Criminal Case Spurs a Rethink of Euthanasia for Mental Illness

The recent launch of a criminal investigation into a case of medically assisted death for psychiatric illness in Belgium is shining a spotlight on growing concerns — even among supporters — about the controversial practice.

The charges, which are reportedly the first criminal investigation of medically assisted euthanasia in that country since it was legalized in 2002, are related to the 2010 death of a 38-year-old woman with Asperger syndrome, a mild form of autism.

As reported by the Associated Press, the charges stem from alleged “irregularities” in the procedure, which include a doctor asking the patient’s father to hold the needle in place while the lethal injection was administered.

The family has also reportedly questioned the patient’s diagnosis of Asperger syndrome, suggesting instead that she was suffering from depression due to a recent breakup.

If convicted, the three doctors involved, who have been accused of “poisoning” the woman, could face a maximum penalty of life in prison.

Among them is Lieve Thienpont, PhD, a prominent advocate for medically assisted death, who is estimated to have been involved in about one third of the approximately 10,000 assisted deaths that have taken place in Belgium since euthanasia was legalized.

There are also broader accusations that Thienpont and others have too easily granted requests for assisted death for mental illness, prompting calls to rethink the entire process.

One online petition, entitled “Review Euthanasia Law for Psychic Suffering (REBEL), has 476 signatures, including those of 253 clinicians. The petition calls for an “ethical reflection” of the law among all involved parties.

“We call for tightening the criteria for psychic suffering, and to allow a commission to judge the case beforehand or preferably remove from the law ‘unbearable and hopeless psychic suffering’ as a criterion for euthanasia. This would be a life-giving initiative,” the petition states.

Unreliable Patient Evaluation

These concerns were echoed in an editorial published in 2018 in the New England Journal of Medicine by psychiatrist Joris Vandenberghe, MD, PhD, of University Hospitals and the University Psychiatric Center KU Leuven in Belgium.

“The current systems in Belgium and the Netherlands fail in terms of reliable patient evaluation, at least in psychiatric illness,” he writes.

While supporting the idea that “rational suicidality” is conceivable even in the presence of mental illness, Vandenberghe notes that medically assisted death for mental illness can be an ethical practice “only if enough guarantees are in place that it truly is a last resort.”

“Inconceivably,” he notes, even the assessment required for deep brain stimulation (DBS) for mental illness is more rigorous than for medically assisted death.

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https://www.medscape.com/viewarticle/909233