Belgian Psychiatric euthanasia request based on sexual attraction

Alex Schadenberg, International Chair - Euthanasia Prevention Coalition

Sébastien

Sébastien

BBC News has reported that a Belgium man, known as Sébastien, is seeking euthanasia based on psychological suffering in order to end his struggle with his sexual attractions.

The BBC article by Jonathon Blake explains that in Belgium, euthanasia for psychological suffering requires three doctors to approve the act (one of the doctors should be a psychiatrist), The law says that they must be suffering incurable, constant and unbearable physical or psychological suffering. The article states:

Sébastien has undergone 17 years of therapy, counselling and medication and believes he has no other option. 
He claims to be attracted to young men and adolescent boys and is scarred from a difficult childhood; his mother was ill and there was a strict Catholic ethos. 
"My whole life has led me to this, really," 
"I have always thought about death. Looking back on my earliest memories, it's always been in my thoughts. It's a permanent suffering, like being a prisoner in my own body," 
"A constant sense of shame, feeling tired, being attracted to people you shouldn't be attracted to - as though everything were the opposite of what I would have wanted."

The article examines differing views on psychiatric euthanasia. Psychiatrist Caroline Depuydt, who works at a psychiatric hospital in Brussels, encourages her patients to try further treatment.

We always have something that could work. Time, medication, psychotherapy - something that we must try and keep going with that. And the psychiatrist must give hope to the patient that it's never finished,

Gilles Genicot, a lecturer in medical law at the University of Liege, and a member of the euthanasia review committee says that you can never rule out the option of euthanasia.

Sébastien's case does not fulfil the legal criteria for euthanasia. 
It's more likely he has psychological problems relating to his sexuality. I cannot find a trace of actual psychic illness here. 
But what you cannot do is purely rule out the option of euthanasia for such patients.
They can fall within the scope of the law once every reasonable treatment has been tried unsuccessfully and three doctors come to the conclusion that no other option remains. 
Sébastien's request for euthanasia has been accepted initially, he now faces further assessments to determine whether his case fits within the law.

When asked whether he would change his mind, Sébastien states:

"If someone could give me some kind of miracle cure, why not? But for now, I really don't believe it any more. And I'm too exhausted also, whatever may be out there." 
Although he is calm - almost matter of fact - about wanting to end his life deliberately, he acknowledges the effect this will have on the people around him. 
"The hardest thing now is telling my family. If I get a yes, that's what's going to be most delicate."

Belgian Psychiatrist, Lieve Thienpont, published a study, last year, on the first 100 requests she received for euthanasia for psychiatric reasons. The data states:

  • 77 euthanasia requests were made by woman, 23 were men,
  • of the 48 approved requests, 35 died by euthanasia, 
  • 1 died by palliative sedation (sedation with withdrawal of water),
  • the average age was 47,
  • 58 were depressed, 50 had a personality disorder,
  • 12 were autistic, 13 had post traumatic stress disorder, 11 had anxiety disorder, 10 had an eating disorder, etc.

Last year, there were 2021 reported euthanasia deaths in Belgium. Recent studies indicate that more than 40% of the euthanasia deaths are not reported.

Australian Assisted Dying Report - A sugar coated poison pill

“vulnerable people—the elderly, lonely, sick or distressed—would feel pressure, whether real or imagined, to request early death” House of Lords.
Paul Russell

Paul Russell

By Paul Russell

The Legal and Social Issues Committee of the Victorian Parliament handed down its Report into End-of-Life choices in Victoria today.

The extensive report makes some valuable comments and recommendations in respect to improvement in palliative care.

It acknowledges that access to palliative care is patchy, is overburdened and needs improvement. In a country rated recently as second in an international table for end-of-life care, it still remains that the availability of such care is more closely related to postcode than it is to need.

The committee heard from many individuals whose family members had passed away in circumstances that were clearly far from what all Victorians would want and certainly far from best practice. The committee seems to take it as read that such cases are compelling proof that Victoria needs a regimen of ‘assisted dying’ – euthanasia or assisted suicide. Few, I contend, are that clear.

