Euthanasia: even for psychiatric disorders? 1
This week, I traveled with the group of resident psychiatrists from Sahlgrenska University Hospital Göteborg to Ghent in Belgium to visit both a psychiatric clinic and a reception/voluntary organization (Vonkel) that handles requests for euthanasia. Also accompanying me on the trip was Mikael Sandlund, a senior professor in psychiatry and an active member of SMER (the Swedish National Council on Medical Ethics). In Belgium, euthanasia has been legal since 2002, both for somatic and psychiatric diseases. Even before that, euthanasia was tolerated to some extent. The most well-known cases involve patients with conditions like ALS or other neurodegenerative diseases who wish to end their lives. In Sweden, where euthanasia is not legal, the issue came to the forefront in 2020 when a patient with ALS received assistance from the Swedish doctor Staffan Bergström. The patient initially intended to go to a clinic in Switzerland, but due to the pandemic, the plan was canceled. Staffan Bergström lost his medical license as a result. Assisting someone in ending their life is not illegal in Sweden, which is why the doctor wasn't prosecuted. However, it was reported to the Swedish Health and Social Care Inspectorate (IVO), and he lost his medical legitimacy.
Definitions
It's important to use the correct terminology because there are differences in how euthanasia is administered.
Euthanasia – an intervention that is performed at the explicit request of the patient with the intention of causing the patient's death.
Euthanasia is then divided into:
Active euthanasia – euthanasia performed by someone other than the patient who carries out the decisive action leading to the patient's death.
Assisted suicide – euthanasia where the patient performs the decisive action themselves.
From what I understand, active euthanasia is not allowed in Switzerland, for example, but it is allowed in the Benelux countries. Therefore, Staffan Bergström did not perform euthanasia, which, in practice, would be considered murder in Sweden.
What's the situation in Belgium?
Since 2002, Belgian law stipulates that doctors of any specialty do not commit a crime if they assist a patient in dying, provided that several conditions are met. These conditions include:
The patient must be legally competent, have a repeated desire for euthanasia (i.e., not be demented, psychotic, or too young). A mature 16-year-old can be approved with their parents' knowledge, but at younger ages, consent from both parents and the child is required. However, this is not applicable to psychiatric conditions.
The patient must suffer from an untreatable and unbearable condition, which may or may not be terminal. Untreatable also means that common treatments of a reasonable amount have been tried without sufficient effect.
If the disease is not terminal, a second doctor must also approve the request. This approval can come from either an organ specialist (e.g., a neurologist for ALS) or a psychiatrist.
This means that even those suffering from psychiatric illnesses can request euthanasia. In these cases, approval from two doctors is required, with one of them being a psychiatrist, along with the doctor who carries out the procedure.
Initially, there was little interest in psychiatric euthanasia in Belgium, and it wasn't something offered by regular healthcare. Today, euthanasia for terminal illnesses is entirely accepted in Belgium and is often performed by general practitioners. However, psychiatric euthanasia remains less common and much more challenging to obtain. It was for this reason that Vonkel was founded when a patient donated money and was approved for euthanasia. However, one of Belgium's most renowned psychiatrists, Lieve Thienpont, who evaluates euthanasia requests, was recently charged and later acquitted. This has made many doctors hesitant to engage in psychiatric euthanasia and has led them to refer patients to Vonkel.
What's the perspective in Sweden?
In Sweden, euthanasia is illegal, and the issue hasn't been thoroughly investigated, at least up to this point. Generally, the general public is more favorable towards euthanasia than the medical profession. In a 2021 study, the attitudes of Swedish doctors on this issue were examined. Of the 250 doctors surveyed (approximately 60% of the total), 47% had a positive view, which is an increase from 35% in a similar survey conducted in 2007.
This concludes the initial introduction to the topic of euthanasia. I will write more about my experiences during the visit to Belgium soon.