“Psychological Suffering is Never Trivial” (translation response letter)

This is a response to the letter by Johan Braeckman et al., which itself was a response to a letter by Ariane Bazan et al.. in which the authors argued that the Belgian legislator ought to remove the option to request euthanasia purely on the basis of psychological suffering. This response was published in De Morgen on 14/12/2015

(Google translation was used for a rough basis, and I corrected the text based on my own knowledge of Dutch–my mother tongue)

Psychological Suffering Is Never Trivial

Ariane Bazan (Prof Clinical Psychology ULB), Gertrudis van de Vijver (Prof Philosophy, University of Gent), Willem Lemmens (Prof Philosophy, University of Antwerpen), Maarten Van Dijck (Prof Epistemology & History of Science, University of Gent), Jasper Feyaerts (Clinical Psychologist, University of Gent)

“Don’t trivialize psychological suffering,” Johan Braeckman and others write in response to our open letter, and this is about the best possible outcome we could have expected. It is the very essence of our argument.

We must, however, qualify the distinction objective/subjective as put forward in the response by Braeckman and others. Psychological suffering is obviously a subjective experience, that is clear, but a mental illness is always more than just subjective. The way the illness relates to objective factors is different than in the case of physical disorders. There is no tissue damage, no detectable degradation process in the brain: you cannot see in an autopsy if someone had a depression or not, which you can, for example, in the case of dementia.

But, contrary to what our critics suggest, brain scans do show changes, for example when someone suffers from depression. What is important is that these changes are functional and dynamic: what they show depends on when the scan is taken. They don’t have the irreversible character of tissue damage. Herein lies the fundamental difference with the subjective suffering in the case of physical ailments: you can objectively determine an irreversible process that underlies this suffering.

The person who plunges into a depression falls prey to a real feeling of lack of perspective. Clinical and research experience show, however, that even a succession of major depressive episodes doesn’t imply that the suffering is hopeless.

Suppose someone says, “I have failed in all areas of my life, professional, personal, familial,” and the therapist thinks otherwise on the basis of various specific elements that the patient previously mentioned. Is the only way to avoid being paternalistic or pedantic to simply respond to this patient: “Yes, You are right.”? No, the therapist will both respond to the reality that the patient experiences while also gently suggesting other angles. Clinical care is empathic, indeed, but it is also thoughtful empathy, which involves a gentle invitation to entertain a different perspective. Here, clinical ethics requires to be receptive to the feeling of hopelessness and to acknowledge it, without abandoning the ethical duty to also explore the horizon of other options.

Not trivializing psychological suffering means precisely this: taking account of its uniqueness. The course of a cancer is indifferent to the way the oncologist listens and speaks. Research shows that with mental problems, the relationship between patient and therapist is a decisive factor for the success of the treatment. That constitutes the fundamentally different reality of mental illness. The patient who suffers psychologically is fundamentally attached to the words of the therapist, while the cancer does not care about what the oncologist says.

This brings us to the crux of the ethical basis of the euthanasia legislation: the centrality of the value of autonomy. Testimonials from euthanasia cases involving patients with purely psychological suffering indicate that patients sometimes ask at the last minute: “You are sure, doctor, aren’t you, that nothing more can be done to help me?” Or “You really can confirm that my disease is incurable, isn’t it doctor? ” (see for example the case of Christophe, Knack, 10.22.2014).

This shows how the will of the patient is neither purely autonomous, or undivided, nor unambiguously expressed. In order to recognize the autonomy of a patient, you have to take into account how the will is divided and always probes what the other wants. The patient becomes far more articulate when she is empowered to explore the broad spectrum of her will, with the support of the therapist who continuously invites her to do so. The role of the therapist is in other words never that of a neutral expert who merely confirms the patient’s choice.

Obviously, this problem presents itself in the context of every euthanasia request, but in the context of physical conditions there is an unambiguous limitation as a result of objectively determinable irreversibility. This crucial containment factor is missing here. We are therefore concerned about how the law assigns a position of medical expert to the doctor in the context of issues that primarily concern interpersonal relations. The debate about euthanasia on grounds of mental suffering alone cannot be settled simply by referring to the virtue of diligence and the value of autonomy. Moreover, it is precisely because of the importance of autonomy as a core value that we have to be very careful with how we assign in our legislation an exceptional position to experts.

Even those who are deeply concerned about the right to self-determination should be sensitive to these concerns.


