Mental illness and euthanasia

[topum]

Once prohibited — indeed, unthinkable — the euthanasia of people with mental illnesses or cognitive disorders, including dementia, is now a common occurrence in Belgium and the Netherlands.

This profoundly troubling fact of modern European life is confirmed by the latest biennial report from Belgium’s Federal Commission on the Control and Evaluation of Euthanasia, presented to Parliament on Oct. 7.

Belgium legalized euthanasia in 2002 for patients suffering “unbearably” from any “untreatable” medical condition, terminal or non-terminal, including psychiatric ones.

In the 2014-2015 period, the report says, 124 of the 3,950 euthanasia cases in Belgium involved persons diagnosed with a “mental and behavioral disorder,” four more than in the previous two years. Tiny Belgium’s population is 11.4 million; 124 euthanasias over two years there is the equivalent of about 3,500 in the United States.

The figure represents 3.1 percent of all 2014-2015 euthanasia cases — and a remarkable 20.8 percent of the (also remarkable) 594 non-terminal patients to whom Belgian doctors administered lethal injections in that period.

Belgian medical system over the past two years administered lethal injections upon the request of five non-terminally ill people with schizophrenia, five with autism, eight with bipolar disorder and 29 with dementia — an increasingly common condition in the aging Western world.

From the article in The Washington Post.

Comments

[sparkythegeek.livejournal.com]

That's what I'd want done to me if I had a condition like that. Why be a drag on the system of family... especially if you've lost your sense of self?

[topum.livejournal.com]

Because it might change and you might find it back? Medical science is coming up with new things and drugs all the time and faster than it ever has it seems.

I don't know much about mental illness or how it feels to be going through it though. And I do not have an opinion on this and cannot take sides in the debate going on in Belgium at the moment, I just find this deeply troubling.

[eyelid.livejournal.com]

I'm not interested in dragging my family through years of expensive misery on the off chance that "maybe they'll find a miraculous cure."

What I find deeply disturbing is western society's stubborn refusal to accept any sort of mortality. Or to respect people's rights to judge for themselves whether they want their lives to continue.

My own living will lists all sorts of conditions in which I want care removed, and the only reason it doesn't include euthanasia is that it's not legal in my state. I find attitudes like yours disturbing because they increase the chance that my wishes will not be respected.

(Also, you play with the numbers a lot above to try to make them look bigger, but 124 in that population over that time period is simply not very large.)

[topum.livejournal.com]

I wish you read it more attentively before getting disturbed by "my attitude", this is from the article in The Washington Post which it clearly states in the end of the end of the post and provides a link to the article, so I do not play with anything. Also how is giving the statistics "playing with numbers"? All the numbers are there everyone can judge for themselves if they are big or small (the author has an opinion but he did not "play with numbers", he cited the statistics). What do you mean by "making them bigger"? I also explicitly state in the comments that I cannot take a view on this. In general though this might affect not only your wishes but also the wishes of those who have the opposite views from yours. You are not wishing to drag your family through whatever that might be, someone else might be (including their family). And I do think that 124 (and increasing) is large in that population, we differ here.

[eyelid.livejournal.com]

this is from the article in The Washington Post which it clearly states in the end of the end of the post and provides a link to the article, so I do not play with anything.

I was not under the impression that you generated the numbers yourself. You play with it by quoting it in a given spirit. You knew the number 124 over two years is not a very impressive number, so you threw in a bunch of other numbers to try to make it more impressive. (which of course is also why the article author did it.) I mean, why else are those numbers there? Why would anyone care that 124 in Belgium is 3,500 over two years if ratcheted up to match America's 350,000,000 population? (which would be one out of 3.5 million people per two years, or one in 7 million people per year. See what I did there with the numbers.) The only reason is to try to make a small number seem more important.

If you thought the 124 number was important on its own, you wouldn't have bothered to cite the other manufactured numbers.

I think it's better debate if everyone is just honest about what they are doing and why, don't you?

