Netherlands sex abuse victim granted euthanasia for “incurable” PTSD, stoking assisted suicide debate in Europe


Papers published recently by the Dutch Euthanasia Commission reportedly revealed that a woman in her twenties was allowed to go ahead with assisted suicide based on psychiatrists’ decision that her mental health condition was “insufferable,” and it was therefore illegal to deny her life-ending drugs.

The woman, who has not been identified, was sexually abused between the ages of 5 and 15, according to Britain’s Independent.

Multiple reports cited the documents published by the Commission as stating the post-traumatic stress disorder (PTSD) the woman suffered due to the abuse was “incurable,” enabling the approval under Dutch law of her request for euthanasia.

The Telegraph reports that the young woman was not an isolated case, and in fact, the rate of approved assisted suicides in the Netherlands for patients suffering from mental disorders has increased dramatically since the procedure was first made legal.

In 2010, only two people were granted euthanasia due to “insufferable” mental conditions, while The Telegraph said that number rose to 56 in 2015, according to the documents released by the Commission.

In remarks likely to cause even greater concern for foes of assisted suicide in Europe, one of the psychiatrists who grants approval for the procedure based on mental illness at the Netherlands euthanasia clinic told The Telegraphshe believes doctors are still “too hesitant” to give the nod in such cases.

The psychiatrist, Paulan Starcke, was due to give a speech — entitled “Condemned to live with unbearable psychiatric suffering, or allowed to die?” – on Thursday at a conference on euthanasia in Amsterdam.

Euthanasia was legalized in the Netherlands in 2002, and the procedure has seen a significant rise in the country since then, with people from across the world traveling to its End-of-Life clinic.

Euthanasia begins in California as Gov. Brown unleashes population control ‘right to die’


It’s now legal in California — a state that abhors the death penalty for violent criminals, child molesters and rapists — to kill yourself or, more specifically, to request death and actually have it carried out.

California

As reported by MarketWatch, Gov. Jerry Brown said that this law would now give terminally ill people the right to make such requests of doctors who would then do what doctors were never intended to do — take a life.

In a signing letter, Brown claimed he consulted with two groups of people who supposedly hold the sanctity of life paramount — doctors and Catholic bishops — while reflecting upon his own death.

“I do not know what I would do if I were dying in prolonged and excruciating pain,” Brown wrote. “I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn’t deny that right to others.”

“The crux of the matter is whether the state of California should continue to make it a crime for a dying person to end his life,” Brown continued, as quoted by CNN, “no matter how great his pain and suffering.”

How profound and “compassionate” — and this, from yet another liberal who promotes a culture of death while being utterly stumped about why mass murders continue to occur in our country.

Growing the “culture of death”

Then there is the hypocrisy, as noted by Citizens Against Assisted Suicide, an organization opposed to the law.

“As someone of wealth and access to the world’s best medical care and doctors, the governor’s background is very different than that of millions of Californians living in health care poverty without that same access,” said the coalition, adding that it is “reviewing all of its options moving forward.”

“These are the people and families potentially hurt by giving doctors the power to prescribe lethal overdoses to patients,” the group stated.

The culture of death was not lost on Daniel Payne, who, writing in The Federalist, notes that the country has a “deepening love affair” with death in all its forms.

“From California comes yet another plank in the death brigade’s never-ending demands for more death. California is now the fifth state to permit doctors to help kill their patients by prescribing them lethal overdoses of drugs: Oregon, Montana, Washington, and Vermont already allow it,” he wrote. “California’s passage of the law means that, in 10 percent of American states, it is legal for a doctor to knowingly help destroy his patient’s life.”

Law filled with ironies

But it wasn’t enough for lawmakers to simply legalize suicide; the law is layered with many ironies. For one, Payne says, it expires in 10 years, as if suddenly, in a decade’s time, assisted suicide will no longer be necessary or relevant (what do California lawmakers know that the rest of us don’t?).

Also, “suicidal patients must make three requests for the deadly prescription (once in writing with two witnesses present), and they must sign a form a couple of days before they kill themselves,” Payne writes.

According to Democratic State Sen. Bill Monning, these are “protections” built into the law. Oh.

“Kill yourself with our blessing,” lawmakers seem to be saying, but you only have 10 years to decide and to ascertain whether or not you’re really, really, really sure.

Where is all of this heading? If The Netherlands is any indication, it’s not good. That country decriminalized euthanasia about 10 years ago, and now, Payne reports, nearly one-third of suicide requests are from people who are just “tired of living.” Turns out when suicide is made legal and accessible, more people will choose it.

