Euthanasia, i.e. the ending of a patient’s life by a physician on explicit patient request, on the grounds of unbearable suffering caused by mental illness is legal only in Belgium, the Netherlands and Luxembourg. Strict due care and procedural criteria are set out to ensure careful practice.
The option of euthanasia is increasingly being considered and discussed in a growing number of countries. Euthanasia remains however a controversial issue, especially when it concerns people suffering from a mental illness, such as major depressive disorder or dementia.
The number of euthanasia cases in Belgium has been increasing year by year since implementation of the euthanasia law in 2002. Euthanasia is most common in cancer patients: in 2015 68% of all reported cases involved people diagnosed with cancer. In previous years, we found a notable increase in deaths from euthanasia in people with conditions other than cancer, and in those without terminal illness, including people with mental illness.
Taking into account the specific difficulties associated with handling euthanasia requests expressed by people suffering from mental illness, a thorough examination of the practice is vital. Our study adds to and informs the international debate on medically assisted dying in general and in people with mental illness specifically.
One of the procedural criteria for careful euthanasia practice is an obligation of the attending physician to report the euthanasia case for review to the Federal Control and Evaluation Committee for Euthanasia. Information on the euthanasia cases is collected through a standardized registration form.
The Committee collects the anonymous information from the registration forms in a database, which we were allowed to use for research purposes. In our article, we report these data from the start of legalization of euthanasia in 2002 until 2013, which are the latest available data.
Our study shows that the number and proportion of euthanasia cases with a psychiatric disorder or dementia diagnosis has increased from 2008 onwards to 3.0% of all cases reported in 2013 (54 cases in 2013). This increase is particularly visible in cases with a diagnosis of mood disorder. In comparison with the total number of reported cases, euthanasia for these specific patient groups remains a limited practice.
The increase in the absolute number of cases is particularly evident in cases with a mood disorder diagnosis. The majority of euthanasia cases with a psychiatric disorder or dementia diagnosis concerned women, ranging from 58.1% in people with dementia to 77.1% in people suffering from mood disorders. All notified cases were judged to comply with the due care criteria specified in the Belgian euthanasia law by the Committee.
Given the highly controversial nature of the practice and the specific complexities associated with handling euthanasia requests expressed by people with mental illness, we strongly recommend more in-depth research on patients’ reasons and physicians’ procedures, as well as on the impact on the family and health care professionals involved.
The evaluation of a euthanasia request is a complex and challenging task for physicians, particularly when a request is based on psychological or existential suffering. Therefore, development of relevant practice guidelines is necessary.
Our article studying euthanasia in the most controversial of patient groups suggests that the legal possibilities of euthanasia legislation are being explored more broadly and have become more and more accepted over the past years in Belgium.