Following a much-publicized campaign to obtain medical assistance in dying, Aurelia Brouwers, a 29-year-old, Dutch psychiatric patient, killed herself on Jan. 26, by drinking a lethal potion served up by a physician affiliated with a roving Dutch death squad, the Levenseindekliniek (an end-of-life clinic) in The Hague, the Netherlands.
Brouwers was not terminally ill. Neither was she afflicted with any physical illness. Under the Dutch Termination of Life on Request Act, she qualified for euthanasia solely because she was deemed to be suffering unbearably from a borderline personality disorder with no prospect for improvement.
That Brouwers did indeed suffer severely during the last few years of her life is beyond doubt. By her own account, she frequently mutilated herself, attempted suicide 20 times, attacked a nurse on a psychiatric ward with a sharp instrument, and deliberately set fire to a shed under an apartment building. As a result of this last incident, she was charged with arson, convicted, and incarcerated for two and a half years.
According to the Mayo Clinic, borderline personality disorder – also known as emotionally unstable personality disorder – is difficult to treat, but many patients respond well to psychotherapy. In a warning to young adults burdened with this illness, the Mayo Clinic urges: “If you have borderline personality disorder, don’t get discouraged. Many people with this disorder get better over time with treatment and can learn to live satisfying lives.”
No such consideration deterred the physician at the end-of-life clinic who assisted Brouwers to commit suicide. In marked contrast, the psychiatrist whom Brouwers had consulted before resorting to the euthanasia services of the end-of-life clinic flatly refused to help her to end her life.
In the Netherlands, reluctance to commit euthanasia is not unusual. In a recent official survey of Dutch psychiatrists, more than 60 per cent said that, for them, it was “unthinkable” ever to euthanize a patient.
That is good, except that only three per cent of these same Dutch psychiatrists said they would also never refer a suicidal patient to another physician for a euthanasia consultation. What does it say about the moral integrity of a physician who absolutely refuses to euthanize a suicidal patient, but has no compunction about virtually consigning that patient to death through referral to a euthanasia-perpetrating physician?
While the number of euthanasia killings based on psychiatric suffering alone in the Netherlands is still relatively small, it is escalating rapidly. In 2016, there were 60 such cases, up from only 13 just five years earlier.
Out of the more than 1,700 psychiatrists registered in the Netherlands, just six are affiliated with the end-of-life clinic. Yet of the 60 psychiatric patients euthanized in 2016, the facility helped to kill 37 (more than 60 per cent).
Paulan Stärcke is one of those six Dutch psychiatrists who have euthanized patients under the auspices of the end-of-life clinic. Currently, she is also a member of a commission that is drawing up a new set of official euthanasia guidelines for the Netherlands Psychiatric Association.
For pro-life Dutch psychiatrists, this is bad news. In a recent interview, Stärcke maintained that as “part of good treatment,” every psychiatrist should not only evaluate a patient for euthanasia upon request, but also, if the request is justified under law, to euthanize that patient. In her opinion, it is “not proper” for a psychiatrist to tell a patient that he or she legally qualifies for euthanasia, but: “For death you must find someone else.”
In addition to 60 psychiatric patients, 141, otherwise healthy, dementia patients were also euthanized in the Netherlands in 2016, up from 42 in 2012. According to an official report by the Dutch Euthanasia Review Committees, “In the vast majority of these cases, the patients were in the initial stages of the disorder.” Even mentally competent dementia patients in the Netherlands can qualify for euthanasia if they are deemed to be suffering unbearably from the near prospect of ending up in a nursing home.
Altogether, Dutch experience confirms that euthanasia is like abortion: the death-dealing procedure might begin under narrow legal circumstances, but soon expands to essentially killing-on-demand.
At least in the Netherlands, pro-life physicians can still refuse to collaborate with euthanasia. In Canada, that is no longer the case. Notwithstanding the ostensible guarantee of freedom of conscience and religion in the Canadian Charter of Rights and Freedoms, a three-judge panel of the Ontario Superior Court of Justice unanimously held in an outrageous ruling on Jan. 31 that pro-life physicians are legally obligated to refer a suicidal patient upon request to a death-dealing euthanasia physician.
Even here in Canada, the slide down the slippery slope to obligatory euthanasia-on-demand is well underway.