Abstract
Belgium is one of very few countries where euthanasia on the basis of psychiatric illness is legally possible. Three physicians involved in the euthanasia of a 38-year-old woman suffering from psychiatric illness recently faced a criminal trial for “murder by poisoning”, for allegedly having failed to comply with several requirements of the Belgian Euthanasia Law. Although none of the physicians were convicted, the case generated extensive debate, in the media and the general public as well as in the medical profession and among policy makers. In this chapter, we take this trial as the starting point for a critical analysis of the clinical-psychiatric, ethical, and legal issues involved in evaluating euthanasia requests in cases of complex psychiatric disorders. In these cases, the requirements of the Belgian Euthanasia Law could be improved by mandating the advice of two psychiatrists, who are experts in the treatment of the specific condition of the person requesting euthanasia. Simultaneously with the process of evaluating the euthanasia request, there should be a parallel treatment track in which all therapeutic and recovery-oriented options are explored. These two tracks should not be in the hands of the same physician.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Notes
- 1.
Law of 28 May 2002 on Euthanasia. Belgian Official Gazette 22 June 2002, 2002/09590, 28515.
- 2.
Penal Code: Article 394 (murder); Article 375 (murder by poisoning); Article 66 (co-perpetrator). Consent of the victim is not a ground for justification under the Penal Code.
- 3.
In the month before and after the trial 1215 news items regarding the trial were published in Belgian newspapers and online news platforms (De Hert et al. 2023).
- 4.
Under Belgian law, the jury of the Court of Assize is required to provide a written justification of its decision. If a party disagrees with the decision, it can petition the Court of Cassation, which can quash the decision if it is based on a misinterpretation of the law or breaches an essential procedural requirement, such as, in this particular case, the obligation to sufficiently motivate the decision. Note, however, that an acquittal before the Court of Assize remains standing even if the Court of Cassation has quashed the acquittal. The case is then referred to a civil court, which on the basis of a new assessment of the facts may only decide on the civil liability of the acquitted person (i.e., whether compensations for damages should be awarded).
- 5.
It is not without problems to evaluate the quality of assessment and diagnosis of complex psychiatric disorders and their potential treatment options in 2009–2010 (DSM-4). Thus, it is both a journey in time and an evaluation which is potentially tainted by current knowledge about the course and outcome of these disorders (DSM-5 as well as evolving treatment options over time).
- 6.
For the evidence-based psychotherapeutic interventions for BPD, handbooks and protocolised treatment manuals were available in 2010: dialectic behaviour therapy 1993, Dutch translations 1996 and 2002; schema therapy 1997 and 2003, Dutch translation 2005; mentalisation-based therapy 2004 and 2006, Dutch translation 2007. A comprehensive search on the effectiveness of these three approaches was performed by one of the present authors and is available upon request.
- 7.
- 8.
Both in Belgium and The Netherlands mood and personality disorders are the most frequent diagnoses of persons with psychiatric illness requesting euthanasia and whose euthanasia is granted and performed. However, the percentage of people with autism spectrum disorders, in both the group of requesters and the group who received euthanasia, in Belgium is double the number reported for The Netherlands (Kammeraat and Kölling 2020; Kim et al. 2016; Nicolini et al. 2020; Tuffrey-Wijne et al. 2018; Waddell 2020).
- 9.
During the trial as well as in the advices of the physicians enclosed with the registration instrument sent to the FCECE by the attending physician, there was a constant linguistic/semantic confusion between AS and ASD in the notes of the physicians. The report from the attending physician contained the oxymoronic term ‘pronounced’ AS (AS always being a disabling condition, but milder than autism). The impossibility of having a diagnosis of ASD in 2010 according to DSM-4 was initially acknowledged by the court experts during the criminal investigation but, remarkably, was disregarded by the experts in the Court of Assize. While in DSM-4 a comorbidity between BPD and AS was considered to be possible, according to DSM-5 a comorbidity between BPD and ASD is very unlikely.
- 10.