“Don’t Trivialize Psychological Suffering” (translation response letter)

This is a translation from Dutch of a Response by Johan Braeckman et al. to an Open Letter Ariane Brazan et al. re Belgian Euthanasia practices in the context of psychological suffering, published in the Flemish-Belgian newspaper De Morgen 8/12/2015. (see also the translation of the response by Ariane Brazan et al. to this letter, published in De Morgen 9/14/2015)

Don’t Trivialize Psychological Suffering (De Morgen 11/12/2015)

Johan Braeckman (Prof Philosophy University of Gent), An Ravelingien (Ethicist, Bioethics Institute Ghent), Maarten Boudry (Philosopher, University of Gent))

In an open letter, dozens of academics and health care providers voice their concerns about the regulation concerning euthanasia in the context of unbearable mental suffering (DM, 8/12). This concern is undoubtedly well intentioned but nonetheless misguided. The letter writers demand “objective” evidence of the irreversibility of psychological distress, such as an “organic injury or tissue damage.” They expect “factors that are independent of what is subjectively felt on the disease and is thought.” They wan to eliminate euthanasia based on “purely psychological suffering” from the current legislation. Particularly the word “merely” is very significant here.

We believe it is a misconception that only in cases of so-called physical suffering euthanasia is “responsible”. The demand to make suffering (and pain) “objectifiable” is a strange form of positivism and scientism. Do we have to ignore the repeated and clear testimony of people’s psychological suffering and not take it seriously as long as we cannot establish it scientifically? Do we address the ultimate request for help only when a brain scan demonstrates the suffering? The letter writers fail to appreciate not only the professional competence of doctors and therapists who establish the diagnosis, but they also want to turn the clock back by decades, by declaring patients incapable of expressing themselves about the nature and intensity of their suffering.

Hopeless suffering

Of course, suffering is subjective. How else could it be? If a person suffers, he or she is obviously the only one who can reasonably assess this experience. Suffering belongs to a subject. To ignore this subjective dimension showcases a lack of empathy. The letter writers’ comment that they are “alarmed by the increasing trivialisation of euthanasia on the grounds of psychological suffering” is therefore questionable.

In an interview with Bart Schols in The Appointment (8/12), Ariane Bazan, one of the initiators of the letter, refers to an article and the book by psychiatrist Lieve Thienpont, “Libera me: About euthanasia and psychological suffering.” The work of Lieve Thienpont apparently convinced her that euthanasia for psychological suffering must again be banned. That’s remarkable, since the book by Lieve Thienpont makes it precisely all too clear how hopeless the situation is of those who request euthanasia for reasons of psychological suffering. These are people who one often has tried to help for many years, with all the means that medicine and psychological support services have to offer. Some of these patients are so desperate that they commit suicide, with sometimes terrible and dehumanizing consequences.

Do the letter writers really think that the legislator, and the doctors who are willing to meet some (!) requests for help, tread so lightly with the request to bid farewell to life in a dignified manner? That they are not aware of the potential of various therapies and of the strict conditions for euthanasia in cases of psychological suffering? Precisely because psychological suffering is harder to measure, and a specific group of patients is not terminally ill, the legislator has added two additional criteria of good care for these patients to a euthanasia request: a second opinion by a psychiatrist and a minimum waiting period of one month.

The letter writers stick to a general discussion about the “feeling of hopelessness” that people experience when they are depressed, which for them is “in no way proportionate to the real hopelessness of a situation.” But obviously, not everyone with a depression qualifies for euthanasia without further therapeutic intervention. That is obvious. In practice, it concerns in our country about fifty people per year, a tiny fraction of the number of people going through a depression.

The letter writers’ dismissal of the hopeless suffering of this small group of people as “purely subjective”, a feeling that is an inherent part of depression, not only illustrates a lack of empathy; it also amounts to a paternalistic reflex: “You think you suffer hopelessly, but we know better. ” Incidentally, acute depression (eg. through a grieving process) usually interferes with the statutory requirement of voluntariness. In most cases of request for euthanasia, it involves other mental disorders, sometimes in combination with long-term chronic and treatment-resistant depression.

The false distinction between physical and psychological suffering

For the letter writers, the idea that the prospect of death can be part of good care amounts to “the radical failure of the mental health care sector”. This remarkable statement was a few decades ago still an often-heard objection in the euthanasia debate, also in the context of physical suffering, “Death is the enemy of medicine; when a physician reliefs someone from his misery, it means the failure of medical care.” Since then, we have come to know better. Unfortunately, the suffering of some patients is so unfathomably deep, that granting their request for an assisted medical and painless death remains the best thing the health sector has to offer. Ariane Bazan and her co-authors are apparently of the opinion that psychiatric patients’ treatments never end. That comes down to the idea that mental patients have no right to refuse treatment, which is completely contrary to the law on patients’ rights.

The euthanasia legislation is based on some fundamental philosophical principles related to a dignified end of life, in which empathy and self-determination are key. We see no good reason why patients who suffer unbearably psychologically, as unambiguously recognized by competent physicians and in line with the legislation, should be taken less seriously than those who are identified as suffering from a supposedly “objective physical” cause. By the way, people with an incurable physical illness also experience mental suffering. If we follow the logic of the letter writers, one can therefore contest the “unbearable” nature of each euthanasia request, which is a violation of the autonomy and therefore the dignity of any patient requesting euthanasia. The vast majority of caregivers today are not precipitating, nor was the legislator in 2002.

