Wednesday, November 2, 2016

Mentally ill - a death with dignity in Holland

From Aeon: "Doctor-assisted suicide for the chronically mentally ill is currently legal in the Netherlands, Belgium and Switzerland, despite being one of the most contentious points in the ongoing right-to-die debate. Letting You Go follows one such Dutch patient, 27-year-old Sanne, who, after nearly a decade of pursuing treatments for her chronic depression, insomnia and borderline personality disorder, has chosen to end her suffering and pursue a planned death. While clearly shaken, Sanne’s father has made the difficult decision to stand by his daughter’s choice, reasoning ‘she couldn’t, and shouldn’t, do this alone’. Unflinching, honest and humane, the Dutch director Kim Faber’s film is both a moving portrait of father and daughter, and an intimate look at one of the most controversial medical ethics issues of our times. The film played at the International Documentary Film Festival Amsterdam (IDFA) in 2014 and AFI DOCS film festival in 2015."
This is the scenario I'm concerned about. Should we simply support the wishes of anyone who wants to die? Is this the "slippery slope" that critics of physician assisted death have noted? Do you have comments after watching this hard to watch video? 


  1. As I have recently started my residency, I struggle with the idea of aiding a person with ending their life. I was taught it is abnormal for a person to want to end their life. That expression of wanting to end your life was a sign of disease rather than a person who had come to a rational decision. While I am still learning the art of medicine, I fear I would not be able to discern when it is the person expressing a desire to end their life and when it is their disease.

    1. Thanks Megan. This struggle should be difficult and never easy. You will run into patients that despite good palliative care and hospice, still find their suffering too great. 59% of the voters in Washington want to have the right to end their lives in that situation. I think I can respect their wishes. But mental illness can be treated and reversible so I think doctors need to be very careful in "playing God". In some countries, the "cowboys" think that they should be able to assist anyone who wants to die. That's the "slippery slope" that I worry about. In Oregon and Washington, only about 1/400 or 1/500 deaths are related to physician assistance (prescribing the lethal drug). So the protections for people with disabilities and mental illness seem to be working. The whole process is a struggle for us all. Welcome to the club!

  2. Many years ago I met a woman who had always struggled with depression and in fact wanted to die, even at a young age.ECT was the only cure, albeit very temporarily. She had two young children, in fact she noted the only times she felt mentally healthy was during her pregnancies, and wouldn't give in to the temptation for her childrens' sake. As a family friend I saw her through two immediate family deaths and she was distraught and almost in envy. I moved away long story short, I Googled her not that long ago and came across her obituary. After her youngest turned 18 years old. My head and heart constantly wonder the cause and possible solution to this woman's seemingly physical/hormonal cause of depression.