precedent, not just for people with mental conditions, but for disabled people in general. Many  disabled people are (rightfully) concerned about assisted death legislation and the potential for people to make assisted death decisions of behalf of disabled people based on perceptions of what living as a disabled person must be like. What if this young woman had not sought an assisted death, but had ended up in the hospital because of the anorexia, and doctors had deemed her “incurable” and her suffering “unbearable” and put a DNR on her? It wouldn’t be the first time a disabled person had a DNR put in them without their consent in a hospital.
  2. I was an emotional mess to varying degrees until my early twenties. When I finally got on the right meds, and with good therapy on a regular basis, things started to turn around, even as I was adjusting to the major life changes brought on by my surgery and stroke – I’m uncomfortable with doctors throwing around the word “incurable” for a 22-year-old, especially since she’d experienced temporary improvement with intensive therapy. And I’m not a certified counselor, but I know women and men who experienced long-term sexual abuse in childhood. After a lot of therapy and hard work they haven’t forgotten, but are able to live with it as they go about their full, fulfilling lives. What a tragedy if, still in the thick of it at the young age of 22, they’d asked for an assisted death and a doctor had deemed them “incurable”!
  3. I was anorexic and severely depressed when I a teenager, and I remember my thought processes at the time. I couldn’t trust my perceptions on anything, not just because of the lens of  body dysmorphia and depression through which I viewed everything, but because my body was just so malnourished. I  can believe that this woman had convinced herself that she wanted to die and that she maybe even could have presented some cogent-sounding arguments in favour of giving her an assisted death. But do I believe that someone with  active PTSD, severe anorexia, depression, compulsions, and hallucinations was able to look clearly and objectively about whether she truly wanted to die? I wasn’t there, I didn’t talk to her, I’m not a doctor. I’m not saying she couldn’t. But I think that it’s reasonable to question whether she really could.

However.

When Treatment Doesn’t Work

Again, I didn’t know this girl. I don’t know what she went through in those 10 years. I don’t know what kind of work she did to get better since the abuse ended. Maybe she tried every kind of therapy she could get her hands on, and nothing made any lasting difference.

I do know that for some people, medications and therapy don’t work for depression. They try drug after drug, and they keep trying new therapists, trying to find one that they click with, and some even try electroshock therapy, and nothing makes a difference. I imagine myself at my worse, depression-wise, trying everything that I can, and feeling more and more discouraged when nothing seems to work…that would literally be hell on earth. Add PTSD to that, and the physical problems that anorexia causes, and I get it. I get what she’d ask for something drastic.  I won’t – I can’t – judge her asking.

Again, Caution

But the fact that she was deemed “incurable” at a very young 22 years when there still could have been so much about her state of mind influencing that decision and she *had* shown some improvement relatively recently makes me think that it was too early to give her what she wanted. And it’s cemented for me the vague feeling of discomfort that I’ve had around the legislation in Canada’s assisted death law, that allows people to make a request based on mental health conditions.

I’m not well when I’m deeply depressed. I can’t trust what my brain is telling me about my life. I need laws (and people that work with them) that work as much as possible with my survival instincts in those times, not against them.

To be clear: I am not suggesting that people with mental conditions lack the capability or capacity to make important life decisions, even when feeling very unwell. That is simply untrue. Each case is individual, and I can only speak for myself. I am just calling for caution. When it comes to assisted death, we need to proceed with caution, and make sure that everyone who needs protection is protected – including the people that may need protection from themselves.

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