A young woman’s euthanasia on mental health grounds: when psychiatrists say they have “done all they could”

Written: April 23, 2024

In recent days my mind has turned many times to a young woman in the Netherlands, who is reportedly going to be euthanized in May, according to national and international news articles. She is 28 and is reportedly struggling with depression and complex trauma. She is also autistic.

Like many people, I feel profound sadness for her as an individual, a deep concern about the alleged concept that “nothing more can be done” – and also a sense of worry and foreboding about what this may mean for future patients who are struggling with severe mental health conditions.

It is reported that her psychiatrist had advised her that they had provided all possible treatments or “done all they could”.

There is no question that mental and emotional suffering is as painful and intense as physical suffering.

This is why a vital part of psychiatric clinicians’ work is trying to help alleviate someone’s suffering. That goes beyond specific treatments and is often dependent on the relationship that the clinician builds with a patient. When you have a strong connection with the team supporting you, where they care about you, value you as a unique individual, see your positive qualities and illuminate those qualities, recognise all that you bring to the world, encourage you, are there for you and alongside you – all of this can be what helps you to survive when your suffering feels unbearable.

Alongside this, there are new and emerging treatments. In terms of depression, I am continually learning about new research and new trials of treatment (not just new medications).This often involves referring someone to a specialist service in another part of the country where they are trialling these new treatments.

Fortunately, people can also self-refer to some of these services.

In the UK, NHS Trusts such as Oxford Health NHSFT are researching new treatments for depression and individuals can self-refer to their Treatment Resistant Depression Clinic: https://oxfordhealthbrc.nihr.ac.uk/our-work/treatment-resistant-depression-clinic/

If complex trauma is at the root of someone’s suffering, there are specialist national NHS psychological services in the UK, including those which are especially for individuals who have not been helped by services and treatments provided in their local area, such as OHSPIC . Individuals can be referred out of area.

Many individuals experiencing complex trauma have struggled to access psychological therapy, or may only have been offered one type of therapy. But there are many different types of evidence-based psychological therapies. Sometimes it is a combination of different therapies that helps individuals.

Sadly it often takes a tenacious approach to access these. Asking for a second opinion on treatment can be a route forwards. Many people know that you can ask for a second opinion about diagnosis. But you can also, quite separately, ask for a second opinion on treatment. This could take place in a different region (in the UK, in a different NHS Trust, for example).

If you’ve had one type of therapy then a “second opinion” assessment could potentially explore whether there are other therapies that could be offered and funded: How to ask for a second opinion

The young woman in the Netherlands is autistic. Many of our autistic clients say that the care they received (while under psychiatric services) didn’t always meet their needs. They describe a huge variation in clinicians’ understanding and ability to ensure that their care was individually tailored to understand and respond to their needs.  https://www.ncl.ac.uk/press/articles/archive/2022/04/conversationautismsuicide/

I run a Suicide Crisis Centre where our whole focus is on protecting the life of each individual under our care. I cannot conceive of ever reaching a point where we felt there was no more that could be done to help someone.

I am also someone with severe and enduring mental health challenges. I came into this work twelve years ago after having been a psychiatric patient that the system didn’t appear able to help. There are entries in my clinical records that evidenced profound pessimism on the part of clinicians. 

However, at the root of that was that they hadn’t yet understood how to help me.

Since then I have been diagnosed with PTSD and bipolar disorder. My current diagnosis is recurrent depressive disorder. When I am in depressive episodes my thinking is profoundly altered. I see no hope for the future and am convinced that my life will always be bleak and without hope. I am convinced that no treatment will help. But this is because I am unwell and my thinking is impaired by depression. I rely on my psychiatric team to recognise this – and to hold onto hope for me and for my future, in those depressive episodes.

However, I know that this “tenaciously holding hope for patients” doesn’t always happen. I have been in meetings where clinicians have spoken with profound pessimism about a patient’s future. In every case so far, I have seen the patient eventually defy their expectations.

I recall one of our first clients at the Suicide Crisis Centre saying to me: “You don’t seem to have given up on me.” She felt that her psychiatric team had. 

For all of us who have struggled to access meaningful help: this means that we haven’t been able to access the particular care, treatment or services that would help us. It does not mean that we can’t be helped.

It’s reported that the young woman in the Netherlands wanted to become a psychiatrist but she eventually ruled this out. I find this particularly poignant. I know that for so many of our clients at our Suicide Crisis Centre, their greatest wish is to help other people in the future.

Having experienced profound suffering themselves, their greatest wish is to help alleviate the suffering of other people. And their own experience gives them an empathy and understanding that makes them particularly skilled in this kind of work. 

We hope that the young woman in the Netherlands can feel the outpouring of care and concern for her across the world. This is a world that values her and values her life very much. 

Note: Most people in the Netherlands prefer the phrase “someone with autism”. In the UK, more people prefer the term “someone is autistic”.

Joy Hibbins runs a Suicide Crisis Centre in the UK: https://www.suicidecrisis.co.uk/

Sources of help

UK: National Suicide Prevention Helpline: 0800 689 5652 and Samaritans: 116 123

International suicide prevention helplines: Suicide Hotlines and Prevention Resources Around the World | Psychology Today United Kingdom

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