Aurelia Brouwers |
In August 2018 the BBC published an article online about a
woman in the Netherlands called Aurelia Brouwers. The full article can be found
here.
Aurelia was quoted as saying:
I'm 29 years old and I've chosen to be
voluntarily euthanised. I've chosen this because I have a lot of mental health
issues. I suffer unbearably and hopelessly. Every breath I take is
torture…
The
article went on to explain that in the Netherlands euthanasia is permitted if a doctor is satisfied a patient's suffering
is "unbearable with no prospect of improvement" and if there is
"no reasonable alternative in the patient's situation".
Although most euthanasia candidates in the Netherlands have
terminal or otherwise untreatable medical conditions, 83 people with mental
health issues were subject to euthanasia in 2017. Only around 10% of requests
for euthanasia from people with psychiatric conditions are approved.
Aurelia said:
When I was 12, I suffered from depression.
And when I was first diagnosed, they told me I had Borderline Personality
Disorder," she says. "Other diagnoses followed - attachment disorder,
chronic depression, I'm chronically suicidal, I have anxiety, psychoses, and I
hear voices.
The
psychiatrist who approved the decision to end Aurelia’s life, Dr. Kit
Vanmechelen, said:
You must have done everything to help
them diminish the symptoms of their pathology. In personality disorders a death
wish isn't uncommon. If that is consistent, and they've had their personality
disorder treatments, it's a death wish the same as in a cancer patient who
says, 'I don't want to go on to the end.'
On 26th January 2018 she was given the poison
that would kill her and took it.
Readers of this blog will know that I continue to be
troubled by people with mental disorders either being allowed to die,or
facilitating their deaths.
Assisted suicide, which is what euthanasia is, remains a
criminal offence in the UK, so cases like Aurelia Brouwers cannot happen here.
That is not to say that there are no cases of assisted suicide, but the
incidence of such cases is low.
According
to the Crown Prosecution Service, between 1st April 2009 and 31st
January 2018, there were 138 cases referred by the police that had been
recorded as assisted suicide. Of these 138 cases, 91 were not proceeded with by
the CPS. 28 cases were withdrawn by the police. This is an average of only
around 15 per year.
The
CPS website states:
There
are currently two ongoing cases. Three cases of assisted attempted suicide have
been successfully prosecuted. One case of assisted suicide was charged and
acquitted after trial in May 2015 and seven cases were referred onwards for
prosecution for homicide or other serious crime.
One such case was that of Kevin Howe. He was a friend of
Stephen Walker, who while drunk, asked him to buy him some petrol so he could
set fire to himself. He duly obliged, and Stephen fulfilled his promise. Stephen
did survive, but Kevin Howe was found guilty of attempted assisted suicide, and
received a 12 year prison sentence.
Another case was that of Lyndsay Jones. She was an
acquaintance of Philip Makinson, who was suffering from severe depression and
had already tried to kill himself by cutting his wrists. She was a heroin
addict, and at his request and with his consent provided him with what she knew
to be a fatal dose of heroin. She was convicted of manslaughter, and received a
prison sentence of 4½ years.
It is significant that both these cases involved people
with mental health problems rather than terminal illness. In one of these
cases, the person who “assisted” the person wishing to kill themselves did so
with deliberate malice. According to the CPS, it is less likely to lead to a
prosecution if the person assisting “was wholly motivated by compassion”. In
these situations, this was certainly not the case.
However, there are situations in which people with mental
disorder have been permitted to die, either through no action being taken to
save life, or through a decision of the courts to cease lifesaving treatment.
One such, of course, is the case of Kerrie Wooltorton,
which I have discussed at length in two blog posts, most recently in June 2018.
Kerrie took a fatal dose of antifreeze, and because she had written an advance
decision to withhold treatment, the doctors in the A&E department allowed
her to die. I am thankfully not aware of any other incidences in which an
advance decision has been made, or allowed to stand, for a person with mental
disorder.
There have also been Court of Protection decisions relating
to people with mental disorder, where a decision has been taken to cease lifesaving
treatment. One, the case of C from 2015, concerned a woman with narcissistic
personality disorder who did not wish to continue treatment for the effects of
a serious overdose because she had “lost her sparkle” and no longer wanted to
live.
There have also been two other cases, the case of X and the case of W, both of whom had anorexia nervosa, where the decision was made not
to continue with forced treatment for their disorders.
There is an essential difference between a regime in which
someone with mental disorder can legally be assisted to end their own life at
their request, and one where it is necessary for a court to make a situation
specific decision regarding whether or not to continue to provide lifesaving
treatment for the consequences of a mental disorder.
