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Thursday 24 July  
Euthanasia still a taboo for mental patients - even in the Netherlands
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Ede, Netherlands
Ede, Netherlands

Euthanasia still a taboo for mental patients - even in the Netherlands

Published on : 26 November 2009 - 5:33pm | By NRC International
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People suffering from an incurable mental disease have the same legal right to euthanasia as physically terminally ill patients in the Netherlands, but they almost never get it.

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By Karlijn van Houwelingen for NRC International

 
A 66-year old woman suffering from depression told her psychiatrist, Cornelis van Houwelingen, she intended to throw herself in front of a train. She had tried to kill herself before. Van Houwelingen had treated the woman for 15 years and tried every possible treatment, to no avail. The woman was suffering intolerably, he said, and could not be helped. So he finally gave her a lethal drug.

Van Houwelingen's decision is rare among psychiatrists. The Dutch law that legalised euthanasia in 2002 also applies to the mentally ill, but psychiatrists have so far been extremely reluctant to resort to assisted suicide.

Two cases in 2008
Of the 2,331 cases reviewed by the regional euthanasia review committees in 2008 only two involved psychiatric patients. All doctors are obligated to report assisted suicides to the committees, who then investigate if all the legal requirements were met.

"Psychiatrists have a holier-than-thou attitude," Hans van Dam, a nurse and a teacher, said at a symposium organised by the Right to Die-NL foundation in the Dutch town of Ede on Monday. The taboo on assisted suicide for mental patients needs to be broken, Van Dam argued. "To put it bluntly: cancer will kill you in a matter of years, but schizophrenia is forever."

"The suffering of psychiatric patients can be just as intolerable as many forms of physical suffering," said Eugène Sutorius, a professor of criminal law and a former president of the foundation.

At Monday's symposium many attendees had horror stories about people who ended up killing themselves in the most atrocious ways after their treating psychiatrist refused to help them. "At some clinics they will say right away: we don't do that here," according to Van Houwelingen. And suicide attempts are not always successful, said Sutorius, "leaving people to go through life even more damaged than before."

"If euthanasia wasn't such a delicate subject I would be tempted to bring it before the disciplinary tribunal," added Sutorius. "Doctors have a duty to discuss this if patients have a death wish and there is no treatment available."

Guidelines
Sutorius estimates 200 to 300 patients each year ask their psychiatrists for assisted suicide. He stressed that patients always have to be encouraged to pick up their lives again, "but we're talking about a small group of people for whom this no longer makes sense. Most psychiatrists will readily acknowledge that a solution needs to be found for these people, but they're afraid to do anything about it."

According to Van Dam, many doctors are afraid that assisting some patients with suicide will create a precedent for other patients. And many psychiatrists are also unaware of the Dutch Psychiatry Association's guidelines on the subject, added Sutorius.

The guideline says "any request for assisted suicide by a psychiatric patient should first be interpreted as a request for life help. Accordingly the treatment should be directed towards finding a new life perspective." But it also says assisted suicide can be "ethically and medically responsible behaviour" in extreme cases where the patient is suffering "hopelessly and intolerably" and there is no other "reasonable solution".

But most of the time, said Sutorius, "psychiatrists just don't want to do it. They're afraid of the paperwork, they're afraid of being prosecuted and they're afraid of death. Sometimes they're afraid their own treatment of the patient was wrong, and in case of assisted suicide that treatment would become part of the report."

Ferdi Keppels, a lay counsellor, asked the symposium to show some understanding for the position of the psychiatrists. "It is all too easy to leave it to the psychiatrist. I personally know a psychiatrist who was all in favour of euthanasia, but who found it terribly difficult when he asked to do it."

Sutorius is hoping for a change of culture at the psychiatric clinics will change. He suggest making it obligatory for psychiatrists to report and motivate why they declined a patient's request for assisted suicide."I don't want to see psychiatrists dragged into court," he said, "but I do want them to make their case."

The author is not related to Cornelis van Houwelingen.

Discussion

Anonymous 7 February 2013 - 4:58am / North America

I am PROUD of my Dutch ancestry! However, the laws there are still too conservative on voluntary euthanasia. No government should have the power to deny an individual the right to a peaceful death, regardless of the individuals reasoning!!!

Having the audacity to claim that you, your government, or your society is compasionate, while at the same time FORCING people that are suffering horribly to continue suffering...is PURE EVIL. If there is justice in the universe, then the people who have prolonged the suffering of others because of their FALSE beliefs of altruism or monetary gain, those people will suffer FAR worse than those that denied rest to. May you enjoy your eternal suffering...at least the sick will only have to suffer through this lifetime, and no longer be at the hands of ignorance and greed!!!

alicewonderland42 28 February 2010 - 6:05am

I read about Cornelis van Houwelingen's case on a Dan Manson blog. He was strong: to be able to kill a person, when you actually became a doctor so you can save people... This is a hard job. I, personally, wouldn't have the courage to do it.