I think that if you want to actually discuss this as a substantive thing, you need to look at what the protections are for people to ensure that they are giving actual consent. Or whether there is any suspicion that they are not based on some kind of circumstances.

Simply quoting the numbers is totally meaningless, it's a pure scare tactic. You're not looking at the system. You're not bothering to see if free will is involved. I don't know why you aren't doing that if you are actually concerned. But none of the reasons I can think of are flattering to you.

[topum.livejournal.com]

Ok this is so nonsensical that I need to assume the best first (that it is to some degree a misunderstanding) and confirm this with you: Do you realise that the above post has not one letter which is mine (except attribution and link to the source) and all of the text in the entry is copied verbatim, changing nothing, not one letter, adding nothing and taking nothing away from the article in TWP? It is the first half of the article plus one paragraph closer to the end, which I included (also copied verbatim) to ensure that I do not leave out any numbers that the author included in their article and copy all of them (I thought it would not be fair to pick only some of the numbers the author included). No editing, no adding numbers, no leaving them out, no changing the text or rearranging it and no adding one word of my own or any spirit to it. Are we on the same page here?

Also, do you realise that one can find this situation disturbing, as I actually do and not necessarily because (or only because) they have doubts about euthanasia being open to people (let alone want it forbidden)? Like I clearly say in one of the comments below, a big part of why I find this situation troubling for example is because it made me realise how many people (and I do think it is many) live with conditions that make them ready to end their lives and what the lives of those people are like everywhere where euthanasia is not available. And yes, I also have doubts about it from the other side. But I do not have a clear view, as I said. And in general how one should find this situation and article, regardless of whether you think euthanasia should or should not be legal? Happy? Cheerful?

Or do you think that reposting this article (copied verbatim plus link to the source) in itself is not acceptable and somehow shows you clearly what is going on in the head of someone who reposted it without adding anything of theirs on top?

I need to confirm this with you first because it might actually clarify a lot of this nonsense away.

[lifeinroseland.livejournal.com]

Oh, wow. Heartbreaking.

[topum.livejournal.com]

I was surprised by the numbers.

[lindahoyland.livejournal.com]

I fear if it ever became legal here, it would be used to kill people deemed a burden. People should (and do have the right to refuse treatment or end their own lives, but it is a slippery slope once the state becomes involved. How can a mentally ill person give informed consent?

[topum.livejournal.com]

I have many questions about this. I was quite surprised by the numbers too.

[eyelid.livejournal.com]

Mental illness and dementia are not all the same and there are often periods of lucidity. I'm very confident that the legal process can include requirements that ensure people are of sound mind when they make these decisions. I am much less confident that people will respect the wishes expressed by these people.

[beautesauvage13.livejournal.com]

It is troubling.  Scary even. 

Athena

[topum.livejournal.com]

Almost four thousand people were euthanised in two years in a country with 11.4 million population. I thought the number would be lower.

[beautesauvage13.livejournal.com]

That's a lot of people killed.  A lot of people with mental illness or terminal illness.  You would think instead of killing them all they'd put more emphasis on finding out why so many people are getting these illnesses and in finding a way to cure them. 

Athena

[eyelid.livejournal.com]

I'd think to the people involved it is more important to end the suffering than to speculate on some hope of miraculous cure in some distant future. It would be for me.

I'm not sure why it's so impossible for people to understand and respect an ill person's reasonable wish to end their life. The focus on mental illness here is frustrating to me because it treats mental illness as "less real" than a physical illness. Which is really offensive to those with mental illness.

[topum.livejournal.com]

I personally know people for whom it isn't. I am not sure why it seems impossible for you to understand that many people might think that it is worth for them to wait for that miraculous and distant cure.

Oh boy, I was waiting for the "offensive" thing. If you do not mind can you keep the "I am offended" bit to yourself in this debate or if you cannot than perhaps skip reading this post and the comments to stop being offended? I will be back to posting happy pictures soon ). I just do not think that focusing on how offended and disturbed we are by others' views (or those we invented for them) right from the get go is very productive for any debate.