Johan Braeckman (hoogleraar wijsbegeerte, Universiteit Gent)
An Ravelingien (ethicus, Bioethics Institute Ghent)
Maarten Boudry (wetenschapsfilosoof, postdoctoraal onderzoeker, Universiteit Gent)
Etienne Vermeersch (gewezen voorzitter van het Raadgevend Comité voor Bio-ethiek)
Wim Distelmans (prof palliatieve geneeskunde, VUB)
Paul De Knop (Rector, VUB)
Wouter Duyck (opleidingsvoorzitter psychologie, Universiteit Gent)
Freddy Mortier (ethicus, UGent)
Marleen Temmerman (buitengewoon Hoogleraar, Universiteit Gent)
Gwendolyn Rutten (voorzitter Open Vld)
Jacinta De Roeck (gewezen senator en voorzitter van LEIF Antwerpen)
Serge Gutwirth (Professor mensenrechten, VUB)
Tony Van Loon (emeritus moraalwetenschappen, Vrije Universiteit Brussel)
Jean-Jacques Amy (Emeritus Hoogleraar Gynaecologie-Verloskunde, Vrije Universiteit Brussel)
Sonja Snacken (Professor criminologie, Vrije Universiteit Brussel)
Peter Paul De Deyn (Neuropsychiater, Hoogleraar, Universiteit Antwerpen en Groningen)
Paul Destrooper (bestuurder LEIF, Forum Palliatieve Zorg en Zuster Leontine Fonds)
Geert De Soete (Decaan Fac. Psychologie en Pedagogische Wetetenschappen, UGent)
Rik Schots (Professor Hematologie UZ Brussel)
Thierry Vansweevelt (Hoogleraar Medisch recht, Universiteit Antwerpen)
Jean Paul Van Bendegem (filosoof VUB, Brussel)
Marina Van Haeren (algemeen directeur deMens.nu en secretaris-generaal Centraal Vrijzinnige Raad)
Frank Schweitser (Ma Wijsbegeerte & Moraalwetenschappen, Verpleegkundige,
W.E.M.M.E.L. expertisecentrum ‘waardig levenseinde’)
Edel Maex (Psychiater, Ziekenhuis Netwerk Antwerpen)
Sylvain Peeters (psycholoog en voorzitter van deMens.nu)
Patrik Vankrunkelsven (docent huisartsgeneeskunde, KULeuven)
Peter Deconinck (emeritus hoogleraar kinderchirurgie, VUB)
Piet Hoebeke (professor, Voorzitter Medische Raad, Vakgroepvoorzitter Uro-Gynaecologie, Diensthoofd Urologie, UZ Gent)
Mario Van Essche (voorzitter HVV en advocaat, Putte)
Gert De Nutte (algemeen coördinator Humanistisch-Vrijzinnige Vereniging)
Franky Bussche (directeur Studie en Onderzoek deMens.nu)
Guy Peeters (arts, Voorzitter Socialistische Mutualiteiten)
Anne-France Ketelaer (jurist en adjunct-algemeen directeur van UVV/deMens.nu)
Marjan Joris (coördinator De Maakbare Mens vzw)
Frank Christiaens (Anesthesioloog – Urgentiegeneesheer, LEIF-arts)
Stefaan De Smet (lector psychiatrische verpleegkunde en onderzoeker forensische psychiatrie, Hogeschool Gent – Vrije Universiteit Brussel – Universiteit Gent)
Bea Verbeeck (Psychiater-psychotherapeut Brussel)
Liesbet Lauwereys (coördinator De Maakbare Mens vzw)
Gwen Verbeke (LEIF-arts, Palliatief arts-geriater AZ Jan Portaels, Vilvoorde)
Magali de Jonghe (lid van de Federale Controle Commissie Euthanasie, lid RvB LEIF W-VL en vrijzinnig humanistisch consulent huisvandeMens Brugge)
Andrea Thienpont (onthaalmedewerker LEIF GENT)
Mia Fermon (partner van Koen, twee jaar geleden overleden door euthanasie)
Benneth De Proft (bestuur Vonkel en LEIF Antwerpen)
Jacqueline Herremans (advokaat, voorzitster association pour le droit de mourir dans la dignité, lid van de Euthanasie commissie)
Robert Gosselin (radioloog – UZ Gent)
Reinier Hueting (huisarts, LEIFarts, Geraardsbergen)
Ann Staels (klinisch psycholoog, Vonkel)
Tino Ruyters (directeur vzw Free Clinic, Antwerpen)
