Euthanasia was legalised in Belgium in 2002 for terminally ill patients. But Wim Distelmans, the chairman of the Federal Euthanasia Commission, recently reported that between 2 and 3 per cent of the 1,924 people who died last year by euthanasia were psychiatric patients. Bipolar disorder was the majority diagnosis.
In December 2013 Baroness (Elizabeth) Butler-Sloss, a former President of the Family Division of the High Court, warned that laws are like nation states in that they are more secure when their boundaries rest on natural frontiers. The law that we have now in Britain, she wrote, rests on just such a frontier – on the principle that we do not involve ourselves in deliberately bringing about the deaths of other people. Once we start making exceptions to that principle, based on arbitrary criteria such as terminal illness or unbearable suffering, the boundary of the law becomes just a line in the sand – easily crossed and hard to defend against encroachment.
That is what we are now looking at in Belgium. A growing number of patients with mental illness are being offered euthanasia. It is what happens when a law is passed with boundaries that are purely arbitrary. And it is what we could expect to see if we were foolish enough to license doctors to supply lethal drugs to terminally ill people in Britain; attempts to change the boundaries would soon follow.
In the US, Oregon's assisted suicide law was passed for people who are terminally ill and have less than six months to live. And now we are seeing, contrary to all assurances, the first attempt to relax the terms of Oregon's law – to change the six-months-to-live condition to 12 months.
Could it happen here? Well, look at the report of Lord Falconer's so-called commission on assisted dying. His “commission” wondered whether people who were disabled but not terminally ill should be offered assistance with suicide. It decided not “at this point in time”. It's little wonder that many disabled people are worried.
These “assisted dying” laws with their arbitrary boundaries, whether in Belgium or Oregon, have within themselves the seeds of their own extension. If the relief of suffering is the aim, why should assisted suicide be offered to people who are expected to die shortly of natural causes but withheld from others who may have years of distress to endure? Or to people who are suffering from physiological conditions but not to others with mental illnesses?
Apart from any other objections to them (and there are enough of those), the proposals we are seeing for “assisted dying” have not been thought through and do not make logical sense. As in Belgium, proposals to change the law in the UK would put mentally ill people at risk.
They challenge our societal attitude towards suicide, which we currently do everything we can to prevent, and our efforts to relieve the suffering and despair of people with suicidal thoughts.
In my opinion as a psychiatrist, such a law would seriously threaten the trust that patients with any serious illness, perhaps especially a mental illness, needs to have in their doctor.
Professor (Baroness) Sheila Hollins is emeritus professor of psychiatry of disability at St George’s, University of London, and a former president of the Royal College of Psychiatrists