‘What could help me to die?’ Doctors clash over euthanasia

GHENT, Belgium (AP) — After struggling with mental illness for years, Cornelia Geerts was so desperate to die that she asked her psychiatrist to kill her.

Her sister worried that her judgment was compromised. The 59-year-old was taking more than 20 pills every day, including antidepressants, an opioid, a tranquilizer, and two medicines often used to treat bipolar disorder and schizophrenia.

About a year later, on October 7, 2014, her doctor administered a lethal dose of drugs. It was all legal procedure in Belgium, which has among the world’s most permissive euthanasia laws.

“I know it was Cornelia’s wish, but I said to the psychiatrist that it was a shame that someone in treatment for years could just be brought to the other side with a simple injection,” said her sister, Adriana Geerts.

Belgium is one of five countries that allow doctors to kill patients at their request, and one of two, along with the Netherlands, that grant the procedure for people with mental illness. The idea is that those with a psychiatric illness should be afforded the same rights as those suffering from a physical one.

“I always regret that we couldn’t do something else,” said Dr. Lieve Thienpont, one of the doctors who signed off on Geerts’ death. “At the same time, I’m part of the relief for the patient.”

Like many in Belgium and elsewhere, Thienpont, a respected psychiatrist and prominent euthanasia advocate, believes that when medicine can’t relieve suffering, euthanasia — when doctors actively kill patients — should be an option. And because psychological suffering can be harder to detect, doctors must take patients at their word.

“You can’t see it on a scan,” she said. “But we have to listen to the patient. We have to believe them because we can’t see (the suffering) always.”

Cases like Geerts and others have shown, though, how difficult it can be to strike a balance between respecting personal freedom and ensuring that people requesting euthanasia have the mental capacity to make that decision. Many, including Geerts’ sister Adriana, think society should try harder to help struggling people with issues they face in jobs and relationships.

Thienpont’s approach to managing euthanasia requests has raised concerns even among doctors who support the procedure for psychological suffering. According to copies of letters obtained by The Associated Press, those worries have led to a clash between Thienpont and Dr. Wim Distelmans, chairman of Belgium’s euthanasia review commission, that has not been publicly disclosed.

The documents do not include accusations that patients were killed who shouldn’t have been, but they suggest doctors may have failed to meet certain legal requirements in some cases. And they highlight how difficult it can be to judge whose pain should end in death.

Distelmans did not respond to requests by email and telephone for an interview. Thienpont described receiving Distelmans’ letter in February as “a very difficult moment” and said that she and members of Distelmans’ team were still working out how to resolve what she called “internal issues.”

In the countries where euthanasia is legal — Belgium, Canada, Colombia, Luxembourg and the Netherlands — the vast majority of cases are people with a fatal illness such as cancer who have only weeks or months to live.

To qualify for euthanasia in Belgium, people must meet a number of criteria, including proving they have “unbearable and untreatable” suffering. Among adults whose lives are ended for psychiatric reasons, the most common conditions are depression, personality disorder and Asperger’s syndrome, a mild form of autism.