The consulted physicians should be independent from both the patient and the attending physician. “Independence” is not defined in the Euthanasia Law but is usually interpreted as implying that there should be no family tie or hierarchical relation between the attending and the consulted physician(s) and that the patient should not have a regular therapeutic relationship with the consulted physician. However, in its latest report, the FCECE stipulates that “independence” does not necessarily mean that the consulted physician should never have met the patient or should not know his or her medical history.
- 11.
In a study the consulted psychiatrist has reported on 100 euthanasia requests by psychiatric patients (Thienpont et al. 2015). All patients were considered mentally competent and were suffering from longstanding and treatment-resistant disorders. In 48% of cases the request was granted and the euthanasia was performed on 35 patients. For the evaluation, on average four consultations were needed over a period of eight months. The large standard deviations from the means indicate that it often took more consultations but also that in a large number of cases only one or two consultations were caried out. The assessment of the unbearable, non-alleviable, suffering suggests a high predictive value (both positive and negative predictive value of 80). This is nevertheless sufficiently accurate in matters of life and death. Twenty percent of people for whom the request was approved were still alive two years later. Although all patients at baseline were considered treatment-resistant, the majority of survivors (57%) were able to cope with their illness with or without treatment. Based on published data from the FCECE an analysis estimates that this psychiatrist has been involved as a consultant in one third to half of all cases of euthanasia in Belgium for patients with a psychiatric disorder (Claes et al. 2015).
- 12.
Law of 22 August 2002 concerning the Rights of the Patient. Belgian Official Gazette 26 September 2002, 2002/22737, 43719.
References
Appelbaum, Paul S. 2007. Assessment of patients’ competence to consent to treatment. New England Journal of Medicine 357: 1834–1840.
American Psychiatric Association. (APA). 2000. Diagnostic and statistical manual of mental disorders (4th ed., TR). Washington DC: American Psychiatric Publishing.
American Psychiatric Association. (APA). 2013. Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington VA: American Psychiatric Publishing.
Baghdadli, Amaria, Frédérick Russet, and Laurent Mottron. 2017. Measurement properties of screening and diagnostic tools for autism spectrum adults of mean normal intelligence: A systematic review. European Psychiatry 44: 104–124.
Bateman, Anthony W., John Gunderson, and Roger Mulder. 2015. Treatment of personality disorder. The Lancet 385 (9969): 735–743.
Berghmans, Ron, Donna Dickenson, and Ruud Ter Meulen. 2014. Mental capacity: In search of alternative perspectives. Health Care Analysis 12 (4): 253–263.
Bohus, Martin, Jutta Stoffers-Winterling, Carla Sharp, Annegret Krause-Utz, Christian Schmahl, and Klaus Lieb. 2021. Borderline personality disorder. The Lancet 398 (10310): 1528–1540.
Calati, Raffaela, Emilie Olié, Débora Dassa, Carla Gramaglia, Sebastien Guillaume, Fabio Madeddu, and Phillipe Courtet. 2021. Euthanasia and assisted suicide in psychiatric patients: A systematic review of the literature. Journal of Psychiatry Research 135: 153–173.
Cassidy, Sarah A., Louise Bradley, Erica Bowen, Sarah Wigham, and Jacqui Rodgers. 2018a. Measurement properties of tools used to assess suicidality in autistic and general population adults: A systematic review. Clinical Psychology Review 62: 56–70.
Cassidy, Sarah, Louise Bradley, Rebecca Shaw, and Simon Baron-Cohen. 2018b. Risk markers for suicidality in autistic adults. Molecular Autism 9: 42. https://doi.org/10.1186/s13229-018-0226-4. eCollection 2018.
Cholbi, Michael. 2015. Medically enabled suicides. In New directions in the ethics of assisted suicide and euthanasia, ed. Michael Cholbi and Jukka Varelius, 169–184. Heidelberg, New York, London: Springer.
Claes, Stephan, Ludi Van Bouwel, An Haekens, Marc Eneman, George Otte, Jan De Lepeleire, Marc Calmeyn, Ariane Bazan, and Willem Lemmens. 2015. Euthanasia for psychiatric patients: Ethical and legal concerns about the Belgian practice. BMJ Open. https://bmjopen.bmj.com/content/5/7/e007454.responses.