In our own country, the scandal involving Planned Parenthood’s illegal profiting of baby body parts is also feeding a growing culture of death, one in which both the mainstream media and Democrat politicians are complicit; the former through its non-reporting, and the latter, through their denials.

 

Belgium approves child euthanasia.


Opinion polls suggest broad support for the law, as Duncan Crawford reports

Parliament in Belgium has passed a bill allowing euthanasia for terminally ill children without any age limit, by 86 votes to 44, with 12 abstentions.

When, as expected, the bill is signed by the king, Belgium will become the first country in the world to remove any age limit on the practice.

It may be requested by terminally ill children who are in great pain and also have parental consent.

Opponents argue children cannot make such a difficult decision.

It is 12 years since Belgium legalised euthanasia for adults.

In the Netherlands, Belgium’s northern neighbour, euthanasia is legal for children over the age of 12, if there is parental consent.

Conditions for child euthanasia

  • Patient must be conscious of their decision
  • Request must be approved by parents and medical team
  • Illness must be terminal
  • Patient must be in great pain with no treatment available to alleviate their distress

Under the Dutch conditions, a patient’s request for euthanasia can be fulfilled by a doctor if the request is “voluntary and well-considered” and the patient is suffering unbearably, with no prospect of improvement.

‘Immoral’ law

One man in the public gallery of Belgium’s parliament shouted “murderers” in French when the vote was passed, Reuters news agency reports.

Supporters of the legislation argue that in practice the law will affect an extremely small number of children, who would probably be in their teens, the BBC’s Duncan Crawford reports from Brussels.

The law states a child would have to be terminally ill, face “unbearable physical suffering” and make repeated requests to die – before euthanasia is considered.

Parents, doctors and psychiatrists would have to agree before a decision is made.

Protesters have lobbied politicians against the changes.

Church leaders argued the law is immoral.

“The law says adolescents cannot make important decisions on economic or emotional issues, but suddenly they’ve become able to decide that someone should make them die,” Brussels Archbishop Andre-Joseph Leonard, head of the Catholic Church in Belgium, said at a prayer vigil last week.

Some paediatricians have warned vulnerable children could be put at risk and have questioned whether a child can really be expected to make such a difficult choice.

Last week 160 Belgian paediatricians signed an open letter against the law, claiming that there was no urgent need for it and that modern medicine is capable of alleviating pain.

But opinion polls have suggested broad support for the changes in Belgium, which is mostly Catholic.

Belgian MPs to debate extending euthanasia laws to under-18s and Alzheimer’s patients.


The country already has some of the most relaxed laws on medically-assisted suicide in the world.

 

Belgium is set to debate this week whether or not it will extend its laws allowing euthanasia to include children and those suffering from long-term “diseases of the brain” like Alzheimer’s.

 

The country already has some of the most relaxed rules in the world when it comes to helping people who are suffering to take their own lives, and lawmakers could be about to push those boundaries even further.

Since 2002, any adult in Belgium who is signed off by two doctors as undergoing “unbearable psychological or physical suffering” can consent to be killed, most commonly by an injection of a lethal combination of drugs. Assisted suicides reportedly now account for around 1 per cent of all deaths.

Under the bill being considered, this could be extended to those under 18 if they requested it, their parents gave their consent, and where an expert psychologist deemed the child to fully understand the implications of their decision.

“This is very important because one child that suffers is one too many,” Jean-Jacques De Gucht, MP for the Open Flemish Liberals and Democrats party, told the Sunday Times.

“It’s about giving people the right to choose how and when to end their life in dignity,” he said.

According to the newspaper, a recent poll suggested that more than two-thirds of the Belgian public back the new laws.

Under the proposals, medically-assisted euthanasia would also be offered as an option to those suffering from Alzheimer’s disease.

Once diagnosed and while still lucid, they would be able to consent to being killed when their illness progressed to the point where doctors decided they were no longer interacting with society – even if on the surface they appeared to be happy and well.

In Europe only Belgium, the Netherlands and Luxembourg have laws which allow for euthanasia in extreme circumstances. In Switzerland and Germany, doctors can prepare the necessary lethal injection but the patient must administer it themselves.

Supporters of the euthanasia bill say it would simply be bringing under legal control something which already happens anyway. Studies have shown that, with terminally ill children whose parents are begging for their suffering to be brought to an end, doctors have been steadily increasing doses of painkillers until they reach lethal amounts.

Dr Dominique Biarent, who runs the intensive care unit at a Brussels children’s hospital, told the Wall Street Journal that this does happen, though rarely, and only ever at the initiative of the child’s parents.

“Our goal is to cure,” she said. “It never happens that we’re pushing parents. We never say, ‘This morning we’re doing euthanasia—yippee!’ It’s a terrible process.”

