Ghent, Belgium : Belgian authorities are investigating the euthanasia of a 38-year-old woman with autism on the suspicion of poisoning after her family alleged there were irregularities in her death.
Doctors who euthanized Belgian woman Tine Nys in 2010 will face an investigation and have been referred to the Court of Assize in Ghent. It is the first criminal investigation into a euthanasia case since Belgium legalized aid-in-dying in 2002.
Belgium allows doctors to euthanize persons with psychiatric ailments if they prove they face “unbearable and untreatable” suffering. The Netherlands also allows euthanasia for those “experiencing unbearable suffering with no prospect of improvement.” It permits patients as young as 12 years old to request euthanasia with the consent of a parent or guardian.
Nys’s family filed a criminal complaint in 2017, alleging Tine’s euthanasia was granted too easily, according to the AP.
“She knew that if she wasn’t diagnosed with autism or Asperger’s that she would not have a chance (of being euthanized),” Sophie Nys said, explaining her sister was intent on doing anything, even manipulating the qualification test, in order to be euthanized.
The complaint also alleged the doctors involved in Nys’s death clumsily administered the lethal medication and asked the family to check for a pulse.
Dr. Lieve Thienpont approved Nys’s request to be euthanized and has reportedly sought to impede investigation into her death.
“We must try to stop these people,” Thienpont reportedly wrote. “It is a seriously dysfunctional, wounded, traumatized family with very little empathy and respect for others.”
Colleagues have admitted Thienpont is more likely to approve euthanasia requests than other doctors.
Dr. Wim Distelmans leads Belgium’s euthanasia review commission and said Thienpont might not have adhered to legal regulations when approving requests for euthanasia and administering lethal drugs, the AP reported. Distelmans also said he won’t accept any patients referred to him by Thienpont.
Aside from Belgium, euthanasia is also legal in Canada, Colombia, Luxembourg and the Netherlands. Only Belgium and the Netherlands allow it for people with mental illness. In most cases, euthanasia is performed in people with a fatal illness like cancer who have only weeks to live.
Euthanasia is not permitted in the U.S., but six states and Washington D.C. allow assisted suicide, where doctors provide people with a deadly dose of medication. People must be terminally ill and the procedure is forbidden for psychological suffering.
More than 10,000 people have been euthanized since the practice became legal, according to the AP, and euthanasia requests due to mental illness in Belgium are often from patients with depression, personality disorders or Asperger’s.
The number of people euthanized in the Netherlands rises every year, according to Reuters. The rate of death by euthanasia was 4.4 percent — 6,585 deaths — in 2017.
California, Colorado, Oregon, Vermont, Hawaii, Montana and Washington permit physician-assisted suicide for terminally ill adult patients.
No trial date has been chosen.
This follows earlier related news in which Belgian doctors clashed over euthanasia for mentally ill.
Doctors clash over euthanasia for mentally ill
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 Geerts’ judgment was compromised. The 59-year-old was taking more than 20 pills a day, including antidepressants, an opioid, a tranquilizer, and two medicines often used to treat bipolar disorder and schizophrenia.
But about a year later, on October 7, 2014, Geerts received a lethal dose of drugs from her doctor.
“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, who believes society should try harder to accommodate the mentally ill.
Cases like Geerts reveal how difficult it can be to navigate the boundary between individual freedom and protecting vulnerable patients when it comes to euthanasia.
Such cases have fueled a clash between leading euthanasia practitioners that suggests doctors may have failed to meet certain legal requirements in some euthanasia cases — although there is no implication that patients were killed improperly.
“I always regret that we couldn’t do something else,” said Dr. Lieve Thienpont, one of the psychiatrists who signed off on Geerts’ death. “At the same time, I’m part of the relief for the patient.”
Like many in Belgium, Thienpont believes that when modern medicine can’t relieve pain, euthanasia — when doctors actively kill patients — should be an option. But Thienpont appears more inclined than most to approve euthanasia, some colleagues say.
According to figures that she has published, some doctors believe Thienpont and colleagues at her clinic may have been responsible for up to 40 percent of euthanasia deaths among psychiatric patients in Belgium from 2007 to 2011. Of the approximately 2,000 euthanasia deaths every year, about 40 are psychiatric patients.
The way she manages her euthanasia requests led to a rift earlier this year with Dr. Wim Distelmans, chairman of Belgium’s euthanasia review commission.
Distelmans and his fellow practitioners said they were being used as a rubber stamp to approve patients referred by Thienpont.
Belgium requires that people seeking euthanasia for psychiatric reasons get an independent consultation from at least two other doctors. The doctors don’t have to agree; the law only says that the objective assessments must be sought.
“We found several times that you had already made promises to patients that were referred to us,” Distelmans and colleagues wrote, complaining that such “promises” undermined their own attempts to engage with patients and determine if euthanasia was justifiable.
“We want to distance ourselves from this way of working,” Distelmans wrote, adding they would no longer accept patients from Thienpont.
Thienpont said the letter raised problems only about how patients were referred, not how she and colleagues were practicing euthanasia. She also blamed the patients for not describing events accurately.
“These patients are very desperate, stressed,” she said. “They say things that are not always correct.”
Some experts said the split between Thienpont and Distelmans raises alarms about euthanasia in Belgium, especially since the dispute has not been publicly disclosed by the commission overseeing it.
“That suggests some cases of euthanasia have proceeded that have not met the statutory, legal requirements,” said Penney Lewis, co-director of the Centre of Medical Law and Ethics at King’s College London. “The idea that this is happening behind closed doors is very worrying.”
Distelmans did not respond to repeated requests for an interview.
Mental health experts say balancing the finality of euthanasia with the transient nature of many psychiatric illnesses is extraordinarily difficult.
“I’m convinced that in Belgium, people have died where there were still treatment options and where there was still a chance for years and even decades of (quality) life,” said Dr. Joris Vandenberghe, a psychiatrist at the University of Leuven, who is working on new euthanasia guidance for the Flemish Psychiatric Association.
Some patients, though, say that euthanasia can save lives.
Amy De Schutter, who endured years of failed treatment at psychiatric institutions, spent months deliberating the best way to kill herself. She had already picked the day of her suicide, but one month before her intended death last year, she was approved for euthanasia.
“It felt like 10,000 kilos was just (lifted),” De Schutter said. Being cleared to legally die at home was comforting enough that De Schutter didn’t set an immediate date for euthanasia.
But for some bereaved relatives, the loss of their loved one is compounded by a belief that doctors should have focused on keeping patients alive.
“I think if the doctors had tried to help (my sister) more or proposed other things, she might have felt there was another solution,” said Adriana Geerts, who accompanied her sister to the euthanasia clinic despite her own misgivings.
“I wish there had been another way,” Geerts said.
Image : Psychiatrist Dr. Lieve Thienpont