Robert Schurink (arts, directeur Nederlandse Vereniging voor een Vrijwillig
Marc Tourwé (hoogleraar Universiteit Antwerpen, faculteit Toegepaste Ingenieurswetenschappen)
Christine Demeulemeester (psychotherapeut, Aalst)
Patrick Wyffels (leifarts, huisarts in Halle-Zoersel)
Winne Caemaert (Osteopate)
Jan Bernheim (Professor em. End-of-Life Care Research Group, Faculty of Medicine, Vrije Universiteit Brussel)
Guido Pennings (hoogleraar Bioethics Institute Ghent)
Heidi Mertes (ethicus UGent)
Dirk Demuynck (uitgever)
Brenda Froyen (ervaringsdeskundige, auteur van het boek Kortsluiting in mijn hoofd)
Rahis Remmery (Onthaalmedewerker LEIF GENT)
Hilde Verbruggen (Onthaal medewerker Leif Antwerpen)
André Van Nieuwkerke (Voorzitter LEIF West-Vlaanderen, Eresenator)
Inès Staelens (patiënt, ervaringsdeskundige)
Dominique Lossignol (M.D., Institut Jules Bordet, ULB)
Ann Callebert (klinisch psycholoog – onderzoekster herstel en euthanasie)
Kurt Audenaert (Hoogleraar psychiatrie, Universiteit Gent)
Erik Struys (bestuurder vzw Omega)
Bert Coessens (Sympathisant Vonkel)
Frank Vandendries (moreel consulent, levenseindecounselor Zuid-Nederland)
Rik Achten (Voorzitter Breinwijzer VZW, Diensthoofd radiologie UZGent)
Marleen Peters (projectleider en publicist, gespecialiseerd in het zelfgewilde levenseinde, Amsterdam)
Erna Van der Auwera (onthaalmedewerker LEIF Antwerpen)
Willy Depecker (psychoanalyticus-psychotherapeut, Brugge)
Dirk Devroey (professor, voorzitter vakgroep huisartsgeneeskunde en chronische zorg VUB)
Gaston R. Demarée (KMI-wetenschapper op rust)
Charles Susanne (prof. antropologie, VUB)
Nathalie Albert (ervaringsdeskundige Alexianen Zorggroep Tienen)
Elke Gyselaers (ervaringsdeskundige, Licentiaat Moraalwetenschappen, VUB)
Bart Callebert (ervaringsdeskundige, Gent)
Jasmien Caemaert (maatschappelijk werker)
Kathleen Van Steenkiste (vrijzinnig humanistisch consulent)
Simon Van Belle (medisch oncoloog, U Gent / UZ Gent)
Karl Laurent (Moreel Consulent Luchthaven Zaventem)
Diana Van de Gracht (vrijwilligster bij ,,Netwerk Levenseinde” in Oudenaarde)
Frank Heyvaert (LEIF arts voor LEIF Antwerpen)
Luc Proot (coördinerend LEIFarts LEIF West-Vlaanderen)
Louisette Vervaet (vrijwilligster verschillende organisaties, eredirecteur)
Peter Theuns (Hoofddocent statistiek en deontologie, Vrije Universiteit Brussel)
Gert De Rouck (informaticus)
Petra de Jong (voormalig directeur NVVE)
Arnold Decraene (huisarts, Lede)
Edward Keppens (emeritus professor, Vrije Universiteit Brussel)
Koen Titeca (psychiater, Kortrijk)
Rita Thienpont (vrijwilligster LEIFpunt Gent/VONKEL)
Wim Betz (arts, professor emeritus VUB)
Geert Derre (zelfstandig psychotherapeut, bestuurder Vonkel en onhaalmedewerker Leif Gent)
Hilde Borms (vrijzinnig humanistisch consulent)
Gustaaf Cornelis (wetenschapsethicus, Vrije Universiteit Brussel, Universiteit Antwerpen)
Jeannine Bellaert (LEIF-W.VL., Coördinator vrijwilligers)
Sigrid Lauwereys, vrijzinnig humanistisch consulent, Aalst
Serge Coopman (arts, Skin & Laser Clinic, Antwerpen)
Gerard De Fré (Psychiater, Aalst)
Mia Voordeckers (Radiotherapie/Leifarts UZ Brussel)
Jurgen Slembrouck (moreel consulent, Antwerpen)
Bart De Schutter (ere-rector VUB)
Pierre Martin Neirinckx (moreel consulent, criminoloog)
Ton Vink (filosoof en counselor, Nederland)
