Kevin Yuill - Assisted Dying: A failure of Psychiatry.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Kevin Yuill

Kevin Yuill, who is an academic who has written extensively about euthanasia and assisted suicide wrote an interesting article that was published by Spiked titled: Assisted Dying: A failure of Psychiatry.

In his article, Yuill comments on the death of Aurelia Brouwers, the 29-year-old Dutch woman who died by euthanasia for psychiatric reasons and the research by Fabian Stahle, from Sweden, uncovering hidden problems with the Oregon assisted suicide law.

Yuill comments on Brouwer's death:

Brouwers had carefully planned her death – in her pyjamas, listening to Hugh Laurie, with her beloved pink T-Rex cuddly toy, Dido – ‘[he] has been my support since I was four-years-old’, as Aurelia put it. She asked her parents to care for Dido, who is to get ‘a spot on the coffin’ at her funeral. 

Brouwers told an interviewer: ‘I think that after such a rotten life I am entitled to a dignified death – people who have a serious illness get a chance for a worthy ending, so why is it so difficult for people who are psychologically ill?’

• 29-year-old Dutch woman scheduled to die by assisted death for psychological reasons. 

Yuill asks the question: at what stage do psychiatric professionals admit defeat and sanction the death of a patient? Yuill states

In the Netherlands as it stands, nine per cent of requests for euthanasia due to ‘unbearable’ and ‘hopeless’ psychological suffering are granted, although it is rare that the patients are as young as Brouwers. Brouwers had decided long ago that her treatment was not working and that her suffering was too great to bear. And her doctors eventually gave her the green light. But when is psychological suffering deemed ‘unbearable’? When is it adjudged ‘hopeless’? These seem to be incredibly subjective criteria.

Yuill challenges the UK assisted dying group Dignity in Dying who have stated that Brouwers would not qualify for assisted death based on the proposed UK legislation.

In the UK, Dignity in Dying and other campaigners for assisted dying insist that cases like Brouwers’ could never happen under their proposed legislation. Citing assisted-dying legislation in Oregon, they claim that similarly ‘robust safeguards’ would be implemented in the UK, preventing cases similar to Brouwers’. 

But, if assisted dying is legalised, is it realistic to expect ‘autonomy’ and ‘compassion’ to be reserved only for those who suffer from life-shortening physical diseases? Although Dignity in Dying denies it, assisted-dying laws are always extended beyond their original justifications. Indeed, in every nation where euthanasia has been legalised, the parameters in which assisted dying is permitted eventually always stretch beyond those with ‘less than six months to live’.

Yuill comments on the recent research by Fabian Stahle, into the Oregon assisted suicide law based on the proposed safeguards in the UK as being similar to the Oregon assisted suicide law:

Stahle had asked the Oregon Health Authority whether a diabetic person who was only dying because they refused treatment would qualify for an assisted death. The OHA’s answer was a straight ‘yes’, and it admitted that this had always been the case. 

Indeed, Oregon oncologist Dr Charles Blanke noted a difficult case regarding a young woman with Hodgkin’s lymphoma who had a 90 per cent chance of survival with treatment but refused it. Blanke acceded to her demand for an assisted death, despite the fact she was likely to lose potentially ‘seven decades’ of life. Opportunities for self-induced terminal illness are numerous. Anyone with anorexia nervosa, for example, can bring themselves to a terminal condition, thus qualifying for an assisted death in Oregon. 

... In Oregon, for example, pain does not figure in the top five reasons why citizens choose assisted death. Instead, it is fear that dominates the reasoning of those seeking to end their lives: fear of not being able to participate in enjoyable activities; fear of loss of autonomy; fear of loss of physical capabilities; fear of loss of dignity; and fear of being a burden. Fear, however, is curable, even if the underlying physical condition is not.

• Oregon Health Authority reveals hidden problems with the Oregon assisted suicide model.

Yuill ends his article by recognizing how legalizing assisted suicide corrupts society:

... But when society legalises assisted dying, it surely corrupts the fundamental belief in the value of life that underlies all medical treatment. Compassion in the past meant doing what we felt was best for a patient. It meant disagreeing with a suicidal patient who felt her life was worthless. Today, compassion seems to mean respecting someone’s requests, even when we don’t feel that those requests are in his or her best interests. As Brouwers declared in her blog in January: ‘Respect that I will die Friday.’ 

Brouwers’ sad case is a grim reminder that a society that sanctions suicide is a society that has given up on certain people. It is a society that has lost its moral bearings. An individual may lose all hope and may feel that life is no longer worth living. She may even take her own life, and there is little we can do to prevent that. But, surely, if a fellow human being expresses the wish to die, we must be loyal to her life, not her wishes.

Kevin Yuill teaches American studies at the University of Sunderland. His book, Assisted Suicide: The Liberal, Humanist Case Against Legalisation, is published by Palgrave Macmillan.