Allowing euthanasia for psychological suffering is problematic | Letters

The story of Zoraya ter Beek should certainly arouse our sympathy (Dutch woman, 29, granted euthanasia due to psychological suffering, May 16). It is tragic that such a young person gets the feeling that his mental suffering is enough to want euthanasia. As psychiatrists, we tend to ask questions about the certainty of her diagnoses and the details of her treatment. A deeper instinct, erased once assisted suicide and euthanasia are legalized and normalized, says that something always needs to be done: there is always hope. Euthanasia offers the opposite: nothing more needs to be done; no hope, only death.

But ter Beek’s story has broader implications. For example, it shows how the eligibility criteria for assisted suicide and euthanasia are expanding. In the Netherlands, as in other countries, the criteria now include not only those who can make decisions, but also those who cannot; not only physical suffering, but also mental suffering (including possibly being ‘tired of life’); not only adults, but also children.

Although Ter Beek thinks that the system in the Netherlands is safe, we must recognize how valuable many psychiatric diagnoses are and how vague a term such as ‘unbearable suffering’ should remain. The hopelessness of people with depression seems to make their suffering unbearable, but doctors must offer hope. It is of the utmost importance that, as elsewhere in the Netherlands, so few doctors are “prepared to be involved in the assisted dying of people with psychological suffering”. It is because the pursuit of death is anathema to the ethics of medical care. Allowing euthanasia for mental health problems indicates a conflict between the policy of suicide prevention and a policy of suicide promotion. To say that ‘assisted dying’ is the right choice is to promote suicide and contradict the ethos of a genuinely caring society.
Julian C Hughes Honorary professor, University of Bristol
Jonathan Cavanagh Professor of psychiatry, University of Glasgow
Allan House Emeritus professor of liaison psychiatry, University of Leeds
Alan Thomas Professor of geriatric psychiatry, University of Newcastle