A Dutch woman chose to undergo euthanasia for mental health reasons—but is this ethical?

A woman in the Netherlands chose to undergo euthanasia on her 34th birthday after struggling with mental health conditions, including depression and an eating disorder.^[]

Controversies of physician-assisted dying

Euthanasia is a form of assisted dying in which a physician administers a lethal medication to a patient, as opposed to assisted suicide, in which the patient administers their own medication. Assisted dying is not legal on the federal level, nor is it legal on the state level across the majority of the US.

States that allow forms of assisted dying include California, Colorado, Hawaii, Montana, Maine, New Jersey, New Mexico, Oregon, Vermont, and Washington, as well as Washington, DC. 

Interestingly, in the Netherlands, a survey of Dutch psychiatrists between 2015 and 2016 found that thousands of psychiatric patients requested forms of assisted dying, and 60 to 70 patients were granted the treatment.^[]

Where legal, assisted dying often requires a patient to be a “competent adult” who is experiencing a “medically futile condition,” according to authors of 2023 paper in the journal Healthcare.^[] Whether or not certain health conditions impair a person’s ability to be considered a competent adult could be up for debate. This debate also extends to whether or not mental health conditions could fall under the definition of “medically futile” conditions.

In the 2023 paper, researchers wrote that “unbearable suffering could be included in the diagnostic or severity criteria of psychiatric disorders, rather than representing the expression of a free and independent choice.”

In cases such as this—in which a woman chose euthanasia after battling mental health problems and an eating disorder—doctors and mental health experts are usually left with mixed feelings.

Niloufar Esmaeilpour, MSc, RCC, SEP, a counselor at Lotus Therapy & Counselling Centre, tells MDLinx that “it is a highly debatable choice to respect the decision to undergo euthanasia in relation to psychological suffering”—one that raises “deep ethical, medical, and social questions.” 

While recognizing that it isn't currently legal in the US, Esmaeilpour says that if a patient raises this question to a counselor or doctor, it would be important to have “a very sensitive [conversation] and explore everything to do with treatment.”

Discussing assisted dying with patients

“A mental health professional has to be human enough to ensure the recommendations that may assist in improving care or increasing resource availability are put in place, and the patient's recovery and management options [are] the best available,” Esmaeilpour says.

Marissa Moore, MA, LPC, a therapist, licensed professional counselor, and mental health consultant writer at Mentalyc, says these types of conversations should involve a lot of listening, along with “empathy, compassion, and a commitment to patient-centered care” from the provider.

“I would listen actively to the patient's concerns, validate their experiences, and explore the underlying motivations behind the request,” Moore tells MDLinx. “I would provide clear and transparent information about the requested treatment, including its potential risks, benefits, and limitations. I would also discuss alternative options and collaboratively develop a treatment plan that addresses the patient's needs and goals while upholding ethical standards and promoting overall well-being.”