19 August 2018
On 4 April 1972, my mother took an overdose of pills she’d been hoarding and died alone. She was 54. The post-mortem confirmed what she already knew: she had carcinomatosis from her neck to her knees and she had anticipated her ‘natural’ death by only 2-3 weeks.
On 26 January 2018, Aurelia Brouwers, a 29-year old Dutch woman for whom voluntary euthanasia had been officially approved, took a prescribed ‘poison’ and died surrounded by her friends. She had been suffering from mental health problems since being abused as a child and had attempted suicide a number of times, including cutting her wrist so badly she’d severed the tendons. Professionals had diagnosed her as having BPD and had given her talking therapy as well as various courses of medication but her mother’s death last autumn triggered her decision: “every day is hell, I have to do this – I want to die in peace with euthanasia” she said.
The first most obvious contrast is how things have changed since 1972. At the time, I thought a lot about how I could have helped my mother and decided I could have stayed with her while she died but I couldn’t have helped her take the pills.
The other big difference is that one was suffering from physical illness and one was suffering from mental illness and there is still an implicit belief that the latter is ‘curable’, either cognitively or chemically. With a physical illness such as cancer or dementia, doctors can identify changes that have occurred in the body; with a mental illness, there is no such evidence – or even consensus amongst the professionals treating it.
Psychiatrists give names to different forms of mental illness, such as OCD and BPD but, if you ask them what’s happening to the person, you’ll get a list of the symptoms, not a scan showing a tumour or holes in the brain. Not only do psychiatrists disagree about diagnoses and treatment of mental illnesses, they don’t even agree about why we sleep. I wonder whether it would be different if something like Aurelia’s childhood abuse was found to have caused physical or neurological changes that could be ‘seen’ with a scanner?
In the Netherlands in 2017, 6,585 cases of voluntary euthanasia were approved, only 83 of which were approved on psychiatric grounds. At least one Dutch psychiatrist argues that, while there might be a case with physical ailments when someone who is no longer ‘human’ is being kept alive, mental health problems are never terminal and euthanasia then involves killing ‘healthy’ people.
In 2001, the Dutch parliament was the first in the world to legalise assisted death in certain cases so physicians can now help someone end their lives if there is “unbearable and hopeless suffering” and the patient is mentally capable of making “a well-considered request” to die. Except there’s a Catch 22: if you have dementia, you can formally record your wish to die when it takes over your life in the future but, when your dementia has advanced to the point when you would have wanted to die, you are no longer mentally fit to make that decision and you can’t; since 2012, only seven people with severe dementia died by euthanasia. So, if you have dementia, you have to die too early.
There is a view that it should be legal for the decision to be taken by someone who loves you rather than by a doctor but, while it’s easy to make the decision for yourself, it would be much harder to make the decision for somebody else.
In England and Wales, the law is much more restrictive and euthanasia is not legal. However, the Supreme Court recently decided that, if a clinical team and the patient’s family agree that it’s not in the patient’s best interests, artificial hydration and nutrition can be withdrawn from a patient with a prolonged disorder of consciousness so they can die ‘naturally’.
As long as we have the legal capacity to do so, our laws also allow us to decide to decline medical treatment, and to have our wishes respected if we lose that capacity, either by an advance decision or by appointing someone our attorney to make the decision for us, but this is not the same as taking positive steps to die.
I’m very aware that I haven’t touched on the different religious beliefs and personal convictions of different individuals and cultures but I’m already out of space so I apologise in advance to anybody who thinks I should have brought these into this summary.