Belgium: Experts call for the removal of euthanasia on the grounds of psychological suffering

This week 65 Belgian professors, psychologists and psychiatrists signed the open letter below. It has been translated from the Flemish version published in De Morgen and informed by the translation by Trodo Lemmens.

Open letter: Death as therapy?

Remove euthanasia on the ground of purely psychological suffering from the law

Ariane Bazan (clinical psychologist, Free University of Brussels), Gertrudis Van de Vijver (philosopher, University of Ghent) and Willlem Lemmens (ethicist, University of Antwerp) wrote this open letter on behalf of 65 professors, psychiatrists and psychologists.

8 December 2015

We, representatives of various relevant occupational groups, are alarmed about the increasing trivializing of euthanasia on the ground of psychological suffering only.

For the first time since the law was put into effect in 2002, a decision to allow euthanasia – the case of Dr Marc Van Hoey – has been challenged by the evaluation committee and forwarded to the judiciary. The Australian broadcaster SBS made a documentary about this euthanasia case and the conversations between the patient and the doctor. The Economist also published a poignant video report (24 and Ready to Die) on a 24-year-old young lady from Bruges who was granted euthanasia on grounds of psychological suffering, but ultimately declined its execution.

In our open letter in the Artsenkrant “Doctors’ Newspaper” (September 2015) we noted the legal uncertainty of a doctor approving euthanasia based solely on psychological suffering. In this opinion piece we want to draw attention to its specific problematic character, and in particular the fact that it’s impossible to objectify the hopelessness of psychological suffering.

One would expect that this incurability is founded on indications of for example, organic injury or tissue damage – in other words, factors that are independent of what is subjectively felt and thought about the illness. Such objectification is problematic in relation to psychological suffering.

Let’s be clear: psychological suffering is real and can be at least as severe as physical suffering. However, specific to mental suffering is the fact that you can rely only on the word of the sufferer to estimate it. And this is a good thing, because he or she is the only one who knows how much it hurts at that moment. At that moment… because when we suffer psychologically, we are often convinced that no other future is possible anymore. It is often precisely this thought that pushes a person into an abyss, because as long as there is perspective, a person can usually tolerate much.

We see that some who are at first declared incurably ill, eventually abandon the notion of euthanasia because new perspectives appeared. In a paradoxical way, this proves that the illness cannot be called incurable.

Nowadays depression is the most common mental illness: the World Health Organization estimates that one in seven people experience serious depression at some point. If we connect these figures to the fact that hopelessness is one of the central characteristics of a depressive phase, it is clear that feelings of hopelessness are not in any way in proportion to the actual hopelessness of a situation.

In contrast to illnesses that are the consequence of tissue damage, mental suffering is associated with a change in functioning – not a deterioration of tissue. This difference is essential, because such dynamic changes, by definition, can revert and do so sometimes quite suddenly. Thus we see that some who are at first declared incurably ill and granted permission to receive euthanasia on that basis, decide they don’t want euthanasia anymore because new – albeit fragile – perspectives have appeared.

In a paradoxical way, this proves that the illness cannot be called incurable. The subjective assessment of one’s own perspective with regards to mental suffering is therefore no reliable ground for making an “incurable” verdict.

The conclusion is clear: the current law assumes wrongly that there are objective clinical criteria with regard to psychological suffering that could justify euthanasia. It is for this reason that euthanasia on the grounds of psychological suffering alone cannot be regulated by law.

Some also defend the proposition that the mere offering of death as an option can lead to a positive change and that it could therefore be considered a component of good care. In our view, it automatically means the radical failure of the mental health sector. The use of ‘death as therapy’, possibly up to the actual execution of euthanasia, implies an a priori renunciation of what therapy still can and should be: the inexhaustible opening up of new perspectives.

As representatives of the various directly-involved professional groups, from different parts of the country and across classic ideological fault lines, we are alarmed by the increasing trivialisation of euthanasia on the grounds of psychological suffering alone. We believe that this situation is intrinsically linked to the fact that the law is based on subjective criteria.

Therefore we urge that euthanasia based on purely psychological suffering be removed from the current legislation.

Signatories:

