Zoraya ter Beek, 28, living in the Netherlands, will receive euthanasia this May after requesting it for suffering from various mental health problems such as autism, borderline personality disorder and depression. This decision was made, despite not suffering from any terminal illness, when her psychiatrist informed her that he could no longer help her cope with her suffering. “I was always very clear that if it doesn’t get better, I can’t do this anymore” explains the young woman.

This Dutch woman requested euthanasia three years ago and, since then, has received approval from three psychiatrists to access assisted suicide. These experts have ruled that her illness is incurable. The first approval came in July, the second in August, and Ter Beek has just received the third, after which she has decided to choose a date next month to die.

The American Psychiatric Association (APA) defines borderline personality disorder (BPD) as a personality disorder characterized by a long-standing pattern of instability in mood, interpersonal relationships, and self-image that is severe enough to cause extreme distress or interfere with social and occupational functioning.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), autism is characterized by Persistent deficits in social communication and social interaction (as well as restricted, repetitive patterns of behavior, interests, or activities).

One of the conditions for a patient to be granted euthanasia in the Netherlands is that he must be mentally competent and able to make informed decisions. But do these conditions occur in the case of patients with serious psychiatric problems?

5% of deaths due to euthanasia

In 2001, the Netherlands became the first country to legalize euthanasia in the world. Since then, the number of requests for assisted suicide has continued to increase. In 2022, 8,720 deaths from this cause were documented, that represents an increase of 13.7% compared to 2021, with 7,666 cases, which represents 5% of the total deaths registered in the country.

Patients with terminal illnesses and psychiatric disorders such as depression or exacerbated anxiety are the ones who most frequently request euthanasia.

Death as a default option

Stef Groenewoud, a health ethicist at the Theological University of Kampen in the Netherlands, says that “I’m seeing euthanasia as some sort of acceptable option brought to the table by physicians, by psychiatrists, when previously it was the ultimate last resort… I see the phenomenon especially in people with psychiatric diseases, and especially young people with psychiatric disorders, where the healthcare professional seems to give up on them more easily than before.”

Theo Boer, a healthcare ethics professor at Protestant Theological University in Groningen, participated in a euthanasia review board in the Netherlands between 2005 and 2014, and noted that: “in those years, I saw the Dutch euthanasia practice evolve from death being a last resort to death being a default option.”

Bioethical assessment

The slippery slope, which we have previously analyzed, reaches dramatic heights in countries where euthanasia has been legalized for the longest time. The abandonment of patients leads them to the euthanasia option, which becomes another option in the approach to chronic, incurable processes or psychiatric disorders.

The failure of medicine is evident in cases like the one at hand, where specialists renounce the care of their patients by making causing their death a clinical option.

In Spain, where the implementation of effective regulation of palliative care continues to be neglected, the same path has been taken since the legalization of euthanasia. It is foreseeable that the requirements for its application will be relaxed, as is already happening in countries with a longer tradition in this regard.

Julio Tudela and Paloma Aznar

Bioethics Observatory – Institute of Life Sciences

Catholic University of Valencia

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