Ruddy Verbinnen (arts, bestuurder van de vzw Omega en Algemeen Coördinator van de Universitaire Associatie Brussel)
Roos Deschamps (ervaringsdeskundige)
François Pauwels (LEIFarts, equipearts Omega)
Maridi Aerts (gastro-enteroloog, LEIF arts, Brussel)
Jaak Remes (vrijwillige medewerker LEIF Gent)
Nathalie Vanderbruggen (Psychiater/ psychotherapeut, UZ Brussel)
Fredje Baert (PASS Actief Gent)
Chantal De Poorter (onthaalmedewerker LEIF-Gent – Vonkel)
Els Verbelen (klinisch psychologe te Kalmthout)
Tom Hannes (filosoof & schrijver)
Fred Waumans (socioloog, Hasselt)
Lidia Rura (doctoraal onderzoeker vertaalwetenschap, UGent, ex-partner van een overleden euthanasiepatiënt)
Jos van Wijk – Voorzitter Coöperatie Laatste Wil – http://www.laatstewil.nu
Gert Rebergen – Secr./penningmeester Coöperatie Laatste Wil – http://www.laatstewil.nu
Karen François (hoofddocent wijsbegeerte, VUB)
Cathy Macharis, Professor, Brussel
Karen Verstraeten (psychotherapeute, specialisatie chronisch zieken, Deurne)
Albert Stas (Directeur deMens.nu)
Kristel De Vos (begeleidster volwassenen met een beperking, Lennik)
Mayke Hundhausen (Onthaalmedewerker LEIF Gent)
Colette Raymakers, voorzitter Netwerk Levenseinde, bestuurder LEIF
Michel Flamée (emeritus professor, Vrije Universiteit Brussel)
Laura Michiels (vrijwilligster LEIFAntwerpen)
Steven De Lelie (acteur)
Jean Meurs, Humanistisch-Vrijzinnige Vereniging, Mol
Mia Tytgat, Humanistisch-Vrijzinnige Vereniging, Mol
Klara Jacops (psychologe, Gent)
Patrick Rentmeesters (burger)
Mil Kooyman (Gewezen vakbondsverantwoordelijke, Bestuurder van Woonzorgcentrum Domino)
Herman Thienpont (psycholoog)
Willem Laureys (MD, Omnipracticus op rust)
Elisa Bulckens (criminologe, psychotherapeut, Antwerpen)
Rudi Collijs (lid Liberales, Lochristi)
Michael Portzky (klinisch psycholoog, Gent)
Jan Baccaert (geoloog, vrijwilliger UGent)
Marjorie Vangansbeke (Massage-therapist)
Herbert Plovie (Geneeskeer-Kolonel b.d., Bredene)
Jean-Jacques De Gucht (gemeenschapssenator)
Veerle De Vos (Psychotherapeute en medewerkster Vonkel, Gent)
Philippe Van Cauwenberghe (Psychiater, Gent)
Patrick Simons (Huisarts- Leif-arts – palliatieve equipearts, Halle)
Henri Bartholomeeusen (Président du Centre d’Action Laïque)
Maya Franssens (Klinisch Psychologe-Neuropsychologe en Psychodiagnosticus, Sleidinge)
Asteer Caemaert (ex-psycholoog/psychotherapeut)
Miek Caenberghs (psychologe en familietherapeute)
Joke Denekens (emeritus Hoogleraar huisartsgeneeskunde)
Rika Peters (LEIF-medewerker Gent)
Jelissa Boiy (verslavingsarts Kortrijk en Roeselare)
Joeri Van Looy (Klinische psycholoog en oplossingsgericht systeemtherapeut, Wilsele)
Marijke Mulder (levenseindecounselor en zingevingscoach, Noord Nederland)
Robert Geeraert (bestuurder LEIF)
Det Tacq (psychologe, Gent)
Frank Stappaerts (inspecteur niet-confessionele zedenleer)
Geert Crombez (professor, Department Experimental-Clinical and Health Psychology, Health Psychology Lab, Universiteit Gent)
Ann Naessens (onthaalmedewerkster LEIF Antwerpen)
Hendrik Cammu (professor, arts, VUBrussel)
Hubert Van Hoorde (ereprofessor, Universiteit Gent)
Eddy Van Gelder (voorzitter raad van bestuur VUB)
Michele Leunen (gynaecologe, UZ Brussel)
Sebastiaan Engelborghs (neuroloog en hoogleraar neurowetenschappen, UAntwerpen)
Ann Buysse (hoogleraar psychologie, UGent)