• Ariane Bazan, Professor, Clinical Psychology, Free University of Brussels (ULB)
• Gertrudis Van de Vijver, Professor, Modern Philosophy and Philosophy of Science, University of Ghent
• Willem Lemmens, Professor, Ethics and Modern Philosophy, University of Antwerp
• Dan Kaminski, Professor, School of Criminology, Catholic University of Leuven (UCL)
• Pierre Mertens, Artist & Child Psychotherapist, International Federation For Spina Bifida & Hydrocephalus, NICC, Art & Society
• Marc Calmeyn, Psychiatrist, Psychiatric Hospital of Our Lady, Bruges
• Jean-Louis Feys, Senior Physician, St Bernard-Manage
• Lieven Lagae, Professor, Pediatric Neurology, University of Leuven
• Kristien Wouters, physician, Institute of Tropical Medicine
• Luc Van Melkebeke, psychiatrist and rehabilitation physician, Ghent
• Wim Galle, analyst, ex-chairman of the Society for Psychoanalysis and Psychotherapy; teaching assistant, Faculty of Psychology, University of Ghent
• Jean-Pierre Verbelen, Emeritus senior lecturer of Biology, University of Antwerp
• Herman De Dijn, Institute of Philosophy, University of Leuven
• Luc Vandecasteele, General Practitioner, GhentBjörn Waerlop, Psychologist, Psychiatric Centre, Ghent – Sleidinge
• Sarah Vande Walle, psychologist, private practice, Deinze
• Jos Vandecappelle, Retired Psychiatrist, Schilde
• Léo Claude Jadot, psychiatrist, psychotherapist, sexologist, Brussels
• Johan Taels, Professor of Ethics, University of Antwerp
• Michel Ghins, Philosopher, Université Catholique de Louvain (UCL)
• Etienne Montero, Dean of Law, Namur
• Timothy Devos, Professor, Faculty of Medicine, Catholic University of Leuven (KUL), Hematologist-internist, University of Leuven
• Filip Koken, Psychotherapist, Ghent
• Benoit Beuselinck, Professor Faculty of Medicine, Catholic University of Leuven (KUL); Oncologist, University of Leuven
• Stephan Claes, Professor of Psychiatry, University of Leuven
• André-Marie Allard, Clinical Psychologist, Legal Expert, Chairman of the Ethics Committee of the Psychiatric Hospital Beau-Vallon, Namur
• Eric Vermeer, Nurse and ethicist, lecturer at the Psychiatric Hospital Beau Vallon, Namur
• Francis Martens, Chairman of the National Federation of Psychoanalytically Oriented Psychologists
• Pat Jacops, Psychoanalysist, Ghent
• Katrien Steenhoudt, psychotherapist, psychoanalyst
• Mattias Desmet, Professor of Clinical Psychology, Faculty Psychoanalysis and Consultation Psychology, University of Ghent
• Emmanuelle Thiry, Palliative care physician, Namur
• Joachim Cauwe, Clinical psychologist, psychotherapist, Ghent
• Xavier Dijon, Proessor emiritus, Faculty of Law, University of Namur
• Gérald Deschietere, Physician, Head of Emergency Department, Cliniques Universitaires Saint-Luc, Brussels
• Imel Deboeck, Pharmacist, Haasrode
• Bea Docx, Psychiatrist, psychoanalyst, Zoersel
• Marc JM Hermans, Psychiatrist, Chief Physician, Psychiatric Hospital Bethany House, Zoersel
• Xavier de Longueville, Medical Director, Psychiatric Hospital Beau Vallon, Namen
• Tine Agon, Clinical Psychologist, Volunteer, Psycho-Social Centre, St. Alexius, Elsene
• Catherine Dopchie, Oncologist, palliative care, Tournai
• Jean-Marc Priels, Clinical Psychologist, Person-centered psychotherapist, Brussels
• Bert De Meulder, Lecturer Health and Welfare, Artesis College, Antwerp
• Ivan Wolf, Psychiatrist, Hasselt
• Etienne Dujardin, Lawyer, Brussels
• Lutgart Naudts, Home Nurse
• Danielle Hons, Palliative care Physician, Namur
• Mark Kinet, Psychiatrist, Psychotherapist, Clinic St. Joseph, Pittem
• Rodolphe Van Wijnendaele, Psychiatrist, CHIREC, Brussels
• Annemarie Makay, Psychologist psychotherapist, private practice, Bruges
• Georges Casteur, General Practitioner, Ostend
• Claire Rommelaere, University of Namur, Faculty of Law, assistant
• Peter Vuylsteke, Oncologist, Head of Service, Namur
• Anne Schaub, Assistant Psychology, Psychotherapist, Walloon Brabant, Court St Etienne
• Filip Buekens, Professor, Centre for Analytical Philosophy, Catholic University of Leuven and Tilburg Institute for Logic and Philosophy of Science (TILPS)
• Reitske Meganck, Professor, Clinical Psychology, University of Ghent; psychotherapist
• Karel Lambers, Psychotherapist, Brussels
• George Otte, Neuropsychiatrist, Chief Physician, Psychiatric Centre Dr. Guislain, Ghent
• Jacky Botterman, Oncologist, Medical Head Palliative Care, AZ St. Lucas, Ghent
• Trenson Eline, Scientific staff, University of Ghent, Department of Psychoanalysis and Psychology Consultation; Psychotherapist and Psychologist at The Doctor’s Office
• Veronique Wetzels, Nurse WZC Simeon and Hanna
• Thierry Lottin, Director Sector Psychology – CHS Clinique Psychiatrique Notre Dame des Anges, Liège
• Jean-Benoît Linsmaux, Psychiatrist, psychotherapist (private practice), Head of Service for Sleep Research and Electrophysiology GHDC – Charleroi
• Ludi Van Bouwel, Psychiatrist / psychotherapist University Psychiatric Centre, KUL, campus Kortenberg Psychoanalysis, Belgian School of Psychoanalysis
• Leen Vanoverschelde, Psychologist, Ghent