The current issue of the medical journal BMJ Open has a disturbing article on the euthanization of people who have mental illnesses. The authors are Belgian psychiatrists whose conception of what it means to be a mental health professional departs significantly from my own. Drs. Lieve Thienpont and Wim Distelmans have certified that suicidal people as young as 24 years old can ethically be put to death under the country’s euthanasia law because their psychiatric disorder (e.g., depression) causes “unbearable suffering”.
The argument for why this policy is compassionate runs as follows. Mental illnesses can make life extremely stressful, sad and challenging. Sometimes treatment helps only a little or not at all. If someone in such a situation wants to end it all, isn’t it therefore a kindness for the physician to step in and put the person to death painlessly and professionally rather than risk a suicide attempt that is painful or is botched?
Well, no, actually. Anyone who has treated people with psychiatric disorders knows that suicidal thoughts and impulses are nearly normative in the population. Many psychiatric patients say things like “I don’t see the point in living”, “I hate my life”, “I wish I had never born” etc., and they really mean it….right up to the point when they don’t. Every mental health professional knows people who have been miserable for years and are now doing well and very much want to be alive. Here is a concrete example, from John Colapinto’s recent New Yorker profile of my colleague Karl Deisseroth. Karl is treating a patient who is anonymized as “Sally”:
Sally, now in her sixties, had suffered since childhood from major depression, and had tried the standard treatments: counselling, medication, even electroconvulsive therapy. Nothing helped. She had spent much of her adult life in bed, and had twice attempted suicide. Seven years ago, she was referred to Deisseroth, who uses a combination of unusual medications and brain stimulation to treat autism and severe depression.
On Deisseroth’s advice, a surgeon implanted beneath Sally’s left collarbone a small, battery-powered device that regularly sends bursts of electricity into the vagus nerve, which carries the signal into a deep-brain structure that doctors think regulates mood. Originally developed for epilepsy, vagus-nerve stimulation has been approved by the Food and Drug Administration for use in the kind of treatment-resistant depression from which Sally suffers, but the exact reason for its effectiveness is not understood. Sally says that VNS has transformed her life, and that, apart from one period of “going pancake,” she has experienced just a few “dips.”
Drs. Thienpont and Distelmans might argue that this is an unfair example: A new treatment is being employed and there’s no way anyone could have predicted that Sally would be so helped by it. But that is precisely the point: It’s always very hard to predict the course of a person’s illness and even moreso the course of their life. No matter how sure Dr. Thienponts and Distelmans may subjectively feel that a psychiatric patient has a life of unending misery in front of them, they are going to be wrong at least some of the time.
A defender of the Belgium law might retort that safeguards are in place to ensure that the decision to euthanize isn’t just based on one psychiatrist’s opinion. Chuck Lane demolishes that rebuttal by pointing out that the committee which is charged with making sure that people like Dr. Distelmans do not engage in unethical euthanasia is co-chaired by…Dr. Distelmans.
An irony struck me as I re-read the Calapinto’s profile of Karl Deisseroth: “He accepts only patients for whom all other treatments have failed.” Drs. Thienpont and Distelmans say the same thing of themselves. If you or your loved one had a serious, hard to treat psychiatric disorder, which doctor would you want to see?