Cristea, Ioana A., Claudio Gentili, Carmen D. Cotet, Daniela Palomba, Corrado Barbui, and Pim Cuijpers. 2017. Efficacy of psychotherapies for borderline personality disorder: A systematic review and meta-analysis. JAMA Psychiatry 74 (4): 319–328.
Czech, Herwig. 2018. Hans Asperger, National Socialism, and “race hygiene” in Nazi-era Vienna. Molecular Autism 9: 29.
Day, Michael. 2018. Three Belgian doctors are investigated over euthanasia of woman with Asperger’s. British Medical Journal 363: k516.
De Hert, Marc. 2017. Euthanasie bij mensen met een psychiatrische stoornis, een brug te ver? Antwerpen: Universiteit Antwerpen.
De Hert, Marc. 2021a. Renvoi d’une affaire d’euthanasie aux assises par la CMA. Tijdschrift voor Gezondheidsrecht/Revue de Droit de la Santé 2020/2021 (1): 320–326.
De Hert, Marc. 2021b. Trois médecins euthanasieurs acquittés du chef d’assassinat par la Cour d’assises. Tijdschrift voor Gezondheidsrecht/Revue de Droit de la Santé 2020/2021 (1): 329–334.
De Hert, Marc. 2021c. Le doute qui entoure la culpabilité d’un médecin ayant pratiqué une euthanasie et qui a donné lieu à son acquittement doit être motivé. Tijdschrift voor Gezondheidsrecht/Revue de Droit de la Santé 2020/2021 (1): 338–340.
De Hert, Marc, and Martien Wampers. 2018. Bekwaam of onbekwaam? Dat is de (moeilijke) vraag Juridische aspecten in België. In Wilsbekwaamheid in de medische praktijk, ed. Irma Hein and Adger Hondius, 29–46. Utrecht: De Tijdstroom.
De Hert, Marc, Liesbet Van Bos, Kim Sweers, Martien Wampers, Jan De Lepeleire, and Christophe U. Correll. 2015. Attitudes of psychiatric nurses about the request for euthanasia on the basis of unbearable mental suffering (UMS). PLoS One 10 (12): e0144749. https://doi.org/10.1371/journal.pone.0144749.
De Hert M, Thys E, Catthoor K, Van den Broeck K, Matthys F, Vansteenlandt K, Detraux. 2023. Media coverage of Belgium’s first criminal case concerning euthanasia for psychiatric patients: A content analysis of Flemish newspapers and magazines. Front Psychiatry. https://doi.org/10.3389/fpsyt.2022.1050086.
De Hert M, Loos S, Van Assche K. 2022a. Euthanasia of a person with a psychiatric disorder does not violate the European Convention on Human Rights (Mortier v. Belgium [no. 78017/17]). Eur Psychiatry 65(1):e80. https://doi.org/10.1192/j.eurpsy.2022.2342
De Hert M, Loos S, Van Assche K. 2022b. The Belgian euthanasia law under scrutiny of the highest courts. Lancet Reg Health Eur 24:100549. https://doi.org/10.1016/j.lanepe.2022.100549
Dees, Marianne K., Myrra J. Vernooij-Dassen, Wim J. Dekkers, and Chris van Weel. 2010. Unbearable suffering of patients with a request for euthanasia or physician-assisted suicide: An integrative review. Psychooncology 19 (4): 339–352.
Dees, Marianne K., Myrra J. Vernooij-Dassen, Wim J. Dekkers, Kris C. Vissers, and Chris van Weel. 2011. ‘Unbearable suffering’: A qualitative study on the perspectives of patients who request assistance in dying. Journal of Medical Ethics 37 (12): 727–734.
Delbeke, Everlyn. 2012. Juridische aspecten van zorgverlening aan het levenseinde. Antwerpen: Intersentia.
den Hartogh, Govert. 2016. Do we need a threshold conception of competence? Medicine Health Care and Philosophy 19: 79–81.
