The most common diagnoses among Belgian psychiatric patients who request help to die due to “unbearable suffering” are depression and personality disorders, a new study finds.

Belgium first legalized euthanasia in 2002. Each year since then, the number of reported euthanized deaths has increased, rising to 2,086 for the 2010/2011 period. This number includes just 58 people suffering from a neuropsychiatric disorder. Over the years, gender, age, diagnoses, and the nature of euthanasia patients’ suffering did not shift proportionally, the researchers say. Between 2008 and 2011, for instance, the male-to-female ratio remained steady at 51:49. Two percent of all patients were between the ages of 20 and 39, 21.5 percent between 40 and 59, slightly more than half between 60 and 79, and a quarter of those euthanized were 80 or older. The majority (91 percent) of patients were terminally ill, with cancer cited in nearly 77 percent of all cases and psychiatric disorders cited in just three percent.

Controversial Drug

To end their lives usually at home or in a hospital, the majority used sodium thiopental, the researchers reported. This barbiturate, listed as an essential drug on the World Health Organization’s list of minimum medical needs for a basic healthcare system, is commonly known as the first of three lethal injection drugs administered to American prisoners who are executed under a death sentence. In 2011, Hospira Inc., the only company still making the drug at that time, stopped production at its Italian plant when the European Union banned export of the barbiturate as a way to end executions in the United States. However, this same drug has been chosen as Belgium’s standard protocol for euthanasia.

For the current study, the researchers sought to report on the characteristics of psychiatric patients who request euthanasia. Quite simply, then, the research team tracked requests for help to die between 2007 and 2011 and then followed up through the end of 2012. The investigation focused on patients receiving treatment in outpatient clinics in the Dutch speaking areas of Belgium.

During the study period, 77 women and 23 men asked for euthanasia on the grounds of unbearable suffering associated with mental illness. Their ages ranged from 21 to 80, with an average age of 47. Most (59) lived alone, while 73 had been deemed unfit to work.

Nearly all (91 of the patients) had been referred for counseling and 90 had been diagnosed with more than one mental health issue. Of this total, 38 patients required further tests and 12 were subsequently diagnosed with Asperger's syndrome, a form of high functioning autism. However, the most frequent diagnosis overall was depression (58 patients), followed by personality disorder (50).

Ultimately, 48 requests for euthanasia were accepted, yet only 35 patients carried out the option. Eight people canceled or delayed the procedure explaining that simply having the option gave them enough peace of mind to continue living.

In December 2012, when follow-up was conducted, 43 patients had died. Along with the 35 who died by euthanasia, six committed suicide, one from anorexia nervosa. The records suggest one patient who committed suicide did so because she found the approvals process too long, while another did so because of family objections.

While the number of euthanasia patients is few, the researchers say, there is no consensus on what constitutes "unbearable suffering" and no guidelines on how best to deal with requests for help to die from those who are mentally ill. During 2010 and 2011, the 2,086 patients who died by euthanasia accounted for just one percent of all deaths, while those not terminally ill made up less than 10 percent of the total. In the video below, courtesy of YouTube, Dr. Lieve Thienpont, a psychiatrist at University Hospital Brussels, discusses the results.

Source: Thienpont L, Verhofstadt M, Van Loon T, et al. Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: a retrospective, descriptive study. BMJ Open. 2015.