While family members submitting their stories to the committee often (but note: not always) called for legislative change, the submissions and stories may well have been evidence of poor care, lack of care options or, indeed, refusal of good care options; we simply do not know. For the committee to seem so easily to have accepted that poor deaths require the State of Victoria to help people to suicide is a travesty as much as it is the potential abandonment of people in great need.

Certainly, the admission that palliative care is still not able to meet the needs of Victorians is an important one and we welcome all policy and planning decisions that bridge the gap between need and availability. Sadly, however, the committee seems intent that, for those who cannot access such care, being made dead is an option. This is a failure of the committee’s stated aims to improve choice; suicide in such circumstances is no choice at all.

Link to the full article

Not Dead Yet Activists protest Me Before You in Philadelphia

The Philadelphia Metro news published an excellent report on the Not Dead Yet protest of the movie Me Before You. The Metro wrote (this article was edited for length):

A new Hollywood film depicting a romance between a quadriplegic and his caretaker that ends in the man choosing suicide over life in a wheelchair is being denounced by the disabled community. 
Two dozen activists with disabilities and their supporters protested outside a South Philadelphia movie theater Monday against the film "Me Before You," calling it "poisonous" and saying it could encourage suicide among people with disabilities. 
“As of Saturday, June 4, I have lived with a spinal cord injury for 15 years,” said activist German Parodi, 32, who uses a wheelchair and became disabled after he was shot in the throat during a carjacking. “There’s no reason for us to kill ourselves.” 
The activists in Philly sang and chanted for more than an hour outside the UA Riverview 17, one of two theaters in the city that is showing the film. They were affiliated with Not Dead Yet, a disability rights group that is organizing protests nationwide and protested the film’s red-carpet premiere in Hollywood. 
For those participating in the protest, the story of the film is a painful parallel to their own experiences. 
“I’ve struggled with depression and suicidal thoughts,” said Anomie Fatale, 28, a musician and performer who became disabled at 20 due to Ehlers-Danlos syndrome. “Putting that out there in the mainstream is dangerous. … It could kill someone.” 
Fatale said she has quadriparesis, severe muscle weakness affecting all four limbs. 
“You are suggesting, romanticizing, glorifying, encouraging suicide. That is a thing I can’t be okay with,” Fatale said. “I’m worried about young, impressionable teenagers. I want to put the right message out there.” 
Director Thea Sharrock recently defended the film against the criticisms of ableism, telling The Hollywood Reporter, “I didn’t quite anticipate this” and that the criticisms arose from “a fundamental misunderstanding of what the message is.”
Activists said the film barely portrays any characters who disagree with the protagonist’s decision to end his life in Switzerland at ..., a real assisted suicide organization. 
“There is product placement for an assisted suicide organization in this film,” said Clark Matthews, 34, a filmmaker who uses a wheelchair. “Can you name the last romantic film with a disabled protagonist? The first one in decades, and of course he kills himself.” 
There is also no depiction in the film of the community of people with disabilities, which activists credited with helping them live their own lives. 
“In the past five years, I started meeting other people with disabilities. I stopped feeling ashamed. These people made me feel like I’m not a burden,” said Liam Dougherty, 26, who uses a wheelchair due to Friedreich's ataxia, a progressive neural disorder. 
“It’s a road I could have gone down,” Dougherty said of the story depicted in the film. “I’m so glad I have a supportive organization that made me realize I shouldn’t have gone down that path.”

Congratulations to the NDY activists in Philadelphia who effectively got their message out.

Bill C-14 needs to be amended or defeated

Alex Schadenberg, Executive Director - Euthanasia Prevention Coalition

Alex Schadenberg

Alex Schadenberg

The House of Commons passed Bill C-14, the government bill to regulate euthanasia and assisted suicide in Canada, with a 186 to 137 vote. Canada's Senate will begin to debate Bill C-14. The Senate has the power to amend and/or defeat the bill.

