Is Physician-Assisted Suicide Right for Severe Psychiatric Disorders?
Two summers ago, our family grabbed a bite to eat in downtown Annapolis and headed over to the Naval Academy for a parade — celebrating the end of Plebe Summer, six weeks of rigorous physical and mental training for new midshipmen.
It was late August, and I was horribly depressed, trying out medication combination No. 45 or something like that (in the last 10 years). My inner dialogue sounded like this:
- Does everyone want to be dead?
- Where do these people get the energy to function?
- I wonder if the young plebes would be excited if they had a way of dying.
- Don’t all of us just want to die as soon as possible?
- Why do we have to wait so long?
- I wish I could die today.
It was an especially black moment. I felt as though I was trapped in between a brick wall and a pane of glass, like a jail cell that kept on shrinking, suffocating me as the space grew more confining. I wanted so badly out of life that I would have done just about anything to get there. Despite my Catholic faith and my strong religious beliefs, if a physician would have offered me some barbiturates to flatten my pulse, I don’t think I would have hesitated to reach for them in desperation.
The road back to health has been uneven, confusing, and full of surprises. However, at the present moment, I’m much more focused on life — and how I can make a difference — than how to die. Just this morning I saw a group of midshipmen as I ran around the campus of the Naval Academy, and my thought was: “Those guys have so much adventure before them.”
Thank God there wasn’t a doctor available who could have helped me end it when I could not see past the black night.
In a disturbing piece awhile back in The New Yorker called “The Death Treatment,” writer Rachel Aviv tells the story of Godelieva De Troye, a Belgian woman with a severe psychiatric disorder who was euthanized by Wim Distelmans, an oncologist and professor of palliative medicine at the Free University of Brussels. He was one of the leading proponents of a 2002 law in Belgium that permits euthanasia for patients who have an incurable illness that causes them unbearable physical or mental suffering, including psychiatric disorders.
Her son and daughter weren’t notified until after her death.
In seeking to understand his mother’s death, Tom, the son, exposes the very dark side of the Belgian law, especially as it pertains to persons with depression and bipolar disorder. A week after his mother’s death, Tom emailed a psychiatrist named Lieve Thienpont, who, with Distelmans, founded Ulteam, a clinic for patients who are considering euthanasia. Aviv says in the past three years, 900 patients have come to Ulteam, half of whom complained that they were suffering psychologically, not physically.
Since Ulteam opened, in 2011, Thienpont said it has been “overrun by psychiatric patients” — a phenomenon that she attributes to the poor quality of psychiatric care in the country. In Belgium, it is not uncommon for patients to live in psychiatric institutions for years. Outpatient care is minimal, poorly funded, and fragmented, as it is in most countries. In a new book, called “Libera Me,” Thienpont urges doctors to accept the limits of psychiatry, and argues that some patients live with so much pain, their thoughts unceasingly directed toward death, that their mental illnesses should be considered “terminal.” Before approving a euthanasia request, she does not require patients to try procedures that they think are invasive. Godelieva had never had electroconvulsive therapy, though it is effective for about half of patients with depression. “Sometimes it really is too late,” Thienpont told me. “If the patient’s energy is gone, then it is not humane to say, ‘Well, maybe if you go to a hospital that specializes in your problem for two more years it will help.’ I think we have to respect when people say, ‘No — that is enough.’ ”
Euthanasia for psychiatric patients was rare in the early years of the law, but patients complained that they were being unfairly stigmatized: psychic suffering, they argued, was just as unbearable as physical pain. Like cancer patients, they were subjected to futile treatments that diminished their quality of life. Dirk De Wachter, a professor of psychiatry at the University of Leuven and the president of the ethics commission for the university’s psychiatric center, said that he reconsidered his opposition to euthanasia after a patient whose request he had rejected committed suicide. In 2004, she set up a camera in front of a newspaper office in Antwerp and set herself on fire.
Last November, when 29-year-old Brittany Maynard moved to Oregon to die on her own terms so that she didn’t have to endure the end stages of her brain cancer, we had similar discussions in Group Beyond Blue, a Facebook support group for depression.
Cynthia Schrage, a member of the group, was very upset by the injustice that Brittany’s story unearthed — that some types of illnesses are seen to be more grueling than others, and only some patients get the opportunity to be relieved of suffering. I asked her to expound on her philosophy for this blog. She wrote:
I think, if we are going to make assisted suicide an option for people, we have to make it an option for all people with serious and chronic illnesses. By denying this avenue to those who suffer from depression and other mood disorders insinuates, however subtly, that those illnesses “aren’t that bad.” I would add that it implies that these people are not capable of rational thought. While I am a firm believer that depression lies, are we really to believe that someone who has just received a diagnosis of a terminal illness that is so vile, so painful, so debilitating, and so dignity-robbing is more capable of rational thought surrounding it than anyone else?
And then she brought up Robin Williams, which I think is a valid point. “I did find the applause factor disconcerting,” Cynthia said, “when only a few months previously, the vast majority of what appeared to be those same people were wringing their hands in sadness over the death of Robin Williams. I do, in fact, find the public to be far more accepting of the indignities of cancer and the fight to prevent it than the fight to prevent suicide. I find it a bit unusual that suicide is generally vilified (or at least accepted with sadness, albeit an angry sadness), unless one plans for it well in advance.”
Cynthia, for the record, is not in favor of assisted suicide. She thinks the bad far outweighs the good. She pointed me to an excellent article in The Atlantic called “Whose Right to Die?” by oncologist and bioethicist Ezekiel Emanuel. He writes:
Most of the patients interested in physician-assisted suicide or euthanasia will not be suffering horrific pain. As noted, depression, hopelessness, and psychological distress are the primary factors motivating the great majority. Should their wishes be granted? Our usual approach to people who try to end their lives for reasons of depression and psychological distress is psychiatric intervention — not giving them a syringe and life-ending drugs.
One woman in our group rallied other members to try to recognize the courage and strength of people with depression to survive debilitating anguish day in and day out and yet continue to move forward with hope and trust that the darkness isn’t permanent. I was very moved by her words:
“Death with dignity” is such a catch-phrase right now in the media. But for those of us who suffer in our dark thoughts everyday, we are living “life with dignity.” Each day we live, and make it through, is a success. It may not be pretty. But it’s still life. So my purpose in starting this thread was to encourage and challenge those who may have struggled with the wishful thinking of ending this life (like I did), and acknowledge the life of dignity and bravery we live everyday in our suffering. Most of the “outside” world will never know. But it doesn’t matter. We know. So my friends, I’m saying this not to you, but to myself: Instead of wishing for death with dignity, how about realizing we live each day with bravery? And each day we successfully do, is a gift. Just a perspective change I realize I have to make. Perhaps it’s overly optimistic. But I have to be. I have to bring some flicker of light into my dark … And I’ll take it anyway I can!
Join ProjectBeyondBlue.com, the new depression community.
Originally posted on Sanity Break at Everyday Health.
Cat photo available from Shutterstock
Borchard, T. (2018). Is Physician-Assisted Suicide Right for Severe Psychiatric Disorders?. Psych Central. Retrieved on August 3, 2020, from https://psychcentral.com/blog/is-physician-assisted-suicide-right-for-severe-psychiatric-disorders/