photo by Regina Walker

Mark Langedijk was a 41-year-old divorced father of two young children living with his parents in the Netherlands.

On July 13, 2016, Mark was joined at his parent’s home by his older brother Marcel. They laughed, drank beer, smoked, and ate ham sandwiches. After a good night’s sleep, Mark’s physician appeared at his home and administered 3 injections. After the third injection Mark was dead by his own choice. He had requested and was approved for Euthanasia for chronic alcoholism.

Jane Doe (her real name has not been released) was a woman in her early 20’s living in the Netherlands who suffered sexual abuse from the ages of 5 until 15. As a result of this abuse she suffered significant psychiatric problems including post-traumatic-stress disorder, anorexia, depression, and hallucinations. Though she achieved some improvement in her symptoms after therapy she requested and was approved for Euthanasia.

Another case in the Netherlands that has recently made the news involved a 34-year-old mom of a three-year-old daughter who was approved for euthanasia in response to depression, Post Traumatic Stress Disorder (PTSD), and a personality disorder.

The Merriam-Webster dictionary defines euthanasia as; “the act or practice of killing or permitting the death of hopelessly sick or injured individuals (as persons or domestic animals) in a relatively painless way for reasons of mercy.” The word Euthanasia comes from the Greek “euthantos” meaning easy death.

Euthanasia is illegal in most of the US though there are some states in which Euthanasia and Physicians Aid in Dying (PAD) is allowed (California, Colorado, Oregon, Vermont and Washington). PAD differs from Euthanasia in that in cases of PAD, the individual self-administers the lethal injection.

When we hear of Euthanasia in the US, we mostly think of individuals who are removed from ventilators when it becomes clear there is no possibility of recovery. Additionally, the image of an end stage cancer patient who is enduring significant pain and is terminal comes to mind. That is no longer the case in other parts of the world.

The Netherlands has become known for it’s more liberal approach to Euthanasia. Though cancer is far ahead the number one diagnosis for euthanasia, psychiatric illnesses are increasing. In 2010, two people were euthanized in response to mental illness. In 2015, 56 people were. There are some who see this move in the Netherlands as courageous and compassionate. Still others view it as a dangerous slide into a questionable ethical area.

Mr. Langedijk battled alcoholism for eight years and was hospitalized for treatment 21 times. He was unable to sustain any significant length of sobriety and his interpersonal life as well as his physical health suffered as a result. Eventually, Mr. Langedijk determined that he was unable to bear the emotional pain his alcohol addiction was causing him. His older brother Marcel Langedijk, a journalist, described Mark as a “hopeless” alcoholic and though devastated by the loss of his brother, Marcel supported his decision to die.

The process that led to Mark’s July 14th death took a year and a half. It took approximately two years for Jane Doe’s request to be approved. Euthanasia was legalized in the Netherlands in 2002 and is permissible only under strict conditions and can only be performed by a physician. Conditions include a physician assessing an individual and being convinced that “unbearable suffering” is being experienced from which there is no hope of relief. The physician must then consult with at least one other physician about the case though the second physician does not have to agree with the decision of the first. Children from the ages of 12 to 18 are also covered by the Dutch euthanasia law. Each case is reviewed post-euthanasia by the RTE regional review commission. If this investigation finds that the case did not meet appropriate criteria, the review body can refer the case to the public prosecutor and health inspectors.

Dutch documentary filmmaker Elena Lindemans produced the award winning film “Mothers Don’t Jump from Buildings” in 2014. The film, made when Ms. Lindemans was 26 years old, tells the story of her mother who committed suicide in 2002 by jumping from a building. Her suicide occurred after Lindemans mother was unable to convince physicians to help her end her life. The film explores the social and personal consequences of a strict euthanasia policy for psychiatric patients and offers the view that euthanasia is a compassionate means for those suffering from psychiatric illnesses to experience a “good death”.

Paulan Stärcke is a psychiatrist at the End-of-Life clinic in The Hague. In May 2016 she presented at the Euthanasia conference in Amsterdam and screened Ms. Lindemans film. Stärcke expressed the belief that psychiatrists are “too hesitant” about agreeing to requests from mental health patients for euthanasia. Stärcke remarked “It is not execution; It is an execution of the wish of a patient. You can prepare for euthanasia, you can say goodbye and it can be a loving memory, not only hurt. Suicide is only hurt.”

Many ethical questions have been raised about the implementation of euthanasia for mental health issues. Additionally, concern has been voiced over the inclusion of children between the ages of 12 to 18 in the Dutch euthanasia law. Though these questions have validity there are no easy answers or obvious right or wrong.

In response to criticism over his brother’s death, Marcel Langedijk responded, ‘“You can close your eyes to it and keep telling yourself everyone is curable but the fact remains, not everyone is….My brother suffered from depression and anxiety and tried to ‘cure’ it with alcohol. He’s from a normal family, he did not want this to happen. He did not take an easy way out. Just a humane one…..I am just glad my brother did not have to jump in front of a train or live a few more years in agony before dying of his abuse. Alcoholism and depression are illnesses, just like cancer. People who suffer from it need a humane way out.”

by Regina Walker