Marie Jeanne Vanrobaeys (zus van iemand die uit het leven stapte op basis van ondraaglijk psychisch lijden)
Carlo Goethals ( leraar, ervaringsdeskundige)
Hugo U. Besard – Kunstenaar/graficus – prof Artesis Plantijn Hogeschool Antwerpen
Monica Verhofstadt (masterstudente klinische psychologie, onderzoekster naar ondraaglijk lijden bij psychiatrische patiënten)
Ann Weckx (scenografe en kunstenaar, verbonden aan Topaz in Wemmel)
Greta Fiers (Oostende)
Piet Van Leuven (emeritus gewoon hoogleraar, Mol)
Vera Rogiers (professor, diensthoofd Toxicologie, fac G&F, VUB)
Guy Hubens (Chirurg Antwerpen, hoogleraar UA)
Bart Keymeulen (Gewoon hoogleraar VUB, Endocrino-diabetoloog)
Els Goderis (directeur huizenvandeMens West-Vlaanderen & ondervoorzitter Leif West-Vlaanderen)
Frank Scheelings (docent VUB, coördinator Centrum voor Academische en Vrijzinnige Archieven)
Carine Vrancken (psycholoog, abortuscentrum Hasselt )
Isabelle Libbrecht (psychiater)
Johan Braeckman (uroloog UZ Brussel, professor VUB)
Mia Taffijn (Verpleegkundige UZ Brussel)
Sven Estercam (arts, diensthoofd en medisch coördinator diensten psychiatrie St Franciskusziekenhuis Heusden-Zolder en Jessaziekenhuis Hasselt)
Charlotte Stolte (Anesthesiste, AZ Nikolaas)
Dirk Avonts (professor huisartsgeneeskunde, Universiteit Gent)
Wim Vandenbussche (hoogleraar Nederlandse taalkunde VUB)
Anouck Debroye (HR Interim Manager & Coach)
Gily Coene (professor VUB)
Magriet De Maegd (Cultureel medewerker in het supportief en palliatief dagcentrum TOPAZ)
Michel De Brabander (huisarts, Humbeek)
Gemma Cogen (verplegende, UZ Brussel)
Frie Blanckaert (gepensioneerd lector Arteveldehogeschool)
Eliane van den Ende (journalist, Beigem)
Theo Compernolle (psychiater)
Mieke VERDIN (actrice, medewerker bij de communicatiemodule van de Leif-opleidingen in Wemmel)
Niels De Temmerman, professor, Vrije Universiteit Brussel
Greet Blanckaert (psychotherapeut, Gent)
Michel Deneyer (docent bio-ethiek, VUB)
Marc Noppen (arts, pneumoloog, CEO UZ Brussel)
Dr. Eric Vandevelde (gynaecoloog, LEIFarts, Ronse)
Jim Van Leemput (ere algemeen directeur VUB, voorzitter Instelling Morele Dienstverlening Antwerpen)
Winnie Belpaeme (vrijzinnig-humanistisch moreel consulente, Gent)
Rik Pinxten (professor emeritus culturele antropologie, Gent)
Hilde Depla (zelfstandig schilder)
Henri Oger (onthaalmedewerker LEIF, Gent)
Tessa vermeiren (journalist met rust)
Pierre Pol Vincke, (zoöloog, gewezen Minister-raad voor Internationale samenwerking FOD-BZ.
Ruth Raes (Coördinator Netwerk Levenseinde, Palliatieve thuiszorg Zuid-Oost-Vlaanderen).
Marianne Marchand (Gewezen Voorzitter Humanistisch Verbond)
Robert Cliquet (prof. em. Antropologie, UGent)
Joris Weyns (LEIF-arts, equipe-arts)
Yves Kengen (Directeur Communication – Médias, Centre d’Action Laïque ASBL)
Katrien Van den Meerschaute (vrijzinnig humanistisch consulent, huisvandeMens, Aalst)
Rita Van der Stoelen (Onthaalmedewerker LEIF, Gent)
Paula Schepens (onthaalmedewerker Leif Gent en Brugge)
Jutte van der Werff ten Bosch (Kinderarts)
Alex Michotte (neuroloog UZ Brussel)
Tine Berbé (vrijzinnig humanistisch consulent, Brussel)
Tim Trachet (VRT journalist)
En: Els Vermeeren, Marc De Waele, Marc Coucke en tientallen andere patiënten, psychologen, therapeuten, artsen, ethici e.a.


