A psychiatrist overstepping their qualifications by saying “It’s never gonna get any better” ((particularly when the source of the suffering is at least partly BPD, for which it’s commonly known that symptoms can get better in someone’s 40s)) clearly should never happen.
However, I’d imagine that most mental health professionals would be extremely careful when making statements about whether there’s hope for things to get better. In fact, there are probably guidelines around that.
Maybe it didn’t happen this way at all: I notice I’m confused.
This could just be careless reporting by the newspaper.
The article says:
She recalled her psychiatrist telling her that they had tried everything, that “there’s nothing more we can do for you. It’s never gonna get any better.”
Was it really the psychiatrist who added “It’s never gonna get any better,” or was it just that the psychiatrist said “There’s nothing more we can do for you,” and then Zoraya herself (the person seeking assisted suicide) told the reporters her conclusion “It’s never going to get any better,” and the reporters wrote it as though she ascribed those words to the psychiatrist?
In any case, this isn’t a proper “watch” (“assisted suicide watch”) if you only report when you find articles that make the whole thing seem slippery-slopy. (And there’s also a question of “how much is it actually like that?” vs “How much is it in the reporting” – maybe the reporter had their own biases in writing it like that. For all we know, this person, Zoraya, has had this plan for ever since she was a teenager, and gave herself 25 years to stop feeling suicidal, and now it’s been enough. And the reporter just chose to highlight a few things that sound dramatic, like the bit about not wanting to inconvenience the boyfriend with having to keep the grave tidy.)
I feel like the response here should be: Think hard about what sorts of guidelines we can create for doctors or mental health professionals to protect against risks of sliding down a slippery slope. It’s worth taking some risks because it seems really bad as well to err in the other direction (as many countries and cultures still do). Besides, it’s not straightforwardly evidence of a slippery slope simply because the numbers went up or seem “startling,” as the article claims. These developments can just as plausibly be viewed as evidence for, “startlingly many people suffer unnecessarily and unacceptably without these laws.” You have to look into the details to figure out which one it is, and it’s gonna be partly a values question rather than something we can settle empirically.
There are other written-about cases like Lauren Hoeve quite recently, also from Netherlands, who’d suffered from debilitating severe myalgic encephalomyelitis (ME) for five years and began her assisted suicide application in 2022. Anyone interested in this topic should probably go through more of these accounts and read sources directly from the people themselves (like blogposts explaining their decision) rather than just media reporting about it.
Theo Boer, a healthcare ethics professor at Protestant Theological University in Groningen, served for a decade on a euthanasia review board in the Netherlands. “I entered the review committee in 2005, and I was there until 2014,” Boer told me. “In those years, I saw the Dutch euthanasia practice evolve from death being a last resort to death being a default option.” He ultimately resigned.
I found a submission by this Theo Boer for the UK parliament, where he explains his reasons for now opposing euthanasia in more detail.
He writes:
It is well known that British advocates of assisted dying argue for a more restricted law than is found in the low countries. Here is my prediction: any law that allows assisted dying will come to be experienced as an injustice and will be challenged in the courts. Why only euthanasia for terminally ill patients, who have access to an ever widening array of palliative care and whose suffering will be relatively short, whereas chronic patients may suffer more intensely and much longer? Why exclude psychiatric patients, many of whom are suffering most heartbreakingly of all? Why only an assisted death for people suffering from a disease, and not for those suffering from irremediable meaninglessness, alienation, loneliness, from life itself? We are presently seeing how in the years 2016-2023 Canada’s Medical Assistance in Dying (MAiD), from being euthanasia for terminal patients only, has evolved into an assisted death for patients whose chronic disease has become unbearable due to shortage of healthcare(Douthat 2022).
This is a “slope” of sorts, but I think it’s not a bad one. The arguments for extending the practice all seem reasonable. What matters is, “are people suffering?” and, “are they right that there’s not enough hope for them to justify continued suffering?”
Regarding pressure/being pressured, I thought this part was interesting:
This brings me to the second question: how to protect vulnerable citizens? Different from what is presently going on in Canada, I do not yet see a specific risk for citizens who by many are considered vulnerable – homeless, underinsured, people on welfare, people with disabilities. Although these groups are present in those who get euthanasia in the Netherlands, it is not my impression that they are overrepresented. If any group is well represented in the euthanasia numbers, it is the better-off, the healthy-aging population, the higher educated. In our research on practice variation, we found that in regions where the average experienced health is higher, the euthanasia numbers are also higher. In places where people on average are better off, obviously serious threats to their wellbeing tend to be more often a reason for a euthanasia request than in places where people are more used to dealing with life’s different hardships. This leads me to adopt a different definition of vulnerability, a vulnerability that may be found in all social and economic groups, from top to bottom: one of despair, meaninglessness, social isolation, feeling redundant. It may apply to wealthy citizens in a villa with woodblock floors and a grand piano, whose children have their businesses elsewhere and whose friends are either dead or institutionalized, just as much as to a single disabled woman on welfare. Anyone under this shadow of despair may make a euthanasia request, and there is no way a government can prevent this kind of vulnerability to motivate a euthanasia request, since the autonomous citizens are not under any other pressure than their own, that is, their own incapacity to face life’s harder episodes. “Life has always been a feast for me,” an elderly man whose euthanasia I assessed, “and that’s how it should end for me.”