Dierickx, Sigrid, Luc Deliens, Joachim Cohen, and Kenneth Chambaere. 2017. Euthanasia for people with psychiatric disorders or dementia in Belgium: Analysis of officially reported cases. BMC Psychiatry 17 (1): 203. https://doi.org/10.1186/s12888-017-1369-0.
Doernberg, Samuel N., John R. Peteet, and Scot Y. Kim. 2016. Capacity evaluations of psychiatric patients requesting assisted death in the Netherlands. Psychosomatics 57 (6): 556–565.
Dudas, Robert D., Chris Lovejoy, Sarah Cassidy, Carrie Allison, Paula Smith, and Simon Baron-Cohen. 2017. The overlap between autistic spectrum conditions and borderline personality disorder. PLoS One 12 (9): e0184447. https://doi.org/10.1371/journal.pone.0184447. eCollection 2017.
Federatie Medisch Specialisten en Nederlandse vereniging voor Psychiatrie (FMP NVvP). 2018. Levensbeëindiging op verzoek bij patiënten met een psychische stoornis. In Startpagina—Levensbeëindiging op verzoek bij patiënten met een psychische stoornis. Richtlijn. Richtlijnendatabase.
Gartlehner, Gerald, Karen Crotty, Sara Kennedy, Mark J. Edlund, Rania Ali, Mariam Siddiqui, Robyn Fortman, Roberta Wines, Emma Persad, and Meera Viswanathan. 2021. Pharmacological treatments for borderline personality disorder: A systematic review and meta-analysis. CNS Drugs 35: 1053–1067.
Gopal, Abilash A. 2015. Physician-assisted suicide: Considering the evidence, existential distress, and an emerging role for psychiatry. Journal of the American Academy of Psychiatry and the Law 43 (2): 183–190.
Grilo, Carlos M., and Tomoko Udo. 2021. Association of borderline personality disorder criteria with suicide attempts among US adults. JAMA Network Open 4 (5): e219389.
Groenewoud, Johanna H., Agnes Van Der Heide, Alfons J. Tholen, Joost W. Schudel, Michiel W. Hengeveld, Bregje D. Onwuteaka-Philipsen, Paul J. Van Der Maas, and Gerrit Van Der Wal. 2004. Psychiatric consultation with regard to requests for euthanasia or physician-assisted suicide. General Hospital Psychiatry 26 (4): 323–330.
Huntjens, Anne, Wies L.M.C. van den Bosch, Bram Sizoo, Ad Kerkhof, Marcus J.H. Huibers, and Mark van der Gaag. 2020. The effect of dialectical behaviour therapy in autism spectrum patients with suicidality and/or self-destructive behaviour (DIASS): Study protocol for a multicentre randomised controlled trial. BMC Psychiatry 20: 127. https://doi.org/10.1186/s12888-020-02531-1.
Jørgensen, Mie S., Ole J. Storebø, Jutta M. Stoffers-Winterling, Erlend Faltinsen, Adnan Todorovac, and Erik Simonsen. 2021. Psychological therapies for adolescents with borderline personality disorder (BPD) or BPD features—A systematic review of randomized clinical trials with meta-analysis and Trial Sequential Analysis. PLoS One 16 (1): e0245331. https://doi.org/10.1371/journal.pone.0245331.
Kammeraat, Monique, and Pieternel Kölling. 2020. Psychiatric patients at the Euthanasia Expertise Center. Online: Onderzoeksrapportage-Psychiatrische-Patiënten-Expertisecentrum-Euthanasie.pdf (expertisecentrumeuthanasie.nl).
Kim, Scott Y., Raumond G. De Vries, and John R. Peteet. 2016. Euthanasia and assisted suicide of patients with psychiatric disorders in the Netherlands 2011 to 2014. JAMA Psychiatry 73 (4): 362–368.
Kissane, David W. 2012. The relief of existential suffering. Archives of Internal Medicine 172: 1501–1505.
