The Right To Die debate in the U.S is seeing a slow increase in states willing to take on statues allowing terminally ill people to peacefully end their lives when they want to. People like Brittany Maynard, who moved to Oregan so she could end her life before brain cancer made her life unbearable, give faces and stories to champion the right of an individual to legally end their life when they’re up against the ravages of a devastating illness. But,should patients be able to end their lives over distressing chronic mental disorders like depression and anorexia?
In Belgium and the Netherlands, people are doing just that. Blindness, a botched transgender surgery, eating disorders, autism, and, of course, depression, are among some of the complaints from approved euthanasia applicants. In fact, depression and personality disorders are the most common diagnoses for Belgium’s psychiatric euthanasia patients. They are approved to end their lives because of the “unbearable suffering” they endure at the hands of their illnesses.
Last summer The New Yorker published a long, engrossing peace about Godelieva De Troyer, a vibrant woman who chose to end her life through euthanasia after a lifetime of emotional anguish. Her children, who she was mostly estranged from at the time, found the decision baffling and hard to cope with.
After she died her children got a note written in the past tense revealing that Godelieva had died. The neighbor who transported her to her final appointment described her as laughing and in a good mood on her way to the hospital, saying this perplexing behavior illustrated how little they really knew her. There were unsent goodbye letters at her house that tried to explain in more detail why she was ending her life this way: “the loneliness, no chance of a cure after forty years of therapy, nothing to look forward to—all this has led me to see that the only thing remaining is a dignified end of life.”
This past weekend, the HBO show VICE showcased the death of Antoinette Westerink, another Belgium resident who was approved to end her life because of a personality disorder. The decision came after three sessions with a psychiatrist. Like Troyer, Westerink’s children found her euthanasia decision hard to accept, and felt left out of the process. Family members aren’t interviewed during evaluations, which seems right when it comes to most psychiatric care, but families of euthanasia patients often feel like they should be more involved when it comes to these life and death decisions.
VICE journalist Vikram Gandhi showed up the night before Antoinette’s scheduled death and was immediately shown a space in her house where she used to have a table. Tomorrow, Antoinette explained, “I lay here in my coffin.”
She cheerily makes him coffee, asking him how he takes it. “Are you nervous at all?” he asks.
“No,” she says, briskly and without hesitation. But then her face clouds over a bit. “People who come around and have tears and cry, that’s difficult. To say goodbye to everyone.”
She shows him the shirt she plans to die in: a purple, guazy, celebratory garment she made herself. She had her picture taken in it for a card she’s sending out to announce her death.
Dying is in the details for Antoinette, as she also has a cloth to be laid on her coffin that depicts the journey of a caterpillar to a butterfly, which she sees as her journey. She emphasizes that the caterpillar has to travel across difficult stones in the illustration, symbolic of how difficult can be.
“When do you become a butterfly?” Vikram asks.
“When you die,” she replies.
Antoinette feels like death is the transition she’s been craving all her life. “I work in a hospice so I’ve seen many dead people,” she says. “You always see their soul go out. They are happy. They are really happy. Nothing matters anymore.”
When explaining for the cameras why she’s decided to take this route, Antoinette cites the “unbearable suffering” keyword that’s attached to mental illness euthanasia in Belgium.
“My step to euthanasia happened because my suffering has become unbearable. All the anxiety that keeps coming back on a daily basis. Before that I was already suffering from delirium and dissociations, depersonalization and PTSD. I can’t do it anymore. It’s over.”
A couple of friends come by for Antoinette’s death. There are no tears, only smiles and statements of support. One friend, Danielle Pasma, says, “the last years, I’ve seen her gradually losing herself. I think someone has the right to choose her own death, and the way she’s going to die.”
Another friend, Marja Schirris, tells Antoinette, “It’s ok, and I’m just here to support you. I don’t even think today is a hard day, I think today is a day to celebrate. Finally, we can let you go.”
Her children, son Gabor de Man and daughter Sheila Roos, stop in to say goodbye even though they don’t approve of their mother’s decision. Gabor de Man is shocked at the swift manner of the approval process. “It surprises me that in the Netherlands you can give someone a death sentence after three conversations,” he says. Sheila, who says her mother has always wanted to die, holds her hand and hugs her mother during and after Antoinette’s final moments.
Dr. Paulan Starcke, Antoinette’s psychiatrist, also comes by for Antoinette’s death. “My diagnosis of Antoinette is that she suffers from a longstanding, probably lifelong personality disorder which is the basis of her complaints,” she says. “I met her three times, intensely, and after the third appointment, I reached a conclusion.”
Antoinette’s mood seems upbeat, and when it’s time to die, she doesn’t delay. She settles on her table and waits for the injection. When she starts to feel the sedatives, Antoinette opens her eyes wide and tells everyone goodbye, then drifts off to sleep. Her death’s shocking in its quiet peacefulness. Still, it’s hard to watch a life slip away, and even though this parting seems to be exactly what Antoinette wanted, the implications of euthanasia for mental illness appear slippery and scary, despite her serenity.
Mental illness often means intense suffering, but it often also means temporary death wishes that disappear when life gets a little better. Many of us who struggle with depression and other common mental health diagnoses experience times where this type of goodbye is exactly what we think we want, but later find ourselves grateful for life we have, and chilled by the inner stalking shadow of self-destruction that threatened to snatch it all away during a bleak, suffocating time.