Wednesday, 2 October 2013

Belgian euthanasia death for mental suffering - could happen under Tasmanian law

The UK Telegraph is reporting the death of a person in Belgium on the grounds of "unbearable psychological suffering".

Both the Telegraph and the Australian News.com.au headlined their articles that Nathan Verhelst was 'euthanised in Belgium after botched sex change'. This is a sensational headline; while materially it is true, as the articles explains, Verhelst was euthanased on the grounds of "unbearable psychological suffering" both as a result of a poor outcome of the operation and long standing psychological issues that stemmed back to childhood. Very sad.

The killing was conducted by a Dr Wim Distelmans, a cancer specialist who also killed the Belgian twins who were going blind last year. Marc and Eddy Verbessem looked for some time before they found a doctor who was willing to act - evidence of the phenomenon of doctor shopping. The articles do not indicate if Verhelst sought out Distelmans because of his earlier killing of the Verbessem brothers, but I think it fair to wonder at this, especially as Distelmans is an oncologist and not a psychiatrist or psychologist.

Distelmans defended his actions: "The choice of Nathan Verhelst has nothing to do with fatigue of life," said Dr Distelmans. "There are other factors that meant he was in a situation with incurable, unbearable suffering. Unbearable suffering for euthanasia can be both physical and psychological. This was a case that clearly met the conditions demanded by the law. Nathan underwent counseling for six months."

This was confirmed by Jacqueline Herremans, a member of the national euthanasia committee, who told RTL television that, 'he had been examined by two doctors, including a psychiatrist, to make sure he was not suffering from a temporary depression.'

When analysing any proposed bill, including the bill currently before the Tasmanian parliament, a legitimate line of thinking for parliamentarians and others is to consider the question: whom will this Act directly affect? Often in the realm of the hypothetical, it all depends upon the wording. 

Here's how the Belgium law is framed:
the patient is in a medically futile condition of constant and unbearable physical or mental suffering that can not be alleviated, resulting from a serious and incurable disorder caused by illness or accident;
As with the local hospital refusing the request of the Verbessem twins, clearly not all Belgian doctors are happy that their law allows for this, the Telegraph summarizing that, 'The case has revived the debate in Belgium over whether euthanasia should be given to those who are psychologically troubled or only to terminally ill patients. The country is also deciding if it should extend euthanasia to children.' 

So, how could the Tasmanian bill, if it were passed, look upon a request from someone in Verhelst's situation? The Voluntary Assisted Dying Bill 2013 is not restricted to terminally ill patients:

This from the Tasmanian Bill:
11. Eligible medical condition

(1) For the purposes of this Act, an eligible medical condition is an incurable and irreversible medical condition, whether caused by illness, disease or injury –
(a) that would result in the death of a person diagnosed with the medical condition and that is causing persistent and not relievable suffering for the person that is intolerable for the person; or
(b) that is a progressive medical condition that is causing persistent and not relievable suffering, for a person diagnosed with the medical condition, that is intolerable for the person –
and that is in the advanced stages with no reasonable prospect of a permanent improvement in the person’s medical condition.
Verhelst would qualify under subsection (b). He had a psychological condition which, in his opinion was not relievable and was intolerable. Clearly his condition had progressed and, at least for the simple reason that he had the medical condition since it developed in childhood, he was in an advanced stage of his illness.

The naysayers can argue that the Tasmanian bill was not intended for such cases (as clearly some are arguing in Belgium), and we can concede that this kind of scenario will not have been in the mind of the Premier, Lara Giddings or Nick McKim. Who could imagine such a scenario? We can be sure that the Belgian Parliament never did.

The naysayers, and reasonable rational people besides, may also recoil and say that Tasmanian doctors would never do that. But don't fall into the trap of thinking that the Belgians are that different from us. I doubt that many Belgians would see this any differently. But it happened.

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