Landelijke Stuurgroep Multidisciplinaire Richtlijnontwikkeling in de GGZ (LSMRGGZ). 2008. Multidisciplinaire Richtlijn Persoonlijkheidsstoornissen. Richtlijn voor de diagnostiek en behandeling van volwassen patiënten met een persoonlijkheidsstoornis. Utrecht: Trimbos-instituut.
Levitt, Sarah, and Daniel Z. Buchman. 2020. Applying futility in psychiatry: A concept whose time has come. Journal of Medical Ethics. https://doi.org/10.1136/medethics-2020-106654.
Lord, Catherine, Traolach S. Brugha, Tony Charman, Jack Cusack, Guillaume Dumas, Thomas Frazier, Emily J.H. Jones, Rebecca M. Jones, Andrew Pickles, Matthew W. State, Julie Lounds Taylor, and Jeremy Veenstra-VanderWeele. 2020. Autism spectrum disorder. Nature Reviews Disease Primers 6 (1): 5. https://doi.org/10.1038/s41572-019-0138-4.
Lord, Catherine, Tony Charman, Alexandra Havdahl, Paul Carbone, Evdokia Anagnostou, Brian Boyd, Themba Carr, Petrus J. de Vries, Cheryl Dissanayake, Gauri Divan, Christine M. Freitag, Marina M. Gotelli, Connie Kasari, Martin Knapp, Peter Mundy, Alex Plank, Lawrence Scahill, Chiara Servili, Paul Shattuck, Emily Simonoff, Alison Tepper Singer, Vicky Slonims, Paul P. Wang, Maria Celica Ysrraelit, Rachel Jellett, Andrew Pickles, James Cusack, Patricia Howlin, Peter Szatmari, Alison Holbrook, Christina Toolan, and James B. McCauley. 2021. The Lancet Commission on the future of care and clinical research in autism. The Lancet. https://doi.org/10.1016/S0140-6736(21)01541-5.
May, Tamara, Pamela D. Pilkington, Rita Younan, and Katrina Williams. 2021. Overlap of autism spectrum disorder and borderline personality disorder: A systematic review and meta-analysis. Autism Research 2021. https://doi.org/10.1002/aur.2619.
Medscape. 2019. Criminal case spurs a rethink of euthanasia for mental illness. Medscape, 19 Feb. https://www.medscape.com/viewarticle/909233.
Mehlum, Lars, Schmahl Christian, Berens Ann, Doering Stephan, Hutsebaut Joost, Kaera Andres, Kramer Ueli, Paul A. Moran, Babette Renneberg, Joaquim S. Ribaudi, Sebastian Simonsen, Michaela Swales, Svenja Taubner, and Ester di Giacomo. 2020. Euthanasia and assisted suicide in patients with personality disorders: A review of current practice and challenges. Borderline Personality Disorder and Emotion Dysregulation 7: 15. https://doi.org/10.1186/s40479-020-00131-9. eCollection 2020.
Michaud, Laurent, Kyle T. Greenway, Sylvie Corbeil, Céline Bourquin, and Stéphane Richard-Devantoy. 2021. Countertransference towards suicidal patients: A systematic review. Current Psychology. https://doi.org/10.1007/s12144-021-01424-0.
Miller, David G., Rebecca Dresser, and Scott Y. Kim. 2019. Advance euthanasia directives: A controversial case and its ethical implications. Journal of Medical Ethics 45 (2): 84–89.
Mungo, Anaïs, Matthieu Hein, Phillipe Hubain, Gwendolé Loas G., and Phillipe Fontaine. 2020. Impulsivity and its therapeutic management in borderline personality disorder: A systematic review. Psychiatric Quarterly 91 (4): 1333–1362.
Mroz, Sarah, Sigrid Dierickx, Joachim Deliens, and Kenneth Chambaere. 2021. Assisted dying around the world: A status quaestionis. Annals of Palliative Medicine 10 (3): 3540–3553. https://doi.org/10.21037/apm-20-637.
National Collaborating Centre for Mental Health (UK) (NCCMH). 2009. Borderline personality disorder: Treatment and management. Leicester: British Psychological Society.