For those who are concerned that Bill C-14 will not be passed by June 6, the date imposed by the Supreme Court of Canada, stop worrying, it will definitely not become law by June 6. Therefore the approach needs to be to amend Bill C-14 in the Senate and if it is not adequately amended, to defeat the bill.

I appreciate the amendments to Bill C-14, An act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying made by the House of Commons

I recognize that conscience protection language has improved and some of the language of the bill was improved, but the most grievous sections of Bill C-14 were not amended. 

If this bill passes, in its current form, the language of Bill C-14 will lead to significant growth of euthanasia. There will be many stories that people will refer to as a "slippery slope." Let me tell you now, these stories will not be the result of a "slippery slope" but rather they will be based on the fact that the language of Bill C-14 allowed these acts to occur.

When I stated that the most grievous sections of the bill have not been amended, here is what I meant:

1. Bill C-14 continues to allow anyone to cause death by euthanasia or assisted suicide. 

• Bill C-14 - Section 227(2) states: No person is a party to culpable homicide if they do anything for the purpose of aiding a medical practitioner or nurse practitioner to provide a person with medical assistance in dying in accordance with section 241.‍2
• Bill C-14 - Section 241(3) states: No person is a party to an offence under paragraph (1)(b) if they do anything for the purpose of aiding a medical practitioner or nurse practitioner to provide a person with medical assistance in dying in accordance with section 241.‍2
• Bill C-14 - Section 241(5) states: No person commits an offence under paragraph (1)‍(b) if they do anything, at another person’s explicit request, for the purpose of aiding that other person to self-administer a substance that has been prescribed for that other person as part of the provision of medical assistance in dying in accordance with section 241.‍2.

No jurisdiction in the world offers legal immunity to anyone who does anything for the purposes of assisted dying. These sections must be struck from the bill.

2. Bill C-14 continues to provide medical practitioners or nurse practitioners total immunity for decisions or acts that contravene Bill C-14.

• Section 241.3 states: Before a medical practitioner or nurse practitioner provides a person with medical assistance in dying, the medical or nurse practitioner must: (a)be of the opinion that the person meets all of the criteria set out in subsection (1)
• Section 227(3) states: For greater certainty, the exemption set out in subsection (1) or (2) applies even if the person invoking it has a reasonable but mistaken beliefabout any fact that is an element of the exemption.

Sections 241.3(a) and 227(3) make it impossible to penalize medical or nurse practitioners for approving or doing an assisted death that contravenes the law, since the bill only requires them to: “be of the opinion” that the person meets all of the criteria of the law. This is the lowest possible standard. Further to that, Bill C-14 provides no effective oversight of the law.

If the person who died was incompetent, the medical or nurse practitioner would only need to state that he/she was “of the opinion” that the person was competent.

The Supreme Court of Canada in Carter approved assisted death based on: “a competent adult person who clearly consents to the termination of life.” 

Section 241.3(a), does not assure that the person is competent or clearly consents to the termination of life.  Therefore Bill C-14 does not respect the language of Carter. Unless Section 241.3(a) is amended to ensure that the person meets all of the criteria set out in subsection (1), Bill C-14 will be struck down by a future court decision. 

Bill C-14, in its current form, must be defeated.

People with disabilities comment on Me Before You

By Alex Schadenberg, Executive Director - Euthanasia Prevention Coalition

Me Before You has become one of the controversial films of the decade, with protests, boycotts and many articles about the film. Not Dead Yet organized protests outside movie theaters, EPC asked its supporters to boycott the film in order to not give the makers of this movie our hard earned cash, nonetheless, the clearest voices have been disability leaders.

John Kelly, the New England Regional Director for Not Dead Yet, who has read the book, was reported by the New Boston Post as saying:

“After a new injury, people are very vulnerable, because suddenly you become part of a marginalized group,” And in terms of the film, “Only a disabled character could have their suicide presented as noble. Imagine if another character in the movie had killed themselves based on their own internalized depression.” 
“People happily cry over people like me killing ourselves,” 
“Where are the films where he changes his mind and they live happily ever after?”

