Sunday, May 15, 2016

Euthanasia in the Netherlands

One understands the rationale. Some very elderly patients, suffering from terminal illness, prefer to end their lives sooner, rather than later. In some circumstances, there is no longer any hope. Thus, in sophisticated and supposedly civilized countries like the Netherlands, euthanasia is legal. Dare we note, that capital punishment is not legal: it is reviled as a barbaric practice.

But, as I posted several days ago, it is not just legal for terminal cancer patients. It is also legal for people suffering from mental illness, in particular, from depression. Since people who are depressed are often convinced that their case is hopeless and that they do better to die, it appears that the laws do not distinguish between physical and mental illness.

Last year 5,516 people in the Netherlands were killed by physicians, among them, children. A few days ago I posted about a young women in her mid- twenties who was suffering from depression following a sexual assault. Her psychiatrists decided that her case was hopeless, that she could never recover, and thus that they should respect her wishes and end her life. While it is certainly true that some rape victims have such feelings, and while it is also true that the current conversation about rape tends to downplay the possibility for recovery, why should a society assert by its actions that a rape victim's life is no longer worth living? Doesn't this contribute to her illness and persuade her that her case is hopeless?

For my part, and for what it’s worth, I disagree. I do not accept that a society should give up on a young woman and declare her case to be hopeless. Since depression is learned helplessness, a society that accepts this opinion as fact risks reinforcing the depression. Shouldn’t a physician’s job be always to keep hope alive, most especially in cases involving mental illness?

You will also be thinking: what is the difference between euthanasia and suicide? Many of those who want their physicians to kill them have tried suicide and have, evidently, failed at it.

One understands the suicide might be considered a selfish act. It bears a stigma; it denotes weakness. But, it is most often an entirely personal decision. Now, with the Dutch euthanasia laws, an individual can overcome the stigma of suicide by being put to death by medical, thus scientific authority. Keep firmly in mind, these decisions are made by physicians, thus by men and women of science.

It’s one thing to say that you feel that your case is hopeless and that you believe that you will never recover. If your condition is mental, we are talking about a belief, even a conviction. It’s quite another thing to say that medical science has decided definitively that your case is hopeless and will never improve. When they say that the only solution is death, aren’t they feeding the conviction?

To repeat myself, one understands that a nonagenarian terminal cancer patient might well prefer to die, but all of the 5,516 Dutch euthanasia victims do not belong in this category.

The authorities might have considered that, in the case of mental illness, the euthanasia law is producing the problem that they are trying to solve. If depressed patients become overcome by feelings of hopelessness, does it help or hurt their condition to hear from their government that they are right, not that they might be right, but that they are absolutely and irrevocably correct.

Are we that sure that these laws do not foster the conditions that convince people that they should die, that they are doing the world a favor and that the world agrees? Euthanasia laws turn an egotistical act into an altruistic act.

What I am trying to say is simple: good intentions do not necessarily lead to good outcomes. And, a treatment that might pertain to an elderly person with terminal cancer does not necessarily apply to a young person suffering from depression. Our scientists insist on conflating mental illness with physical illness. They believe that it's all a matter of biochemistry. Thousands of people in the Netherlands, and surely in other enlightened countries, are being executed for this error.


Ares Olympus said...

Lacking a link, I found this source, with some graphs, so its about 4% of total deaths and shows close to 4000 of the 5516 assisted suicides were related to cancer, and all the other categories were too small to really differentiate.
There were 5,516 reported cases of assisted dying in 2015, with 208 cases of patient self-administration and 5,277 cases of doctor administration. Assisted deaths represented 3.9% of all Dutch deaths in 2015.
Multi-functional old-age decline underlies around 3-4% of cases. Untreatable mental illness is a rare health factor in Dutch assisted dying, with dementia present in 1 in 50 assisted deaths (2%) and other mental illness in 1 in 100 deaths (1%).

So 1% of 5500 implies about 55 assisted sucides related to mental illness, or about 0.04% of total deaths. I wonder how many "unassisted" suicides are related to mental illness?

Wikipedia shows the suicide rate is about 8.2/100k, a country of 16.8 million people.

So that suggests about ~1400 suicides per year, so I'd assume this smaller number excludes assisted suicides. If we consider suicide for people without physical illness ALWAYS an irrational act, then perhaps we have ~1400 people with depression who are taking their own lives without working with anyone else.

So if we consider ~55 assisted suicides with depression, and ~1400 unassisted suicides with depression, then we can still consider the larger problem are those who keep silent and don't tell anyone of their plans.

So if we want to evaluate those ~55 cases of assisted suicide, we ought to put that in the context of how many people ASKED for assisted sucicide and were subsequentially given mental health attention and changed their mind, via therapy or drugs or whatever interventions.

So those numbers are guesses, maybe close enough for order of magnitudes? So the question to me is how many of those ~1400 people might have changed their mind, if they could confess their suicidal thoughts without having their rights taken away.

I think in therapy, there is privacy between a therapist and patient EXCEPT if the patient indicates anything the possibility of physical harm to self or other. So if a patient knows this, and doesn't want to be forcefully hospitalized, he has to be very careful to not admit anything. I suppose there are different standards, and probably higher standards about underage patients.

I also recall some stories, like someone who was sure he wanted to die until the moment he flung himself over a bridge railing, and in that instant, another part of him arose and didn't want to die, and somehow he lived from the fall.

So stories like that suggest the method of suicide is important, and some methods allow people to "approach death" while still having moments to change their mind, and that's also why women succeed less in suicide, because they pick less lethal methods.

It seems like an open question to me - if a patient feels a "conviction" to end their life, is there another part of them that is suppressed and can be triggered in life-or-death moments. You could almost imagine the idea of "evil spirits" (or autonomous complexes if you're (pseudo-)scientific) and perhaps this hypothetical being is controlling them, and its only in the moment of facing death that the spirit leaves them, and they're free to choose life, if they survive the encounter.

Anyway, all these meandering thought make me consider the important thing is to delay a decision, and allowing a patient to decide "I can wait one more day" can go a long way, and the death fixation may eventually find another solution to their predicament.

priss rules said...

If rape is a problem, it sure helps European women to import so many wild virile men from the Third World.

Ares Olympus said...

I see The Young Turks discuss the case (an adult woman who was sexually abused from age 5-15, presumably by a family member), and they generally agree adults at least have the right to end our our life, while society should do all it can to discourage this choice. Why A Rape Victim Was Euthanized

In the very least it reminds me that we can all look in the wrong direction for enemies, and that the most psychologically damaging behavior happens within a family, from people who may actually believe they love and care about us. (And equally intractible, we have the problem of how society intervenes in family relations when authorities like Social Services may never really know exactly what's going on behind closed doors.)