National Institute for Health and Clinical Excellence (NICE). 2011. Autism: Recognition, referral and diagnosis of children and young people on the autism spectrum. NICE clinical guideline. Retrieved from https://www.nice.org.uk/guidance/cg128.
National Institute for Health and Clinical Excellence (NICE). 2012. Autism. Recognition, referral, diagnosis and management of adults on the autism spectrum. The British Psychological Society and The Royal College of Psychiatrists.
Nederlandse Vereniging voor Psychiatrie (NVvP). 2009. Richtlijn verzoek om hulp bij zelfdoding door patiënten met een psychiatrische stoornis. Utrecht: De Tijdstroom.
Nederlandse Vereniging voor Psychiatrie (NVvP), Nederlands Instituut van Psychologen (NIP). 2013. Multidisciplinaire richtlijn diagnostiek en behandeling van autismespectrumstoornissen bij volwassenen. Utrecht: De Tijdstroom.
Nicolini, Marie E., John R. Peteet, Kevin D. Donovan, and Scott Y. Kim. 2020. Euthanasia and assisted suicide of persons with psychiatric disorders: The challenge of personality disorders. Psychological Medicine 50 (4): 575–582.
Noens, Ilse, Catharina Struyven, May Van Gool, and Peter Vermeulen. 2018. Classificerend Diagnostisch Protocol Autismespectrumstoornis bij volwassenen (Classification diagnostic protocol autism spectrum disorders in adults). Brussels: Kwaliteitscentrum voor Diagnostiek vzw in samenwerking met Vlaams Agentschap voor Personen met een Handicap.
Poon, Kenneth K., and Dalvin J. Sidhu. 2017. Adults with autism spectrum disorders: A review of outcomes, social attainment, and interventions. Current Opinion in Psychiatry 30 (2): 82–83.
Raus, Kasper, and Sigrid Sterckx. 2015. Euthanasia for mental suffering. In New directions in the ethics of assisted suicide and euthanasia, ed. Michael Cholbi and Jukka Varelius, 79–96. Heidelberg, New York, London: Springer.
Raus, Kasper, Bert Vanderhaegen, and Sigrid Sterckx. 2021. Euthanasia in Belgium: Shortcomings of the law and its application and of the monitoring of practice. The Journal of Medicine and Philosophy 46 (1): 80–107.
Rosen, Nicole E., Catherine Lord, and Fred R. Volkmar. 2021. The diagnosis of autism: From Kanner to DSM-III to DSM-5 and beyond. Journal of Autism and Developmental Disorders 51 (12): 4253–4270.
Ruissen, Andrea, Gerben Meynen, and Guy A.M. Widdershoven. 2011. Perspectives on patient competence in psychiatry: Cognitive functions, emotions and values. Tijdschrift voor Psychiatrie 53 (7): 411–412.
Sheffer, Edith. 2018. Asperger’s children: The origins of autism in Nazi Vienna. New York: W.W. Norton.
Storebø, Ole J., Jutta M. Stoffers-Winterling, Brigit A. Völlm, Mickey T. Kongerslev, Jessica T. Mattivi, Mie S. Jørgensen, Erlend Faltinsen, Adnan Todorovac, Christian P. Sales, Henriette E. Callesen, Klaus Lieb, and Erik Simonsen. 2020. Psychological therapies for people with borderline personality disorder. Cochrane Database of Systematic Reviews 5 (5): CD012955.
Strang, Peter, Susan Strang, Ragnar Hultborn, and Staffan Arnér. 2004. Existential pain—An entity, a provocation, or a challenge? Journal of Pain and Symptom Management 27 (3): 241–250.
The Guardian. 2020. Doctors acquitted in Belgium’s first criminal euthanasia case. The Guardian, 31 Jan. https://www.theguardian.com/society/2020/jan/31/doctors-acquitted-belgium-first-criminal-euthanasia-case.
