Identifying the Person as the Problem: Euthanasia for Mental Illness

It was a practice that is foreign to most us today: The victim was executed for a crime committed against her. In the case of sexual defilement in which the woman was the victim, the woman was stoned to death in order to keep her uncleanliness out of the tribe. It seems barbaric to our modern-day sensitivities.

But, what if a woman wants to be punished for something done to her? What if she sees herself as too defiled to enter into the community? What if she thinks she should be killed?

Today victims of child sexual crimes and sexual assault are not put in jail or executed for being dirty. The Enlightenment brought with it the idea of autonomy, and with autonomy comes personal responsibility. The just response to sex crimes is to have the perpetrator tried and convicted in a court of law. However, in our modern world, the community’s responsibility toward the victim is a bit hazy. Dealing with the aftermath of sexual crimes, in particular, tends to be private and personal.

The Dutch Euthanasia Commission granted a 29-year-old woman permission to die by physician-assisted suicide. She suffered from post-traumatic stress from childhood sexual abuse that occurred from age 5 to 15. Among her mental health co-morbidities (because people with PTSD tend to express several types of symptoms), she had what was deemed “untreatable” anorexia due to depression and anxiety.

The Psychological Damage of Sex Crimes

In the up-coming issue of Salvo (Issue 37), I wrote the Casualty Report on sex trafficking. In doing the research for this report, one of the key ways that traffickers and pimps maintain control of their victims is by making them feel worthless. By shaming their victims through abusive and degrading tactics, the victim will not only lose her will to fight back, but she will lose hope for a way out. This is how pimps “train their victims.” Once the cycle of shame has begun, the victim will stay in the abusive relationship because she doesn’t believe she deserves better. Even once she is out of the abusive situation, she will often engage in self-harm as a way to cope with her deep-seated sense of worthlessness.

In his book Shame Interrupted Ed Welch says that “any sexual violation brings shame on the victim…it should be bring shame on the perpetrator” (Welch, 14). Shame is something far deeper and more intense than guilt. It is dehumanizing. Welch defines shame as

[Y]ou were disgraced because you acted less than human, you were treated as if you were less than human, or you were associated with something less than human, and there are witnesses. (Welch, 2)

The 29-year-old woman was treated as something less than human for most of her childhood. When she was approved for physician-assisted suicide, she was treated as less than human then, too.

PTSD Is NOT Incurable

In an op-ed for TIME online, Joan Cook, a trauma psychiatrist, says that “No provider anywhere should ever tell a trauma survivor that their condition is incurable.” She points out that treatment can be hard and it can take a long time, but it is not incurable.

In a Huffington Post article by Jenni Schaefer, author and survivor of sexual abuse, she attests that she was not competent to make a rational and informed decision about physician-assisted suicide while in the throes of her mental illness. The feelings of hopelessness, she says, are part of the illness.

In The Netherlands, one of the criteria for approval for physician-assisted suicide is that the patient must be competent to make the decision. How can she be both rational and competent and have an “incurable” mental illness?

Jenni’s mentor and PTSD expert, Dr. Tim Brewton, said that it is the obligation of the therapist to instill hope. He says that from a clinical perspective,

I do not believe in ever giving up on an individual’s potential for recovery. In fact, I think it is the duty of a doctor or therapist to instill hope of improvement, particularly in a young person. One very important lesson that I have learned over the years is that I can never predict who will improve and who will not. I have been proven wrong too many times, and we cannot see the future. It is better to be present in the moment with patients and to do one’s best to help them sit with their discomfort and move forward in all ways possible.

Shame consumes a person until the person is completely gone. Welch points out that the deep logic of anorexia, which the woman suffered from, is that the person feels unworthy and deserves nothing, so she gives herself nothing and perhaps she can just disappear (Welch, 28). This woman felt unworthy of life and the Dutch Euthanasia Commission agreed with her.

Autonomy and Compassion

Sexual crimes violate the person, not only physically, but also mentally. It is the ultimate expression of treating another as an inhuman piece of meat, a means to an end. If the victim survives the attack, she is not free; she is in mental bondage. Her autonomy has been stripped from her. Killing her is not honoring her freedom to choose when and how she will die. It is honoring the perpetrator’s original intent, which is to consume and discard.

Our enlightened and progressive culture has a habit of “solving” the problem by getting rid of the person, whether it is the unborn, the disabled, or the mentally ill. The problem of suffering is solved by eliminating the sufferer. This is sanitized by calling it “compassionate” and justified by invoking autonomy. If Western countries, like The Netherlands, really do value freedom and autonomy, then true freedom means helping the victim out of her mental bondage by showing her the love and dignity that she doesn’t think she deserves.

Note: After writing this post, I came across this column by Clare Allen in The Guardian, (“The label ‘incurable’ is not a justification for ending a life”). In it, she makes several observations about mental illness and euthanasia including a point that should be more obvious than it apparently is: “It seems to me that anyone who has lived through 10 years of sexual abuse may benefit more from being listened to than labelled.”

Loneliness, Depression, and Euthanasia


Loneliness is part of the trifecta of modern angst (along with boredom and fragmentation).

A recent study published in JAMA Psychiatry looked at physician-assisted suicide (PAS) cases in Belgium that were approved because the patient had an unbearable psychiatric illness. The study found that in more than half of the cases, the patient declined treatment that could have helped. Often the patient sought approval for euthanasia after visiting with a doctor for the first time, some patients even visiting a mobile clinic that is funded by a euthanasia group. Forty-six of the 66 cases were women. Importantly, loneliness was cited as a common theme.