The Belgian law has come under renewed international focus when a man chose to die last week after he said a failed sex change operation turned him into “a monster”.

Belgian transsexual helped to die


Belgian helped to die after three sex change operations.

Generic undated photograph of hospital syringes.
Cases of recorded deaths from euthanasia on psychological grounds have risen in Belgium.

A transsexual has been helped to die by doctors in Belgium, after a series of failed sex-change operations.

Nathan Verhelst, born a girl, asked for help to end his life on grounds of psychological suffering. He died in a Brussels hospital on Monday.

Two doctors concluded the 44-year-old did not have temporary depression. His case received scant media coverage.

Belgium legalised euthanasia in 2002. There were 52 cases of euthanasia on psychological grounds last year.

‘Rigorous procedure’

“He died in all serenity,” doctor Wim Distlemans told the Belgian newspaper, Het Laatste Nieuws.

Nathan Verhelst was born Nancy into a family of three boys. The newspaper, which said it had spoken to him on the eve of his death, reported that he had been rejected by his parents who had wanted another son.

He had three operations to change sex between 2009 and 2012.

“The first time I saw myself in the mirror I felt an aversion for my new body,” he was quoted as saying.

The hospital said there was an “extremely rigorous procedure” in place before any patient was put to death. “When we have a case which is… complicated, we ask ourselves more questions in order to be certain about the diagnosis,” Dr Jean-Michel Thomas said.

Uncontroversial

The BBC’s Matthew Price in Brussels says the number of people opting for euthanasia in Belgium has risen steadily since legalisation. Most candidates are over 60 years old and have cancer.

Voluntary euthanasia for those over 18 is relatively uncontroversial in Belgium. Parliament is now considering expanding the law to under 18s as well.

Patients must be capable of deciding for themselves. They must be conscious and have to give a “voluntary, considered and repeated” request to die.

There were 1,432 recorded cases of euthanasia in Belgium in 2012; a 25% increase on the previous year’s figure. They represented 2% of all deaths, the AFP news agency reported.

Physician-Assisted Suicide.


John Wallace is a 72-year-old man with metastatic pancreatic cancer. At time of diagnosis, the cancer was metastatic to his regional lymph nodes and liver. He was treated with palliative chemotherapy, but the disease continued to progress. Recently he has become jaundiced, and he has very little appetite. He has been seeing a palliative care physician and a social worker on an ongoing basis. His abdominal pain is now well controlled with high-dose narcotics, but the narcotics have caused constipation. In addition to seeing the social worker, he has also been seeing a psychologist to help him to cope with his illness.

Mr. Wallace has been married to his wife, Joyce, for 51 years, and they have three children and six grandchildren. He and his wife have lived in Salem, Oregon, for the past 23 years, and most of his family lives nearby. He understands the prognosis of the disease, and he does not wish to spend his last days suffering or in an unresponsive state. He discusses his desire for euthanasia with his wife and family members, and they offer him their support. The next day, he calls his physician and asks for information about physician-assisted suicide.

TREATMENT OPTIONS

Do you believe that Mr. Wallace should be able to receive life-terminating drugs from his physician? Which one of the following approaches to the broader issue do you find appropriate? Base your choice on the published literature, your own experience, and other sources of information.

To aid in your decision making, each of these approaches is defended in the following short essays by experts in the field. Given your knowledge of the patient and the points made by the experts, which option would you choose? Make your choice and offer your comments at NEJM.org.

  • Option 1: Physician-Assisted Suicide Should Not Be Permitted
  • Option 2: Physician-Assisted Suicide Should Be Permitted

 

 

OPTION 1

Physician-Assisted Suicide Should Not Be Permitted

J. Donald Boudreau, M.D., Margaret A. Somerville, A.u.A. (pharm.), D.C.L.

We recognize that a patient in Mr. Wallace’s situation is in a state of grief. We appreciate his desire to be of sound mind at the end of his life and not to have to suffer as death approaches. We also recognize the obligations of physicians to respect a patient’s refusal of treatment, to relieve pain and suffering, and to provide palliative care. However, we believe that the art of healing should always remain at the core of medical practice, and the role of healer involves providing patients with hope and renewed aspirations, however tenuous and temporary. Within the realm of palliative care, there exists a well-recognized paradox that one can die healed.1 Physicians have a duty to uphold the sacred healing space — not destroy it. Therefore, physicians must hear Mr. Wallace’s request for death but never carry it out.

Supporters of physician-assisted suicide justify their position by placing the value of individual autonomy above all other values and ethical considerations. Giving individual autonomy absolute priority runs roughshod over competing values, protections, and needs and ignores the harmful effects on other people, societal institutions (the medical profession in particular), and the general community.