Link to the full article
 

Kevin Yuill: Me Before You is fiction, but so are most arguments for assisted suicide

Alex Schadenberg, International Chair - Euthanasia Prevention Coalition

Kevin Yuill

Kevin Yuill

Kevin Yuill, a history professor at Sunderland University, wrote an excellent article that was published in the Telegraph today. Yuill's argues that Me Before You is simply one of many fictional stories about assisted suicide, but then he also states that arguments supporting assisted suicide are also fictionally based. Yuill writes:

There is an outbreak of fictional assisted suicides, of which the film released this week, Me Before You, is simply the most recent example. Before, we had Million Dollar Baby, The Sea Inside, One True Thing, and episodes of Lena Dunham’s Girls, Coronation Street, and Hollyoaks. Such a plot-device is neither new nor "taboo-busting" – that taboo has been well and truly busted. 
It is interesting that the case for assisted suicide exists more in the fevered imagination of authors and screenwriters than in reality. Only a handful of Britons kill themselves in Swiss assisted suicide clinics every year; the rate of fictional representations to people actually killing themselves in Switzerland must be nearly 1:1. But Me Before You has sparked protests, mostly from disabled groups, because it implicitly asks the question: If you were quadriplegic (or severely disabled), would/should you kill yourself? 
Of course, the film is fiction and not particularly imaginative fiction at that, but there is a real context to the unease of groups of disabled activists like Not Dead Yet who have protested outside cinemas.

Yuill outlines some of the information from his book: Assisted Suicide: The Liberal, Humanist Case Against Legalization (2015) 

The whole case for assisted suicide is fictional. Rather than empathy, it is based on anxiety in the worried well. “I’d rather die than suffer like you do”, some actually say out loud to disabled people, who, in my experience are a feisty lot who enjoy (and all too often must fight for) their lives. There are real disabled lives – and there is the narcissistic projection of gloomy imaginings onto the disabled. 

Link to the full article

Physicians Alliance Against Euthanasia - Sign the Declaration

Physicians: Sign the Declaration (English) (French)

Citizens: Support the Declaration (English) (French)

WE AFFIRM THAT:

1. Patients at the end of life should receive diligent and competent care to relieve their pain and suffering. The physician has the obligation to use all the means available to achieve this end.

2. If a patient refuses treatment or requests its withdrawal, his or her wishes must be respected.

3. Modern palliative care skills, drugs and technology permit adequate symptom control for all terminally ill patients. These methods should be universally accessible.

4. A physician who is caring for a dying patient, and who cannot adequately control the person’s symptoms, should have access to the necessary expertise and support to be able to do so.

5. When suffering remains uncontrolled by state-of-the-art palliative care, individually adjusted sedation to a point of comfort may be used. In this, as in all palliative care, the goal remains optimal quality of life.

6. To provoke death voluntarily, by lethal injection or any other method, cannot be considered under any circumstance as “medical care”, and is contrary to medical ethics. It is never necessary to kill a patient in order to end his or her suffering. The 2400-year-old Hippocratic tradition was a major advance in civilization. It forbids euthanasia and mandates the protection of the weak and the maintenance of trust between the physician and the patient. It calls on physicians and other health professionals to use their knowledge and skills to heal the sick, creating a climate of mutual solidarity. It is ironic that the accepted standards of this ancient code of conduct, written at a time when the means of countering end of life suffering were very limited, might be considered inadequate in this age of refined capacity to control symptoms.

7. We must learn from the negative experiences of countries that have legalized euthanasia. Decriminalization often causes more problems than it is claimed to solve; those documented in the medical and legal literature include:

  • High rates of euthanasia without consent;
  • The impossibility of ensuring adequate reporting and respect for safeguards;
  • A loss of trust in the physician-patient relationship;
  • Conflicts within medical teams and within patients’ families

8. Medical licensing bodies must continue to fulfil their role as protectors of the public and of life, and support physicians in their efforts to improve the quality and accessibility of care of the dying, thus allowing all patients to receive excellent symptom relief throughout their illness and at the time of death.