With the former, there is always the risk that a clinic
specialising in assisting suicide, which presumably would expect to receive payment
for the service, may not be sufficiently rigorous in deciding whether or not
someone has the capacity to make a decision that will end their life. Indeed,
it could be possible for a rogue clinician to encourage people to die.
There are several examples of doctors and nurses who have
deliberately killed their patients. A British one is of course Dr Harold
Shipman. Another currently in the German courts is Niels Hoegel, a nurse who
has admitted killing at least 100 patients under his care.
My basic position stands, which is that no-one who wants to
end their life because of their mental disorder should be permitted to do so if it can be prevented. This is one of the basic principles that informs my practice as an AMHP. Furthermore,
the resources should be in place to reduce completed suicide as much as
possible.
In October 2018, Jackie Doyle-Price was appointed as
Minister for suicide prevention. This was in response to the fact that suicide
is now the leading cause of death in men under 45 years in age.
Unfortunately, despite the recent announcement that £2
billion is being provided for mental health services, this is not actually new
money, and in view of the leaching away of funding for mental health care over
the last 8 years, even if it was all spent on improving services, it would be
unlikely to significantly improve suicide prevention.
The Government report, Preventing Suicide in England,
published in January 2017, stated that “the latest data shows that people who
have died by suicide who have been in contact with mental health services is
estimated to have increased to 1,372 in 20146 from 1,329 in 2013.”
The
most recent NCISH Report for 2018 into Suicide and Safety in Mental Health
reported that “in England the number of patient suicides in 2016 was similar to
the previous two years but the patient suicide rate fell as patient numbers
increased.”
This report suggested “10 ways to improve safety” in this
helpful diagram.
It is clear that current services are failing miserably to
provide these essential safety strategies, and it is unlikely that the current Government, Suicide Minister or not, has the motivation or will to make a significant
difference to suicide prevention.
I feel that a patient should be allowed to have the means to have a peaceful death if their mental illness is severe and unremitting and the patient has been discharged from support from a mental health team on the basis that the team feel there is nothing they can provide to support the patient or help them towards recovery. To discharge a severely depressed person because the team feel their input is not beneficial is the point when the patient should be enabled to make their own choices as to how much suffering they are able to bear.
ReplyDeleteWhat is missing in this is what is the underlying belief system and values the person holds and consideration of this. I dislike the term Euthanasia and prefer Assisted Death. If I have intractable and intolerable mental pain parity means that I have as much right to end my life as someone in physical pain. Severe enduring mental health conditions are a disability with overlying acute symptoms.There comes a time whereby acceptance of the situation is inevitable and if - as in my case- I have always believed in the right to die then this is a decision made with capacity that should be respected. I would want someone to have been offered as much support as possible to live a meaningful life but when it is clear there is no more that can be done then allow me to die with dignity. In lime with my core beliefs. I find it sad that those so young have made this decision but you cant just turn up at Dignitas and say 'kill me i am depressed'- i is a long necessarily complex detailed process. I want peace And my core beliefs to be respected at this stage in my life. I dont see that as suicide.
ReplyDeleteBanning reliable, legal euthanasia for those of us who want to end our unbearable suffering does not stop people trying to take their lives, it just prolongs suffering, forces us to go DIY alone, & results in botched attempts & gruesome surprises for F&F. Other countries are more humane.
ReplyDeleteFor someone who purports (and is legally ibliged) the social perspective of mental health, I would argue you seem to have a strong paternalistic and state involvement driven element to your oracrice. If a person who, even with all the best resources, care and treatments no longer wishes to end their life because they no longer want to live with the pain of their condition, that should be their right, subject to capacity and strict legal safeguards. I also take great exception to you mentioning Shipman and the German nurse, these are incredibly rare occurrences and comes across as you attacking healthcare orofeprofessi as being inherently untrustworthy.
ReplyDeleteI am not opposed per se to someone with a terminal illness wishing to end their life, but I am bothered a great deal by assisted suicide being offered to people with mental disorders. It is Government policy, and the policy of many if not all MH Trusts to reduce the incidence of suicide, which is generally associated with mental disorder. If the mental disorder can be successfully treated, then the person would not want to kill themselves. The fact the the Governemnt have starved Trusts of funds to provide adequate treatment and support for people with mental disorder does not justify encouraging such people to take their own lives, with or without help. I don't think thinking that is paternalistic. And by the way, there was a case in the Netherlands only last week, where a doctor administered a chemical designed to end the life of an elderly woman in spite of evidence that appeared to indicate that the woman was objecting to this procedure.
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