Friday, July 24, 2015

Study: 100 requests for euthanasia for psychiatric reasons in Belgium.

Alex Schadenberg
By Alex Schadenberg
International Chair - Euthanasia Prevention Coalition

The British Medical Journal (BMJ) published a "study" on July 28, 2015 examining 100 requests for euthanasia for psychiatric reasons in Belgium. 

Four of the six authors of 
the study are connected to the euthanasia clinic in Belgium.

Wim Distlemans operates the euthanasia clinic in Belgium, and Lieve Thienpont, Kurt Audenaert, Peter P De Deyn work with the euthanasia clinic. 

Distelmans has been connected to many of the high profile euthanasia deaths, including Godelieva De Troyer, the mother of Tom Mortier.

Thienport is the psychiatrist who approved the euthanasia death in the recent story of "Laura" the 24-year-old physically healthy Belgian woman who lives with suicidal thoughts. 

Thienport was the psychiatrist who examined the 100 people who requested euthanasia for psychiatric reasons. 

Link to a Youtube video of Thienport speaking about the study.

The stated objectives of the study are: 
first, to report on characteristics of psychiatric patients requesting euthanasia because of psychological suffering; and second, to describe the formal assessment procedures and outcomes of the euthanasia requests. To the best of our knowledge, this is the first study to explore the determinants, procedures and outcomes of euthanasia requests in a relatively large group of psychiatric patients with psychological suffering.
The objectives of this study should state: 
this study was written to justify lethal injection for people who are healthy but living with psychological suffering in Belgium. 
It is possible that Distelmans and Thienport designed the study in defense of the practice of euthanasia for psychiatric reasons after receiving complaints.

What did the study find?

The "study" examines 100 consecutive requests for euthanasia at a psychiatric out-patient clinic between October 2007 and December 2011. The analysis of the data closed in December 2012. The data states:
  • 77 euthanasia requests were made by woman, 23 were men,
  • of the 48 approved requests, 35 died by euthanasia, 
  • 1 died by palliative sedation (sedation with withdrawal of water),
  • the average age was 47,
  • 58 were depressed, 50 had a personality disorder,
  • 12 were autistic, 13 had post traumatic stress disorder, 11 had anxiety disorder, 10 had an eating disorder, and more
The study begins by promoting the "safeguards" in the Belgian euthanasia law and explaining how the safeguards for euthanasia for psychiatric reasons follows tighter guidelines. The first section of the study takes pains to convince the readers that euthanasia is carefully done in Belgium.

It then examines the data from the reported euthanasia deaths indicating that the number of reported euthanasia deaths has been increasing in Belgium from 742 (2004/2005) to 2086 (2010/2011). Belgian statistics indicate that there was a 26% increase in euthanasia deaths in 2013.

The study suggests that an increase in reporting of euthanasia, a requirement of the Belgian euthanasia law, may be reflected in the increased number of reported euthanasia deaths.
"This rise over a 6-year period may reflect a true increase or better reporting of cases of euthanasia."
A recent study in the New England Journal of Medicine (NEJM) (March 19, 2015) found that euthanasia represented 4.6% of all deaths in the Flanders region of Belgium in 2013, while the official reports indicate that euthanasia represented 2.4% of all deaths in the Flanders region of Belgium in 2013.

When comparing the NEJM (March 2015) data (Jan - June 2013) from Flanders Belgium to the data in a previous study that was published in the BMJ (November 2010) (June - Dec 2007) from Flanders Belgium, it appears that the percentage of unreported euthanasia deaths is statistically unchanged between 2007 (47%) and 2013 (49%).

Last year, Dr Marc Cosyns, a Belgian euthanasia doctor, admitted that he does not report his euthanasia deaths. With nearly half of all euthanasia deaths not being reported one can safely conclude that the "safeguards" in the Belgian euthanasia law are often ignored.

The study continues to suggest that the Belgian euthanasia law is careful. The study states:
Legally, the physician is required to discuss the wishes of the patient with the relatives named by the patient. Consent from the relatives is not required, and the attending physician needs the patient’s permission to inform family members of the euthanasia request.
This statement may be a response to complaints by families. Tom Mortier was shocked when his depressed mother died by lethal injection, and her family was not informed of her impending death.

People with disabilities are more likely to die by euthanasia for psychiatric reasons.

Of the 100 requests for euthanasia for psychiatric reasons, 81 of them were not employed (8 were retired, 73 were receiving disability allowances or retired early), 14 were working or on a temporary leave, 1 was a student, 1 was in prison, and 1 was on welfare. Primarily, these were people with disabilities who are receiving a disability allowance

The study does not examine whether the person also had physical disabilities but it indicates that people with disabilities disproportionately die by euthanasia for psychiatric reasons.

Euthanasia as "treatment" for psychiatric reasons:

The study states that:
  • 38 people who requested euthanasia for psychiatric reasons were referred for further testing. Out of these, 17 of them were approved for lethal injection and 10 died by euthanasia.
  • 62 people who requested euthanasia for psychiatric reasons were not referred for further testing. Out of these, 31 were approved for lethal injection and 25 died by euthanasia.
  • 35 of 48 people who were approved for lethal injection died by euthanasia. The 13 people, in this group, who did not die by euthanasia, 8 changed their mind, 2 withdrew their application based on family response, 2 died by suicide and 1 was in prison.
  • 65 people did not die by euthanasia. By the end of 2012, 57 were alive, 48 of the 57 cases were on hold based on the person receiving therapy or not needing therapy, 9 of these cases the euthanasia request was still being considered.
  • of the 35 people who died by euthanasia for psychiatric reasons, 14 of them were lethally injected by a doctor at the euthanasia clinic.
The authors should have collected more data about the 57 people who were alive at the end of 2012. Since the study was published in July 2015 and since all of the participants were patients of Lieve Thienpont, therefore further information would have been available and helpful.

Psychological suffering?

The study concludes by pointing out that the concept of "unbearable suffering" is subjective and undefined. The study states:
A literature review made clear that the concept of ‘unbearable suffering’ has not yet been defined adequately, and that views on this concept are in a state of flux. It is generally accepted that this concept is considered to be subjective, dependent on personal values, and that it must be determined in the first place by the patient.
Unbearable suffering for psychological reasons is even more subjective and undefined, as stated by the study:
Unfortunately, there are no guidelines for the management of euthanasia requests on grounds of mental suffering in Belgium.
This "study" has was done by members of the euthanasia movement. All of the requests for euthanasia were made by people who were patients of Lieve Thienpont, a psychiatrist who works with Wim Distlemans at the euthanasia clinic.

This may be the first study to examine the experience with euthanasia for psychological pain, but it is also a study that appears to have been done to create more acceptance of euthanasia for psychiatric reasons.

1 comment:

Audrey Laferriere said...

It never really occurred to me that "relevant others" would encourage a patient to do euthanasia. If that is not a criminal crime, then it should be.

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