LEICESTER, United Kingdom – A half-day symposium on the ethics surrounding suicide and euthanasia took place this weekend at the Oxford-based Anscombe Bioethics Centre, the leading Catholic institute in the field in the United Kingdom.
The symposium was part of a three-day symposium on the ethics of psychiatry and mental health care.
The issue has gained urgency after the Netherlands and Belgium began allowing euthanasia for people suffering from mental illnesses.
Last year, a chain of Belgian psychiatric hospitals owned by the Brothers of Charity religious order defied the Vatican in allowing its patients to be euthanized.
“In just a few years, requests for euthanasia in psychiatry became more and more ‘acceptable’ and common in Belgium, despite the fact that one often said – also among pro-euthanasia doctors – that the law was intended for somatic terminal diseases, not mental suffering caused by psychiatric diseases,” said Dr. Willem Lemmens, a participant at the Oxford symposium.
Lemmens is a Professor of Modern Philosophy and Ethics at the University of Antwerp and told Crux “those psychiatrists opposing the too broad and lenient application of the law are scorned for being inhumane and for lacking empathy with unbearable suffering.”
“So, the moral climate has changed drastically, in the sense that euthanasia is called by some a ‘fundamental right’ and death a ‘therapeutic solution.’ Euthanasia is sacralized, so to say, and every critique is dismissed as inhumane, thus immoral,” he said.
With euthanasia and assisted suicide being legalized in several U.S. states, and being debated in parts of the United Kingdom, Lemmens said pro-life advocates should “raise your voice in a dignified manner and listen to the critical testimonies and voices in Belgium and the Netherlands.”
Lemmens spoke to Crux about how legalized euthanasia is affecting the field of psychiatry.
Crux: In what ways has the 2002 Euthanasia law in Belgium affected the field of psychiatry in the nation?
Lemmens: The Belgian law defines euthanasia as ‘the act which intentionally ends the life of a person at his or her request and which is carried out by an individual other than the person in question.’ This other should be a physician, who should take in account some restrictive conditions: the suffering should be unbearable, physical or mental and this suffering should be the result of ‘a serious and incurable disorder caused by illness or accident.’
In just a few years, requests for euthanasia in psychiatry became more and more ‘acceptable’ and common in Belgium, despite the fact that one often said – also among pro-euthanasia doctors – that the law was intended for somatic terminal diseases, not mental suffering caused by psychiatric diseases. The change in culture is profound, because euthanasia becomes an option for patients who are often suicidal.
Also, psychiatrists are often put under pressure to ‘grant’ euthanasia, sometimes even by the family of a patient. Some psychiatrists – clearly a minority – think they should at all costs ‘respect the autonomy of the patient,’ despite the fact that they acknowledge the subjective dimension of a euthanasia request for mental suffering only and also the difficulty to determine that there are no treatment options left. All this has created a sphere of mutual distrust among psychiatrists, also because worrisome cases were revealed in the press about which some want to keep silent.
Some 250 psychiatrists and psychologists at least are convinced these cases should be investigated thoroughly and some worrisome tendencies and ‘rumors’ about abuses should be addressed.
You have said that euthanasia has “some of the most vulnerable citizens unprotected” in the field of psychiatry. Can you expand on this?
As I said, some worrisome cases came forward: Testimonies by families who testify that a beloved one, suffering from mental disorders, was given euthanasia without consent of the family or against the advice of certain physicians. Part of the worrisome situation is the fact that psychiatric patients themselves search for lenient psychiatrists. In name of the ideal of autonomy, the patients are allowed by law to keep this secret from their families and friends. Not a few psychiatrists are alarmed by the fact that they ‘lost’ some of their most vulnerable patients in that way.
How has the “moral climate” surrounding psychiatry changed in Belgium?
A well-known mantra of pro-euthanasia doctors and ideologues is that the euthanasia law has put Belgium on a ‘lone ethical height.’
Typically, the euthanasia law of 2002 is seen as a law that wants to break the taboo on ‘voluntary dying.’ However, the practice created by this law creates new taboos: Those psychiatrists opposing the too broad and lenient application of the law are scorned for being inhumane and for lacking empathy with unbearable suffering. So, the moral climate has changed drastically, in the sense that euthanasia is called by some a ‘fundamental right’ and death a ‘therapeutic solution.’
Euthanasia is sacralized, so to say, and every critique is dismissed as inhumane, thus immoral. There is also a growing distrust and culture of ‘omerta’ between psychiatrists, some of whom rather prefer not to speak out about their worries.
And the minority strongly in favor of euthanasia for their patients receive broad attention in the media and are often hailed as pioneers and real humanists.
What recommendations do you have that could help to counter the processes of moral disengagement caused by the legalization of euthanasia?
Psychiatrists, nurses, families and all citizens confronted with worrisome cases and tendencies should speak out in a calm, firm manner. Politicians should establish the possibility of hearings and expert interviews to bring the alleged abuses and concerns in the open.
Now, there is a climate of distrust and taboo: This should stop. If nothing serious is going wrong, if there are no abuses, as some pretend: Why not speak out openly and listen to the families with traumas, the physicians – especially psychiatrists – and other experts who do have worries?
The professional councils and associations of psychiatrists should openly encourage discussion and debate, and not try to silence the critical voices, as is often the case.
There has been a growing call to legalize euthanasia, or at least physician-assisted suicide, in the United Kingdom. Given the Belgian experience, what would you say is the most effective response to this movement.
My advice would be: Raise your voice in a dignified manner and listen to the critical testimonies and voices in Belgium and the Netherlands. It never can be wrong to stand for your principles: Psychiatrists opposing euthanasia in psychiatry have a 2,000-year-old Hippocratic tradition behind them. Physicians should heal, not kill their patients, especially not if they are not terminally ill!
It might be that in the end the ideology of autonomy and self-determination will become stronger, and perhaps will establish drastic changes in the law, like in Belgium. Keep saying what went wrong in Belgium; show that there are a lot of critical voices also in these countries. If a society makes room for euthanasia, there should remain physicians that testify and show that another medical culture is possible: A due care for mental suffering, where euthanasia is not a therapeutic option, because in fact it means the end of all therapy.