“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.

REMOVE EUTHANASIA ON THE BASIS OF PURELY PSYCHOLOGICAL SUFFERING FROM THE LEGISLATION.

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.

 

Signatories:
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