Mental suffering and euthanasia: the frayed edges of a public debate

In his opinion, Buijsen argues that one of the reasons for division is lack of understanding. Buijsen cites the Chabot case, which ruled that psychological suffering can also be hopeless and unbearable within the meaning of euthanasia law. However, the case did not cause an increase in assisted suicide. "Assisted suicide by doctors in patients with hopeless and unbearable psychological suffering did not increase afterwards. It is still rare, although there has been an upward trend in recent years", Buijsen said.

Chabot case
In the case of psychiatrist Chabot, who helped a woman with severe depression and a complicated grieving process to commit suicide, the Supreme Court has made important rulings. The woman, who was not physically ill, was given substances by Chabot to end her life. Although the district court and the court of appeal discharged him from prosecution on grounds of emergency, the prosecution appealed to the Supreme Court.

The Supreme Court ruled that a state of emergency can also apply when helping psychologically suffering patients who are not in the dying stage, and that a mental disorder does not automatically preclude a person from having a free will. The Supreme Court stressed that great caution is required when aiding patients who are mentally suffering and that an independent doctor must examine the patient, which had not happened in this case. Chabot's invocation of a state of emergency was rejected, but he received no punishment, showing that his actions were ethically little to blame.

The professor explains his view on the assessment of hopeless and unbearable psychological suffering. "Hopeless is the medically objective aspect of the Euthanasia Act's suffering criterion, unbearable psychological suffering the subjective one. The intolerability of psychological suffering is also palpable to psychiatrists, so that part of the criterion is usually met." But according to Buijsen, many psychiatrists are unwilling to readily accept the hopelessness of psychological suffering. "Most feel that the mental health service always still has something to offer that can be tried to relieve suffering."

Euthanasia and public trust

Buijsen regularly publishes on the subject and he explains what he triggers by doing so. "To my NRC piece on euthanasia and psychiatry, I had a lot of reactions. Meanwhile, psychiatrists have also taken the advice to heart. The agreement is that psychiatrists will no longer seek the media on this issue." The professor saw an adverse effect of public media appearances by psychiatrists on trust in the medical profession. "On this issue, members of the profession need to exchange views with each other. Psychiatrists need to talk to each other. It does the issue no good when people mainly talk about each other and seek the support of outsiders, such as the OM, the IGJ, or that of the public by recounting individual cases of euthanasia on talk shows", Buijsen said.  

Buijsen explains why he does not assign external factors such as the OM and the IGJ a role in the debate on euthanasia in mental suffering. "The OM and the IGJ - very wisely - also did not give in when approached by the more conservative members of the profession asking them to act against psychiatrists who, in their view, were responding a bit too easily to requests for assisted suicide from (especially young) psychiatric patients."

Not a treatment option, but an action option

A key point of Buijsen's criticism of the current public discourse is that some psychiatrists consider euthanasia to be a treatment option in cases of mental suffering. According to Buijsen, this is a serious misconception: euthanasia or assisted suicide is not a standard part of medical treatment, but an exceptional action option. This distinction is essential, Buijsen said, because treatment options represent an enforceable right of the patient within the professional standard of care. Euthanasia, however, is a doctor's choice based on compassion and individual circumstances, not a treatment protocol.

Psychiatrists who publicly portray assisted suicide as a treatment option create the misleading impression that patients are entitled to it when regular treatments have been exhausted, according to Buijsen. He calls this not only unprofessional but harmful to trust in the medical profession.

Although the Euthanasia Act allows individual doctors to perform euthanasia without legal consequences, Buijsen stressed that this remains an individual decision. It is a choice made by doctors based on compassion and the specific circumstances of the patient, and not a standard procedure to which the patient is entitled. This freedom of choice and the exceptional nature of euthanasia must be respected, Buijsen said.