WHEN we think about euthanasia, many of us picture an elderly person.

They’ve had many good years, but an illness has ruined their quality of life. They’re in pain, and they want to end things on their own terms. For many people, this is an easy concept to accept.

But a recent case in the Netherlands is getting a lot of media attention, and it’s troubling ethicists.

A sexual abuse victim in her 20s was allowed to go ahead with assisted suicide as she was suffering from “incurable” post-traumatic-stress disorder (PTSD), according to the Dutch Euthanasia Commission.

The law in the Netherlands states that doctors may perform euthanasia on anyone with “unbearable suffering”.

The girl had been abused between the age of five and 15. As a result of her abuse, she suffered severe anorexia, chronic depression, and hallucinations.

Doctors said her conditions were “incurable” despite some small improvements in her mental state after intensive therapy. Two years ago, they agreed to her wish to end her life.

The doctors judged her to be “totally competent” and that there was “no major depression or other mood disorder which affected her thinking”.

News of her death has triggered debate around the world about the ethics of assisted dying.

Nikki Kenward, from disability rights group Distant Voices, said: “It is both horrifying and worrying that mental health professionals could regard euthanasia in any form as an answer to the complex and deep wounds that result from sexual abuse.”

UK Labour MP, Robert Flello said: “It almost sends the message that if you are the victim of abuse, and as a result you get a mental illness, you are punished by being killed, that the punishment for the crime of being a victim is death.

“It serves to reinforce why any move towards legalising assisted suicide, or assisted dying, is so dangerous.”

On home soil Australian psychiatrist and mental health campaigner Professor Ian Hickie echoed these sentiments, labelling the girl’s euthanasia “entirely inappropriate”.

“It makes all sorts of poorly substantiated assumptions about causation, available treatments, supportive care and prognosis.

“It really demonstrates how the current concepts around euthanasia cannot be applied to mental illness”.

But Philip Nitschke, director of Exit International, a non-profit organisation advocating legalisation of euthanasia, says the case has people in a flap as it feeds into the common belief that the euthanasia “slippery slope” is being played out in the Netherlands.

“[It] has been seized upon by opponents of voluntary euthanasia as evidence of an inevitable “watering down” of eligibility requirements for a Dutch assisted suicide. This is not true,” he says.

One of the key elements of voluntary euthanasia is that individuals be of “sound mind” when they make the decision to take their own life. And this is where the 20-year-old’s case concerns many people — is it possible to be suffering from PTSD and be of sound mind?

“[Sound mind] may be difficult to establish, but it can be established, and it’s clear from this case the Dutch went to extreme efforts to find this out,” says Nitschke.

“The decision, after several years, was that she could make an informed decision, and her wish was respected.

“Could her condition have improved with more therapy? Possibly, and she would have been made aware of this. Clearly she decided against it. I don’t think we should be forcing people to suffer in the hope that their condition might improve. This is like asking the cancer patient to wait because there may be a cure.”

Beyond the example of the 20-year-old, there is an overall rise in the number of people with mental illness using voluntary euthanasia in Holland.

Whereas just two people had themselves euthanised in the country in 2010 due to an “insufferable” mental illness, 56 people did so last year.

While euthanasia opponents find this statistic alarming, Dr Nitschke has the opposite response, and finds the figures “reassuring”.

“It shows that in Holland there is the acknowledgment that serious mental suffering can be as debilitating as physical illness and should not be excluded from the option of an elective death to finally end their suffering. The increase reflects the growing acceptance of this within the medical profession”.

THE ISSUE OF ‘RATIONAL SUICIDE’

The idea that people do not have to be terminally ill or depressed to want to die can rattle those who have long considered themselves an advocate for euthanasia. When the person wanting to end their life is not an 85-year-old with terminal lung cancer and instead is a 20-year-old sexual abuse victim or a 45-year-old wanting to avoid jail, it challenges many people’s concept of assisted dying.

This topic of rational suicide will be discussed at a conference in Melbourne in September. Belgium psychiatrist Dr Lieve Thienpont will attend and will be presenting the view that psychiatric illness is not a reason for excluding people from assistance to die.

The conference has been condemned by many in the medical profession (including Professor Hickie, who said he finds the concept “unacceptable”) and Nitschke himself admits it’s a “dangerous idea”, but as he told The Guardian, “the reality is, a portion of our population will suicide and I don’t think we should make it so hard.

“We need to acknowledge that suffering comes in many forms and if a rational person sees death as a solution, it’s their decision, it should be respected”.

If you would like to speak to someone about depression or mental health call Lifeline (131 114) or Beyond Blue (1300 22 4636).