Permitting physician-assisted suicide creates a slippery slope that unavoidably leads to expanded access to assisted suicide interventions — and abuses. Advocates of euthanasia deny that slippery slopes exist, arguing that legal constraints and administrative safeguards are effective in preventing them. But the evidence is clearly to the contrary, as the High Court of Ireland recently affirmed. In upholding the constitutionality of the prohibition on assisted suicide, the justices wrote, “. . . the fact that the number of LAWER (`life-ending acts without explicit request’) cases remains strikingly high in jurisdictions which have liberalised their law on assisted suicide . . . speaks for itself as to the risks involved.”2 Vulnerable communities in our societies — persons who are old and frail and those who are disabled or terminally ill — perceive themselves to be threatened.3Physicians must not be willfully blind to these serious dangers.

Many aspects of physician-assisted suicide breach physicians’ long-standing ethical norms. For instance, the 2011 annual report on the Death with Dignity Act in Oregon shows that physicians were present at fewer than 10% of “assisted deaths.”4 Why might they want to disconnect themselves from what they have enabled? Perhaps they have a moral intuition that intentionally facilitating or inflicting death is wrong. Patients expect an empathic presence from their physicians, and authentic healers commit to accompanying patients throughout the illness trajectory.

Referring to physician-assisted suicide as “treatment” is a new rhetorical tool that is used by the advocates of euthanasia. The goal is to make assisted suicide seem less alarming to the public and to promote the idea that legalizing the practice is just another small step along a path already taken and ethically approved. By intentionally confusing physician-assisted suicide with legitimate palliative care, pro-euthanasia advocates hope that the public will conclude that it is a medically and ethically accepted end-of-life treatment.5

For palliative care to remain a healing intervention, it cannot include “therapeutic homicide.”6Euthanizing and healing are intrinsically incompatible. Involvement of physicians in such interventions is unethical and harms the fundamental role of the doctor as healer.

 

 

OPTION 2

Physician-Assisted Suicide Should Be Permitted

Nikola Biller-Andorno, M.D., Ph.D.

To many of us — physicians and nonphysicians alike — death appears as a menace, as something we fear and want to avoid at all cost. At the same time, most of us know someone for whom death has come as a relief. These deaths were sometimes long-awaited or they were actively sought out, prepared for in secrecy, and endured alone. For those persons, the opportunity to ask a competent professional for assistance in ending their lives in a legally and socially accepted way would be a clear improvement. Mr. Wallace is fortunate that this is an option in the state in which he lives and that he can discuss it openly with his family and his physician.

The role of physicians is not simply to preserve life but also to apply expertise and skills to help improve their patients’ health or alleviate their suffering. The latter includes providing comfort and support to dying patients. Such patients may, after careful consideration, come to the conclusion that in their particular situation, asking a physician for assistance in suicide best reflects their interests and preferences. Responding to such a carefully considered request can be compatible with the goals and ethos of medicine, as well as with a trusting patient–physician relationship.

There is broad consensus about the importance and desirability of palliative medicine and hospice care, and physician-assisted suicide is in no way a repudiation of those practices.7 Yet in some cases, symptoms cannot be sufficiently controlled; in many other instances, what is at stake is a perceived loss of autonomy and dignity.8 Some patients wish to proactively shape the end of their life; to those patients, taking action to end their life is better than passively waiting for death to occur.

Physician-assisted suicide is now legal in a number of states in the United States, including Oregon and Washington State, as well as in Switzerland and in the Netherlands. The data from these places show that the implementation of physician-assisted suicide, when it is accompanied by certain safeguards (including comprehensive screening and informed consent processes), does not lead to uncontrolled expansion or abuse. In Switzerland, the number of assisted suicides has risen steadily over the past decade, but the total number of suicides has declined.9 The data from Oregon and Washington show that the majority of persons who request physician-assisted suicide are white, educated men — not a population that would be considered particularly vulnerable. Also, only a minority of persons who inquire about suicide assistance actually complete the process; this indicates that the option is perceived as a choice that can be abandoned.10

Even in societies with broad public support for physician-assisted suicide, a certain uneasiness and ambivalence remain, particularly among physicians who have to carry the emotional burden and moral responsibility of having enabled someone to end his or her life.11,12 The decision to provide suicide assistance cannot be forced on physicians but needs to be left to their individual conscience. However, if a physician is prepared to respond to a request for assistance in suicide, there are no compelling ethical reasons not to allow that physician to do so. In any case, careful regulation, comprehensive monitoring, and an ongoing critical debate are required to ensure that physician-assisted suicide remains a choice that is based on caring relationships among the patient, the family, and health care professionals.

 

Source: Nejm