Anonymous 23 December 2009 - 4:38pm / Sri lanka

I am someone who suffers from depression. I want to leave the world. It is not the weather that causes depression. It is just the environment of the earth. Only elite people can be happy. I am a poor person. I wanted to be a pilot and other things but cant do it due to financial reasons. I see no purpose in living like this. The suffering is intolerable. Assisted suicide would be a blessing. Better than living a frustrated life. I support the sale of suicide kits and euthanasia.

jasmin 23 December 2009 - 5:57pm / India

Dear Anonymous from Sri Lanka, I understand your frustration and depression very well. But you need not despair, good times will come, if you open your self up to existence and have faith in yourself and God. You are very wrong in presuming that elite people are happy; they are the unhappiest people on earth for riches are not of the banks but of the mind and spirit. You can be as happy and productive as you want to be, if you are in a positive frame of mind. Negative thoughts beget negativity and hopelessness. Dear friend, please look again at the riches, God has given you: your body, your life, family, friends, dreams and above all- Hope. Hope of a better future. Please look at your life's goal in a positive way. Make new goals that are achievable and within your financial reach. Small success will boost you up and lead to bigger successes. And success attracts positive pople and you will find new ways to fulfil your dreams. Have patience and faith in yourself and God. Do not think of ending life. It is the most beautiful gift of God, cherish it and be grateful to Him for other gifts as well. I am always there to support you with my prayers. God bless you with all you desire.....A sister from India

Anonymous 15 February 2012 - 10:32pm / United States

Dear Jasmin from India (and all the other bible-thumpers I see trolling the internet), your irrational argument that "only god can give a life; only god can end it again" is EXACTLY why there are still so few real medical options for quality health-care -- the still-pervasive and unfounded arguments delivered by delusional spiritualists building public policy off their supposedly "miraculous" hallucinations. For the love of Darwin this is the 21st century already. Stop telling people how -- or whether! -- to live their lives based on this holy-roller crap. There's no reason to continue suffering in this world simply because "there are the riches of the lord waiting in the next one." There's not even any concrete proof of intelligent life on other planets, never mind angels and gods and Dante's Inferno, oh my. Considering the number of idiotic "Jeebus loves you" responses I read commenting on articles about euthanasia, abortion, and other health-care procedures that seemingly run afoul of long-held B.S. church traditions, though... I wonder just how much intelligent life we have on this planet either.

Probably the reason it isn't legal to "do away with" the mental defects of our society is because the churches, mosques, and temples would all be empty and the rosters go down to zero.

jasmin 29 November 2009 - 3:06pm / India
Dear Anonymous from Netherlands, I fully understand your point. I work in a charitable mental institute here at Amritsar. We have 1302 inmates who are destitutes or are suffering from various mental disorders. They have been abandoned by the very families who should have treated them with compassion. However, the point of discussion is euthanasia for these patients. I beg to disagree as our patients here are well looked after by a very compassionate staff, and the doctors have never felt the need to take that extreme step for them. I hope the same is true in Netherlands. However, I do find that the grey skies and little sunshine in Holland has a lot to do with deep depression in your country. It has been proved scientifically that weather affects the mind. For visiting our institute please follow this link: http://www.pingalwaraonline.org/....thanks
anonymous 27 November 2009 - 1:09pm / globe
Hiram, it seems, the Dutch want only productive citizens in their country.They don't want to serve diseased, miserable and depressed people. That's why euthanasia and suicide helping organisations exist here.It is a scary place...
Hiram 26 November 2009 - 6:34pm / USA
"A 66-year old woman suffering from depression told her psychiatrist, Cornelis van Houwelingen, she intended to throw herself in front of a train.".....Is depression classified as a "mental disease"? Why would another state " The woman was suffering intolerably, he said, and could not be helped. So he finally gave her a lethal drug."? Stupid logic! When a person is depressed, he or she is not in the state of mind to make a sound decision. { Don't you understand that a mental patient doesn't fully understand the consquences of his or actions. This is why people who have mental problems are not held accountable for murders they commit. There are medications, besides lethal drugs, to overcome depression.
girlnterrupted 26 February 2010 - 1:43pm / USA

Hiram, you seem to be quite ignorant when it comes to depression. The woman in question had been depressed for YEARS; her psychiatrist had treated her for 15 years with as many medications as he was able to, and she did not respond to anything. What "state of mind" are you talking about? You mean someone who is suffering is not in the state of mind to decide what to do with their lives? That's like saying that a cancer patient is in so much pain that he is not in a state of mind to decide to request assisted suicide. The SOLE reason these people are seeking euthanasia is because they're in unbearable pain, whether physical or mental/emotional. If that's not a good "state of mind" then so be it, but they'll never be in any other state of mind because they arrive at euthanasia after trying everything else. What do you suggest? That they suffer forever because they can't be healthy enough to decide to be killed? Lol. Sounds ridiculous, but that's really what your post suggests.

And btw, people who commit crimes aren't necessarily those who are clinically depressed, so that's a pretty bad analogy. Those people (serial killers, rapists, etc) have other mental illnesses. hope this HELPS.

Anonymous 29 November 2009 - 12:45pm / Netherlands
You obviously have never suffered withdepression. Years of trying different medications, different therapies with no relief. Not everyone with depression responds positively to medication(s). There is a point in time when the patient finally says enough is enough and the suffering is intolerable. Better assisted with lethal drugs that then trauma to everyone with jumping in front of a train, off a bridge, hanging.......

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