“Remove EUthanasia on the Basis of Purely Psychological Suffering from the Legislation” (Translation Open Letter)

This is a translation of an Open Letter of 8 December 2015 by Belgian Psychiatrists, Psychologists, Philosophers and Others re Psychological Suffering in Belgian Euthanasia Legislation, published in De Morgen, a Flemish newspaper, asking the Belgian legislator to remove the option for euthanasia on the basis of purely psychological suffering. I used google translation to create a quick basis, and corrected that rough translation based on my own knowledge of Dutch (Dutch is my native language). Here is the original Dutch version.


DEATH AS THERAPY.  Ariane Bazan (clinical psychologist ULB), Gertrudis Van de Vijver (philosopher UGent) en Willem Lemmens (ethicist, Universiteit Antwerpen) write this open letter in name of 65 professors, psychiatrists and psychologists.

For the first time since the adoption of the law in 2002, a decision to allow euthanasia – the case De Moor / Van Hoey – was challenged by the evaluation committee and forwarded to the public prosecutor. The Australian broadcaster SBS made a documentary about this case and about the conversations between the patient and doctor. Another poignant video report was recently made public by The Economist, involving a 24-year-old young woman from Bruges, who ultimately declined the execution of her euthanasia request, which had been granted, and which was based on psychological distress. (24 and Ready to Die).

In our open letter in the Artsenkrant (September 2015) we already drew attention to the legal uncertainty for the doctor in cases of euthanasia based on purely psychological suffering. In this opinion piece we draw attention to its particularly problematic character, in particular the impossibility to objectify the hopelessness of psychological suffering.

One would expect that the untreatable nature of this condition is supported by, for example, indications of an organic injury, or of tissue damage, in other words, with factors independent of what is subjectively felt or thought as a result of the disease. Such objectification is problematic in mental suffering.

Let us be clear: mental suffering is real and can be at least as severe as physical suffering. What is unique, however, is that you can only rely on the word of the person who is suffering to evaluate it. And this is clearly a good thing, because he or she is the only one who knows how much it hurts at that precise moment. At that moment indeed … because when we suffer psychologically, we are often convinced that no other future is possible. It is often precisely these thoughts that push a person into the abyss, since as long as there is perspective, one can usually tolerate very much. We see that some who were first declared terminally ill eventually abandon euthanasia because new prospects appeared. In a paradoxical way, this proves that the disease cannot be called incurable.

Depression is today the most common mental illness: according to estimates by the World Health Organization one in seven people have to deal at one point with serious depression. If we connect these figures to the fact that hopelessness is one of the central features of a depressive phase, it is clear that the feeling of hopelessness is in no way commensurate with the truly hopelessness of a situation.

In contrast to diseases that are the consequence of tissue damage, mental suffering is connected to a change in functioning – and not a deterioration of tissue. This difference is essential because such dynamic changes, by definition, can and do revert, and sometimes quite suddenly. Thus we see that some people who were first declared untreatably ill and who received on that basis permission for euthanasia decline to exercise their option because new – albeit fragile – prospects appeared.

In a paradoxical way, this proves that the disease cannot be called incurable. The subjective assessment of one’s own perspective in the context of mental suffering therefore offers no stable support to make an ‘incurably ill’ verdict.

The conclusion is clear: the current law assumes wrongly that there are objective clinical criteria for psychological suffering that might justify euthanasia. It is for this reason that euthanasia on the grounds of mental suffering alone cannot be regulated by law.

Some also defend the thesis that the mere offering of death as an option can cause a positive change and can therefore also be considered a component of good care. In our view, however, this inevitably entails the radical failure of the mental health sector. The use of ‘death as therapy,’ possibly up to the point of actually even performing the requested euthanasia, implies a priori renouncing what therapy still can and should be offering: the inexhaustible opening up of new perspectives.

As representatives of the various directly-involved professional groups, from different parts of the country and from across the different ideological fault lines, we are alarmed by the increasing trivialisation of euthanasia on the grounds of mental suffering alone. We believe that this situation is intrinsically linked to the concept of an act which is based on subjective criteria. That is why we insist that allowing euthanasia based on purely psychological suffering be removed from the current legislation.