You can read the research article here, available by subscription, and the New York Times article here.

Last year, Rachel Aviv wrote a poignant and insightful article in The New Yorker on euthanasia for non-terminal people in the Netherlands. In it she recounts the story of Tom whose mother suffered from depression and eventually elected to undergo euthanasia. Tom did not know about it until after the fact and was angry that he was not called so he could talk to his mother. His mother died with three photographs in her pocket: one of her holding Tom as a baby, one of her feeding her granddaughter ice cream, and one of her and her daughter in a field. She had just broken up with her boyfriend and was estranged from her daughter. Tom and his wife could visit her sometimes, but career and children took much of their time. Furthermore, her lifelong struggle with depression and inability to form close relationships contributed to her isolation. She was lonely and she elected to die alone.

Loneliness is pervasive. This is not the idea of someone being by themselves. Many people can be alone and not be lonely. Also, many people can go to parties, have friends, and still feel utterly alone. As social commentators have pointed out, loneliness is part of the trifecta of modern angst: loneliness, boredom (hyperboredom) and fragmentation. Greg Monbiot in an insightful column in The Guardian dubs our time as the “Age of Loneliness.” One of the Dutch psychologists mentioned in Rachel Aviv’s article says that euthanasia for psychiatric disorders is a response to the nihilism pervasive in the Dutch culture. He says that people ask “What is life worth when there is no God?” or “What is life worth when I am not successful?”

In Japan, the incidence of dying alone, and sometimes not being discovered for weeks, has become so common that the Japanese have a word for it: kodokushi. There is an entire industry dedicated to cleaning after the discovery of someone who has died a lonely death with no friends or relatives. In Japan, many of these lonely deaths are men who had dedicated their lives to their jobs only to be laid off or forced into early retirement. They had no relationships outside of work. Their jobs were the essence of their identity. Without it, they were lost.

A 2014 report showed that loneliness has greater negative health effects than obesity, and a Washington Post article from this past January reported more studies on the health effects of loneliness. In sum, scientists have found that loneliness leads to physiological changes and is more damaging to one’s health than cigarettes, diabetes, and obesity. Studies have shown a correlation between loneliness and early death, onset of Alzheimer’s and dementia, and increased risk for cancer and heart attacks. This is likely due to increased activity in genes that cause inflammation coupled with decreased activity in genes that produce antibodies.

Canada recently legalized physician-assisted suicide, and in the U.S., California recently joined Oregon, Vermont, Washington, and Montana as states where PAS is legal. Most of these places have stringent guidelines for who qualifies for euthanasia. The U.S. laws specify that the patient have a terminal illness and some of them require that the patient have less than six months to live. While “slippery slope” arguments can sometimes be spurious, in this case, we do have two examples of what happens when suicide is medicalized and re-framed as a dignified death. Belgium and The Netherlands continue to open up euthanasia to more and more people. They are not required to be terminal and the age limit continues to decrease with some advocating for no age limit for qualifying for euthanasia.

But, if loneliness is a pervasive problem in our culture, medically-endorsed suicide does little to help and may contribute to the sense of isolation. There was a time when suicide was a cry for help. Now, for the depressed and lonely, it affirms their fears that they are unwanted. Mother Teresa is quoted as saying that “the biggest disease today is not leprosy or cancer or tuberculosis, but rather the feeling of being unwanted, uncared for and deserted by everybody.” Rather than trying to care for people who are struggling, doctors are helping lonely people to end it all. Suicide is not a “solution” for someone struggling with a mental health issue. It is abandoning someone in their time of need.

See also:
Dutch Treatment: A Eureka Moment for Holland’s Medical Ethics
Daily Killings: Euthanasia Grows in Deepest Darkest Belgium
Dr. Phillip Nitschke and the Reinvention of Assisted Suicide

What Is Natural?

For several weeks now I have been trying to write about the Nuffield Bioethics Report called (un)Natural. The Nuffield Bioethics Council is a non-partisan bioethics think tank that analyzes particular issues of importance in science, medicine, and technology. They are based in the UK and have some influence over policy issues because of their presence in the mainstream media.

Their report with the longer title of “Ideas about naturalness in public and political debates about science, technology, and medicine,” analyzes the various ways that the terms “natural,” “unnatural,” and “nature” are used in the media, in journal articles, and in other venues. They are particularly concerned with how those terms shape people’s perceptions of new technologies. They solicited the help from experts in language and had poetry readings.

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Eggsploitation: The Movie

Eggsploitation-poster-01-med The infertility industry has grown into a multi-billion dollar business in the United States. Its primary commodity is human eggs.
Young women are solicited by ads on college
campus bulletin boards, social media, and online classifieds which offer them up
to $100,000 for their “donated” eggs. They will “help make someone’s dream come
true” they're told.

But what about the target of the solicitation, the potential egg donor? Is she treated justly? What are the
short- and long-term risks to her health? Are these issues even discussed?

They should be. Here's a good place to start. Eggsploitation, produced by the Center for Bioethics and Culture, examines this booming business through the tragic and revealing stories of real women who became
involved in it and whose lives were permanently altered because of it. 

National Director Jennifer Lahl will be offering the first preview screening of Eggsploitation this Thursday, July 8th, at 7:00pm at the Covenant Presbyterian Church, 2012 W Dickens Avenue, Chicago, IL 60647. Screening is free. College students are especially invited.