Thienpont, Lieve, Monica Verhofstadt, Tony Van Loon, Wim Distelmans, Kurt Audenaert, and Peter P. De Deyn. 2015. Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: A retrospective, descriptive study. BMJ Open 5 (7): e007454. https://doi.org/10.1136/bmjopen-2014-007454.
Thomas, Elizabeth C., Shelly Ben-David, Emily Treichler, Stephanie Roth, Lisa B. Dixon, Mark Salzer, and Yaara Zisman-Ilani. 2021. A systematic review of shared decision–making interventions for service users with serious mental illnesses: State of the science and future directions. Psychiatric Services 72 (11): 1288–1300.
Tuffrey-Wijne, Irene, Leopold Curfs, Ilora Finlay, and Sheila Hollins. 2018. Euthanasia and assisted suicide for people with an intellectual disability and/or autism spectrum disorder: An examination of nine relevant euthanasia cases in the Netherlands (2012–2016). BMC Medical Ethics 19 (1): 17. https://doi.org/10.1186/s12910-018-0257-6.
van Veen, Sisco M.P., Andrea M. Ruissen, and Guy A.M. Widdershoven. 2020. Irremediable psychiatric suffering in the context of physician assisted death: A scoping review of arguments in the literature. Canadian Journal of Psychiatry 65 (9): 593–603.
van Veen, Sico M.P., Natalie Evans, Andrea M. Ruissen, Joris Vandenberghe, Aartjan T.F. Beekman, and Guy A.M. Widdershoven. 2021. Irremediable psychiatric suffering in the context of physician assisted death: A Delphi-study. medRxiv. https://doi.org/10.1101/2021.07.19.21260430.
Varelius, Jukka. 2014. On the relevance of an argument as regards the role of existential suffering in the end-of-life context. Journal of Medical Ethics 40: 114–116.
Verhofstadt, Monica, Kenneth Chambaere, Roeslan Leontjevas, and Gjalt-Jorn Y. Peters. 2019a. Towards an assessment instrument for suffering in patients with psychiatric conditions: Assessing cognitive validity. British Journal of Psychiatry Open 5 (3): e35. https://doi.org/10.1192/bjo.2019.25.
Verhofstadt, Monica, Kristof Van Assche, Sigrid Sterckx, Kurt Audenaert, and Kenneth Chambaere. 2019b. Psychiatric patients requesting euthanasia: Guidelines for sound clinical and ethical decision making. International Journal of Law and Psychiatry 64: 150–161.
Verhofstadt, Monika, Kurt Audenaert, Kris Van den Broeck, Luc Deliens, Freddy Mortier, Koen Titeca, Koen Pardon, Dirk De Bacquer, and Kenneth Chambaere. 2020. The engagement of psychiatrists in the assessment of euthanasia requests from psychiatric patients in Belgium: A survey study. BMC Psychiatry 20 (1): 400. https://doi.org/10.1186/s12888-020-02792-w.
Vlaamse Vereniging voor Psychiatrie (VVP). 2017. Hoe omgaan met een euthanasieverzoek in psychiatrie binnen het huidig wettelijk kader? Adviestekst van de Vlaamse Vereniging voor Psychiatrie (VVP) over te hanteren zorgvuldigheidsvereisten, 7–39. http://vvponline.be/uploads/docs/bib/euthanasie_finaal_vvp_1_dec.pdf.
Waddell, Michael M. 2020. Autism and assisted suicide. Journal of Disability and Religion 24 (1): 1–28.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
De Hert, M., Sterckx, S., Van Assche, K. (2023). Due Care in the Context of Euthanasia Requests by Persons with Psychiatric Illness: Lessons from a Recent Criminal Trial in Belgium. In: Cholbi, M., Varelius, J. (eds) New Directions in the Ethics of Assisted Suicide and Euthanasia. The International Library of Bioethics, vol 103. Springer, Cham. https://doi.org/10.1007/978-3-031-25315-7_11
Download citation
DOI: https://doi.org/10.1007/978-3-031-25315-7_11
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-25314-0
Online ISBN: 978-3-031-25315-7
eBook Packages: Religion and PhilosophyPhilosophy and Religion (R0)