Ariane Bazan, Prof. Klinische Psychologie, Université Libre de Bruxelles (ULB)
Gertrudis Van de Vijver, Prof. Moderne Wijsbegeerte en Wetenschapsfilosofie, Universiteit Gent
Willem Lemmens, Prof. Ethiek en Moderne Wijsbegeerte, Universiteit Antwerpen
Dan Kaminski, Prof., School voor Criminologie, Université Catholique de Louvain (UCL)
Pierre Mertens, Kunstenaar & Psychotherapeut Child-Help, International Federation For Spina Bifida & Hydrocephalus, NICC, Art & Society
Marc Calmeyn Psychiater, Psychiatrisch Ziekenhuis Onze-Lieve-Vrouw, Brugge
Jean-Louis Feys Hoofdgeneesheer St Bernard-Manage
Lieven Lagae Prof. Kinderneurologie, Katholieke Universiteit Leuven
Kristien Wouters arts, Instituut voor Tropische Geneeskunde
Luc Van Melkebeke psychiater & revalidatie-arts, Gent
Wim Galle, analyticus, ex-voorzitter van het Gezelschap voor Psychoanalyse en Psychotherapie; praktijkassistent Faculteit Psychologie, Universiteit Gent
Jean-Pierre Verbelen, emeritus hoogleraar Biologie, Universiteit Antwerpen
Herman De Dijn, HIW, Katholieke Universiteit Leuven
Luc Vandecasteele, huisarts, Gent  
Björn Waerlop, Psycholoog, Psychiatrisch Centrum, Gent – Sleidinge
Sarah Vande Walle, Psycholoog, privépraktijk, Deinze
Jos Vandecappelle, Psychiater op rust, Schilde
Léo Claude Jadot, Psychiater, psychotherapeut, seksuoloog, Brussel
Johan Taels, Prof. Ethiek, Universiteit Antwerpen
Michel Ghins, Filosoof, Université Catholique de Louvain (UCL)
Etienne Montero, Decaan rechten, Namur
Timothy Devos, Prof. Faculteit Geneeskunde, KUL, Hematoloog-internist, UZ Leuven
Filip Kolen, Psychotherapeut, Gent
Benoit Beuselinck, Professor Faculteit Geneeskunde KULeuven, Oncoloog UZ Leuven
Stephan Claes, Prof. Psychiatrie, Katholieke Universiteit Leuven
André-Marie Allard, Klinisch Psycholoog, Juridisch Expert, Voorzitter van het Ethisch Comité van het ‘Hôpital Psychiatrique du Beau-Vallon’, Namen
Eric Vermeer, Verpleegkundige en ethicus, docent aan het Psychiatrisch Ziekenhuis Beau Vallon, Namen
Francis Martens, Voorzitter van de Nationale federatie van de psychoanalytisch georiënteerde psychologen
Pat Jacops, Psychoanalyse, Gent
Katrien Steenhoudt, Psychotherapeute, psychoanalytica
Mattias Desmet, Prof. Klinische psychologie, Vakgroep psychoanalyse en raadplegingspsychologie, Universiteit Gent
Emmanuelle Thiry, Arts palliatieve zorgen, Namen
Joachim Cauwe, Klinisch psycholoog, psychotherapeut, Gent
Xavier Dijon, Prof. em., Faculteit Recht, Universiteit Namen
Gérald Deschietere, Arts, Hoofd Crisisafdeling, Cliniques Universitaires St-Luc, Brussel
Imel Deboeck, Apotheker, Haasrode
Bea Docx, Psychiater, psychoanalytica, Zoersel
Marc J. M. Hermans, Psychiater, hoofdgeneesheer Psychiatrisch Ziekenhuis Bethaniënhuis, Zoersel
Xavier De Longueville, Medisch directeur, Hôpital Psychiatrique du Beau Vallon, Namen
Tine Agon, Klinisch psycholoog, Dienst vrije tijd, Psycho-Sociaal Centrum, Sint-Alexius, Elsene
Catherine Dopchie, Oncoloog, palliatieve zorgen, Doornik
Jean-Marc Priels, Klinisch Psycholoog, Persoonsgerichte psychotherapeut, Brussel
Bert De Meulder, Lector Gezondheid en Welzijn,  Artesis Plantijn Hogeschool, Antwerpen
Ivan Wolfs, Psychiater, Hasselt
Etienne Dujardin, Jurist, Brussel
Lutgart Naudts, Thuisverpleegkundige
Danielle Hons, Arts palliatieve zorgen, Namen
Mark Kinet, Psychiater, Psychotherapeut, Kliniek St. Jozef, Pittem
Rodolphe Van Wijnendaele, Psychiater, CHIREC, Brussel
Annemarie Makay, Psycholoog-psychotherapeut, privé praktijk, Brugge
Georges Casteur, Huisarts, Oostende
Claire Rommelaere, Université de Namur, Faculteit Rechten, assistente
Peter Vuylsteke, Oncoloog, diensthoofd, Namen
Anne Schaub, Assistente Psychologie, Psychotherapeute, Waals Brabant, Court St Etienne
Filip Buekens, Prof., Centrum voor Analytische Filosofie, Katholieke Universiteit Leuven & Tilburg Institute for Logic and Philosophy of Science (TILPS)
Reitske Meganck, Prof. Klinische psychologie, Universiteit Gent; psychotherapeut
Karel Lambers, Psychotherapeut, Brussel
Georges Otte, Neuropsychiater, hoofdgeneesheer P.C. Dr. Guislain, Gent
Jacky Botterman, Oncoloog, Medisch Diensthoofd Palliatieve Zorg, AZ St.-Lucas, Gent
Trenson Eline, Wetenschappelijk personeel UGent, Vakgroep psychoanalyse en raadplegingspsychologie; psychotherapeut & psycholoog in De Spreekkamer
Veronique Wetzels, Verpleegkundige WZC Simeon en Hanna
Thierry Lottin, Directie Sector Psychologie – CHS Clinique Psychiatrique Notre Dame des Anges, Luik
Jean-Benoît Linsmaux, Psychiater, psychotherapeut (privépraktijk), Hoofd Dienst voor Slaaponderzoek en Electrofysiologie GHDC – Charleroi
Ludi Van Bouwel, Psychiater/psychotherapeute Universitair Psychiatrisch centrum, KUL, campus Kortenberg Psychoanalytica, Belgische School voor Psychoanalyse
Leen Vanoverschelde, Psychologe, Gent