And I do not think the view that mental illness is less real is taken seriously by many these days. There is the obvious problem though in deterring the ability to make decisions by people suffering from mental illness. And this is something we need to figure out and that is worth a debate (which I thing we will see more of in the near future).

[eyelid.livejournal.com]

I am not sure why it seems impossible for you to understand that many people might think that it is worth for them to wait for that miraculous and distant cure.

?? Where on earth did you get that idea? I definitely think there are people who want to hold on to life by their fingernails no matter what. G-d knows why - but that's their choice. I don't care at all. Let them hang on. I'm not the one saying that's "disturbing" or shouldn't be allowed.

It's YOU who can't seem to believe that people would make/want a DIFFERENT choice. YOU are the one who is "disturbed" because people might choose something different from you. YOU are the one insinuating that something is wrong here.

It's YOU who needs to understand that other people might feel that suffering - and making their FAMILIES suffer - on the vanishingly small chance that a miracle cure might be found is not worth it. And that's not because they're mentally ill. Physically ill but completely mentally sound people sometimes feel the same.

In short, you need to get that not everyone feels like you do.

And that is okay, for them to feel differently. It's not "disturbing".


Oh boy, I was waiting for the "offensive" thing. If you do not mind can you keep the "I am offended" bit to yourself

Well, I'm kind of not surprised that you were waiting for the offensive thing, given what you said and how concern-trolling you've been about mental illness.

I'm not sure why exactly you can say whatever you like and no one is allowed to be offended by it? Does that work both ways? Can I start saying whatever I like to you and you don't get to be offended?

I'd think carefully before I answered that one, if I were you. ;)

[snailbones.livejournal.com]

Wow - the numbers are scary. And I didn't know mental illness qualified - how can that person make a choice like that for themselves?

So many questions...

[topum.livejournal.com]

Also in February 2014, Belgium became the first country to allow voluntary child euthanasia without any age limit. In the Netherlands, euthanasia remains technically illegal for patients under the age of 12. However, Eduard Verhagen has documented several cases of infant euthanasia. Together with colleagues and prosecutors, he has developed a protocol to be followed in those cases. Prosecutors will refrain from pressing charges if this "Groningen Protocol" is followed.

[sleepybadger.livejournal.com]

I have mixed feelings about this. My father has a disease called Lewy Body Dementia, which is kind of a combination of Parkinson's and Alzheimers. He doesn't know who most anyone is anymore, can't have a conversation, can't follow things well enough to read or watch a tv show or movie. He's also fully bedbound, has not been able to get out of bed for months, and will never again for the rest of his life. Before he lost most of his ability to move, he was easily agitated and would hit people. He had to be physically restrained last time he was in the hospital. Many people with Lewy Body have hallucinations, and there's very little they can do medication-wise to help. My dad's father also had Lewy Body, so all of us are worried that we might end up this way too. If I imagine being trapped in a bed, unable to get up or do anything for myself, not knowing who the people around me are, unable to carry on a conversation or read a book or watch a show, and possibly having frightening hallucinations on top of it, I want to have the ability to die and be done rather than living that way. That said, though, how can you give informed consent? Right now my dad can't even pick what he wants to eat, let alone make a life or death decision. Maybe I say I wouldn't want to live that way now, but if I was actually in that situation, maybe I would change my mind and not be able to express that. Also, as someone else said, it would be very hard to keep it from being something that people might try to talk grandma into so they don't have to figure out how to afford the help they need to take care of her (or afford a nursing home). In the US, paying for these things is financially devastating. At one point my mom checked out nursing homes to get an idea of how much it would be if she couldn't continue to care for dad. He was still able to get around at that point, and most places quoted her in the range of $6000 - 8000 per month. I imagine it would be more in his current state, and he could be in this state for years. Mom got insurance for them when they were younger, which will cover about $5000/month for care, but most people don't have that (plus it takes several months to get approvals for them to pay for it, and you have to be paying out of pocket for 90 days before they'll cover anything).