I’d be curious to figure out why it is exactly that requests for euthanasia are higher in demographs where people tend to be better off/suffering less.
That said, I’m not at all convinced that this would prove that there’s something horribly wrong going on with these developments after legalization of assisted suicide. (Still, I’d be curious to investigate this further.)
Reading this account, it feels to me like Theo Boer has a problem with death intrinsically, as opposed to only having a problem with death when a person has for-themselves good/strong reasons to continue to want to live. That’s not an outlook I agree with.
“Their own incapacity to face life’s harder episodes” is a question-begging phrasing. For all we know, many people who choose assisted suicide would voluntarily chose to continue with their suffering if there was more at stake that they cared about! For instance, if they learned that by continuing to suffer, they’d solve world poverty, they might continue to suffer. It seems wrong, then, to say they’re “incapable,” when the real reason is more about how they don’t want it enough. It’s their life, so their decision.
“Since the autonomous citizens are not under any other pressure than their own” – this is also an interesting perspective. He seems to be conceding that no matter how much society and relatives try to reassure chronically ill or disabled elderly people that they’re still valued and cared about (something we absolutely must emphasize or work towards if it isn’t everywhere the case!), those people will struggle with worries of being a burden. That’s unfortunate, but also very natural. It’s how I would feel too. But people who feel that way don’t necessarily jump right towards considering assisted suicide! Consider two different cases:
You still enjoy life/are happy.
You have been feeling suicidal for many years, and there’s no realistic hope for things to get better.
In which of these cases is “worries about being a burden” (even if you know on some level that these worries probably don’t accurately reflect the reality of the views of your caretakers or loved ones) a bigger reason to sway your decision towards wanting euthanasia? Obviously, it is in the second case, where you lack positive reasons to stay alive, so negative reasons weigh more comparatively, even if they’re quite weak in absolute terms. In fact, what if “what will other people think” had been the primary motivation that kept you wanting to live for a long time, as long as you could provide more value for your relatives or loved ones? Is there not also something disconcerting about that? (To underscore this point, many people who are depressed write that the main reason they don’t consider suicide more seriously is because of what it would do to their relatives and loved ones. If you want to see for yourself, you can read reddit threads on this for examples of people’s suicidal ideation.)
“Life has always been a feast for me,” an elderly man whose euthanasia I assessed, “and that’s how it should end for me.”
This quote comes at the end of a passage that was all about “pressure,” but it has nothing to do with pressure anymore, nor does it have to do with being “incapable of facing life’s hardship.” Instead, it just sounds like this person disagrees about the view that “facing life’s hardship” for no upside is something that’s a virtue or otherwise important/right to do. This is more like an expression of a philosophy that life can be completed (see also the ending of the series ‘The Good Place,’) or, somewhat differently, that there’s no need to prolong it after the best (and still-good) times are now over. If that’s someone’s attitude, let them have it.
Overall, I respect Theo Boer for both the work he’s done for terminally ill patients in the early stages of the assisted suicide program in the Netherlands and for speaking out against the assisted suicide practice after it went in a direction that he no longer could support. At the same time, I think he has an attitude towards the topic that I don’t agree with. In my view, he doesn’t seem to take seriously how bad it is to suffer, and especially, how bad and pointlesss it is to suffer for no good reason.
It might well be true that doctors and mental health professionals are now okay with assisted suicide as a solution too quickly (without trying other avenues first), but I’m not sure I’d trust Theo Boer’s judgment on this, given the significant differences in our points of view. In any case, I acknowledge this is a risk and that we should take steps to make sure this doesn’t occur or doesn’t become too strong of an issue (and people who decide to go through with it should be well-informed about other options and encouraged to try these other options in case they haven’t already been doing this to no success for many years).
A psychiatrist overstepping their qualifications by saying “It’s never gonna get any better” ((particularly when the source of the suffering is at least partly BPD, for which it’s commonly known that symptoms can get better in someone’s 40s)) clearly should never happen.
However, I’d imagine that most mental health professionals would be extremely careful when making statements about whether there’s hope for things to get better. In fact, there are probably guidelines around that.
Maybe it didn’t happen this way at all: I notice I’m confused.
This could just be careless reporting by the newspaper.
The article says:
Was it really the psychiatrist who added “It’s never gonna get any better,” or was it just that the psychiatrist said “There’s nothing more we can do for you,” and then Zoraya herself (the person seeking assisted suicide) told the reporters her conclusion “It’s never going to get any better,” and the reporters wrote it as though she ascribed those words to the psychiatrist?
In any case, this isn’t a proper “watch” (“assisted suicide watch”) if you only report when you find articles that make the whole thing seem slippery-slopy. (And there’s also a question of “how much is it actually like that?” vs “How much is it in the reporting” – maybe the reporter had their own biases in writing it like that. For all we know, this person, Zoraya, has had this plan for ever since she was a teenager, and gave herself 25 years to stop feeling suicidal, and now it’s been enough. And the reporter just chose to highlight a few things that sound dramatic, like the bit about not wanting to inconvenience the boyfriend with having to keep the grave tidy.)
