What is ‘assisted’ dying?
Thousands of suffering people, most of
them in Europe, are given lethal drugs
each year to end their lives under a doc-
tor’s care. When the debate over the issue
gained prominence in the 1990s, the medi-
cal community drew a distinction between
euthanasia, when a doctor administers
an injected dose to a person too ill to
swallow drugs, and assisted suicide, in
which the patient performs the deed. Since
then, “assisted dying” has emerged as an
umbrella term. The Netherlands was the
first country to legalize the process, in
2002, followed closely by Belgium; the
Dutch now see upwards of 6,000 assisted
deaths annually, and Belgium had more than 2,600 last year. When
it was first made legal, doctor-assisted death was seen as a way to
spare terminally ill, pain-racked patients unnecessary suffering in
their final days. But definitions of what kind of anguish is unbear-
able have in many cases widened over time, leading to debate about
when a doctor is justified in helping a patient die.Where is it legal?
The Netherlands, Belgium, Luxembourg, Canada, Switzerland, and
Colombia. And last month, German courts overturned a 2015 law
prohibiting assisted suicide, and the Portuguese parliament passed a
bill to legalize it, although that bill has yet to be signed into law. In
Australia and the U.S., the practice is legal in certain states. Patients
sometimes cross borders in pursuit of aid in dying; since 2017,
when Anne Bert, a French novelist suffering from the degenerative
neurological disorder Charcot disease, publicized her intention to
end her life in Belgium at age 59, Belgian clinics have seen a sharp
increase in requests from French patients. We now get “one or two
calls per week, compared with one every six months before,” said
Dr. François Damas. Most patients who desire the service, though,
are too ill to travel for the necessary con-
sultation, second opinion, and mandatory
waiting period.How are the criteria expanding?
Both Belgium and the Netherlands began
allowing assisted suicide in 2002 for
patients in “constant and unbearable
physical or psychological pain” attested
to by at least two doctors. The first
to die that way were terminal cancer
patients. But over the years, the crite-
ria for “psychological pain” has been
applied more and more broadly, and to
more people without terminal illness.
The Belgian law was expanded in 2014
to include minors, who must get their
parents’ permission to end their lives. In
2015, of the 2,022 patients who opted
for euthanasia in Belgium, 299 did not
have fatal illness. One case that drew
debate and criticism in Belgium was that
of deaf twins Marc and Eddy Verbessem,
45, who chose to die in 2012 because
they were going blind and would soonbe unable to communicate with each
other. Of the 6,585 assisted deaths in
the Netherlands in 2017, 83 cases cited
psychiatric suffering alone.Are there accusations of overuse?
Some activists say that helping depressed
people kill themselves is not compas-
sionate care. “Almost all serious psychi-
atric patients think that their situation is
‘unbearable’ and ‘without perspective,’”
says René Stockman, a priest and men-
tal health expert with the Catholic order
Brothers of Charity, citing the legal
criteria patients must meet. There have
also been highly publicized concerns
over possible revocation of consent. In 2016, a Dutch dementia
patient, 74, who had said in an advance directive written several
years earlier that she would rather die than go into a nursing home,
was sedated before being injected with a deadly drug cocktail. The
woman, who was no longer lucid enough to understand what was
happening, was restrained by her family when she woke up and
began struggling during the procedure. Her physician, who was not
named in court, became the first in the Netherlands to be tried for
improper euthanasia; the doctor was acquitted last year.How do supporters respond?
Supporters of assisted dying say that the safeguards are adequate,
or even too onerous. They argue that thousands of nursing home
patients—reliable statistics are impossible to come by—starve
themselves to death each year. Canadian doctor Ellen Wiebe had a
102-year-old patient so desperate to end her agonizing spinal pain
that she tried to kill herself in her nursing home using a pair of
scissors. “This woman was clearly not depressed,” Wiebe said. “I
was so grateful that I could honor her wishes and end her suffering
on her terms.” Dignitas, the Swiss nonprofit founded in 1998 that
has helped more than 3,000 people
die surrounded by loved ones, says
that its services are far preferable to
letting ill people “make a lonely, risky
suicide attempt.”What is the trend in the U.S.?
Oregon was the first state to legalize
assisted dying, in 1997; since then
California, Colorado, Hawaii, New
Jersey, Washington, Vermont, and
the District of Columbia have fol-
lowed. Activists point to Oregon as
evidence that legalization need not
lead to a slippery slope of expanded
criteria. Oregon’s standards have not
changed: Candidates must have a
terminal illness that will cause death
within six months, be over 18 and
mentally competent, and be able to
take the life-ending medication them-
selves. The practice remains relatively
rare; in 2018, 168 people in Oregon
died by assisted suicide.Briefing NEWS^11
In Switzerland, a room ready for a 104-year-old’s deathThe spread of assisted suicide
AP
The case of Tine Nys
Belgium’s first criminal case concerning eutha-
nasia was resolved Jan. 31, when three doc-
tors were acquitted of unlawfully poisoning
Tine Nys, 38, a heroin addict who had suffered
from depression for years and had attempted
suicide several times. Her parents and sister,
present at her death in 2010, said she had not
received adequate mental health treatment
before her decision. Her sister, Sophie, said Nys
may have manipulated the system by faking the
tests to obtain an autism diagnosis. Because
autism is “incurable and chronic,” it meets one
of Belgium’s legal requirements for euthanasia.
Nys’ own psychiatrist refused her permission
for assisted suicide; the doctor who approved it,
Lieve Thienpont, diagnosed her with Asperger’s
syndrome and gave the go-ahead after meeting
her just three times. But doctors said all proce-
dures had been followed correctly, and the jury
deliberated just eight hours before acquitting.
Witnesses, including Nys’ friends, said she had
been “determined to die.”As more doctors help patients die, a debate rages over what constitutes ‘unbearable suffering.’