[topum.livejournal.com]

This sounds awful. I also do not have a clear view on this in case of both physical and mental illness. Clearly mental illness is much trickier and we will see much more debate on this in the near future. I found the article disturbing, 4,000 people (and increasing) was a higher number than I expected. And I found it disturbing not in a "Oh my, why are we killing people, no!" way (although that also crossed my mind at for a split second at first). One of the thoughts that also came to my mind was how many people are suffering so much that they are ready to be euthanised and what is happening to these people in places euthanasia is not allowed.

[zhelana.livejournal.com]

The saddest part to me is those people with autism. The people who are truly suffering from it are too... locked up in their own little world to really know any better. So they must have been pushed to it by care givers. And that to me is criminal.

[topum.livejournal.com]

I am sure it is not as simple as their caregivers just deciding to do this for them. As horrific as this is bound to be, I think there is a very rigorous process in place there. I cannot take sides on this at the moment, I need to know much more than I do. I think we will see much more of this debate in the future.

[zhelana.livejournal.com]

You're probably right.

[altamira16.livejournal.com]

What kind of rigorous process allows this?

[topum.livejournal.com]

This is horrific. We were talking about others making the decision for someone though (and that the process in those cases probably is more rigorous then simply caregivers making that decision), here they had full presence of mind to do it themselves.

[pageeater.livejournal.com]

For me, there is a big difference between Euthanasia and Right To Die. With people unable to give informed consent, it's Euthanasia - and what a horrible burden of a decision. For others, I believe a Right To Die should be in place over a certain age. Right To Die should enable a person to get the drugs that will make their passing as painless as the privilege we give our pets. Just my opinion. It's a sticky subject - and if you throw ageism in the mix, what a kettle of worms.

[topum.livejournal.com]

Yes, this is a tricky one. You think that right to die should be tied to an age threshold (be available to everyone over a certain age regardless of their condition) and not the actual severity of the condition (level of pain, suffering, no hope for cure, etc) regardless of the age?

[pageeater.livejournal.com]

No. Not regardless of age. We have age restriction on voting, on mind altering drug consumption. I think it has to be the same with right-to-die. But condition does set the bar lower than age restrictions. And the level of restrictions would be a hard battle. For example - hard burn victims - no matter the age - should they have the right to say "I quit?" I'm thinking of elders to begin with (first law) - let's say 73 and older. They should be allowed the freedom to choose. Of course, interviews etc - to be sure the choice is truly theirs and not pressured by others.

Freedom never comes cheap. And there are always infringements and some negative outcomes. But an individual's freedom should supersede all else, regarding their own body. In my opinion.

[topum.livejournal.com]

I see, thank you.

I have been trying to find the entry in your journal on cutting on non-value activities where we had a short conversation in the comments because I wanted to respond to you response to my comment but I somehow cannot find it. And I cannot find those comments in my inbox as well. You deleted that entry, right? Have to ask to ensure that I have not started mixing dreams and reality, haha.

[pageeater.livejournal.com]

I'll have to go back and look. I don't usually delete... but sometimes I do privatize after a while. Is virtual reality a six of dreams and reality? ;-)

[topum.livejournal.com]

No worries, I found a notification of my comment deletion in your journal, it must have been that comment so you probably deleted the entry or the comment. So the mystery is solved and is not bugging me anymore ).

[simplesue.livejournal.com]

USA has a long way to go to catch up with Belgium.
Suffering is no way to live.
Thanks for this post, it's the first I heard about Belgium on this topic.

[topum.livejournal.com]

Yes, Belgium is pioneering this. I think we will see much more discussion of this in the near future as we will be figuring out how to deal with it. For now I cannot take sides on this in case of mental illness especially, I see how having this option is important but at the same time I see the problems with it in case of mental illness and I would need to know much more than I do now to make up my mind on this. For me it would not be an option but that does not mean that I will think that it shouldn't be there for those who want to choose it provided that the risks of those who don't being pushed into it are adequately mitigated. This is a tricky one though. Things seem to be happening in this area in the US too: http://legalinsurrection.com/2016/10/insurers-use-californias-assisted-suicide-law-to-deny-treatment-for-terminal-patients/