I feel like the response here should be: Think hard about what sorts of guidelines we can create for doctors or mental health professionals to protect against risks of sliding down a slippery slope. It’s worth taking some risks because it seems really bad as well to err in the other direction (as many countries and cultures still do). Besides, it’s not straightforwardly evidence of a slippery slope simply because the numbers went up or seem “startling,” as the article claims. These developments can just as plausibly be viewed as evidence for, “startlingly many people suffer unnecessarily and unacceptably without these laws.” You have to look into the details to figure out which one it is, and it’s gonna be partly a values question rather than something we can settle empirically.
There are other written-about cases like Lauren Hoeve quite recently, also from Netherlands, who’d suffered from debilitating severe myalgic encephalomyelitis (ME) for five years and began her assisted suicide application in 2022. Anyone interested in this topic should probably go through more of these accounts and read sources directly from the people themselves (like blogposts explaining their decision) rather than just media reporting about it.
You also quote this part of the article:
I found a submission by this Theo Boer for the UK parliament, where he explains his reasons for now opposing euthanasia in more detail.
He writes:
This is a “slope” of sorts, but I think it’s not a bad one. The arguments for extending the practice all seem reasonable. What matters is, “are people suffering?” and, “are they right that there’s not enough hope for them to justify continued suffering?”
Regarding pressure/being pressured, I thought this part was interesting:
I’d be curious to figure out why it is exactly that requests for euthanasia are higher in demographs where people tend to be better off/suffering less.
That said, I’m not at all convinced that this would prove that there’s something horribly wrong going on with these developments after legalization of assisted suicide. (Still, I’d be curious to investigate this further.)
Reading this account, it feels to me like Theo Boer has a problem with death intrinsically, as opposed to only having a problem with death when a person has for-themselves good/strong reasons to continue to want to live. That’s not an outlook I agree with.
“Their own incapacity to face life’s harder episodes” is a question-begging phrasing. For all we know, many people who choose assisted suicide would voluntarily chose to continue with their suffering if there was more at stake that they cared about! For instance, if they learned that by continuing to suffer, they’d solve world poverty, they might continue to suffer. It seems wrong, then, to say they’re “incapable,” when the real reason is more about how they don’t want it enough. It’s their life, so their decision.
“Since the autonomous citizens are not under any other pressure than their own” – this is also an interesting perspective. He seems to be conceding that no matter how much society and relatives try to reassure chronically ill or disabled elderly people that they’re still valued and cared about (something we absolutely must emphasize or work towards if it isn’t everywhere the case!), those people will struggle with worries of being a burden. That’s unfortunate, but also very natural. It’s how I would feel too. But people who feel that way don’t necessarily jump right towards considering assisted suicide! Consider two different cases:
You still enjoy life/are happy.
You have been feeling suicidal for many years, and there’s no realistic hope for things to get better.
In which of these cases is “worries about being a burden” (even if you know on some level that these worries probably don’t accurately reflect the reality of the views of your caretakers or loved ones) a bigger reason to sway your decision towards wanting euthanasia? Obviously, it is in the second case, where you lack positive reasons to stay alive, so negative reasons weigh more comparatively, even if they’re quite weak in absolute terms. In fact, what if “what will other people think” had been the primary motivation that kept you wanting to live for a long time, as long as you could provide more value for your relatives or loved ones? Is there not also something disconcerting about that? (To underscore this point, many people who are depressed write that the main reason they don’t consider suicide more seriously is because of what it would do to their relatives and loved ones. If you want to see for yourself, you can read reddit threads on this for examples of people’s suicidal ideation.)
This quote comes at the end of a passage that was all about “pressure,” but it has nothing to do with pressure anymore, nor does it have to do with being “incapable of facing life’s hardship.” Instead, it just sounds like this person disagrees about the view that “facing life’s hardship” for no upside is something that’s a virtue or otherwise important/right to do. This is more like an expression of a philosophy that life can be completed (see also the ending of the series ‘The Good Place,’) or, somewhat differently, that there’s no need to prolong it after the best (and still-good) times are now over. If that’s someone’s attitude, let them have it.
Overall, I respect Theo Boer for both the work he’s done for terminally ill patients in the early stages of the assisted suicide program in the Netherlands and for speaking out against the assisted suicide practice after it went in a direction that he no longer could support. At the same time, I think he has an attitude towards the topic that I don’t agree with. In my view, he doesn’t seem to take seriously how bad it is to suffer, and especially, how bad and pointlesss it is to suffer for no good reason.
It might well be true that doctors and mental health professionals are now okay with assisted suicide as a solution too quickly (without trying other avenues first), but I’m not sure I’d trust Theo Boer’s judgment on this, given the significant differences in our points of view. In any case, I acknowledge this is a risk and that we should take steps to make sure this doesn’t occur or doesn’t become too strong of an issue (and people who decide to go through with it should be well-informed about other options and encouraged to try these other options in case they haven’t already been doing this to no success for many years).