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October 1, 2022

Backlog of Euthanasia Requests by Mental Health Sufferers

In a report to the Dutch Parliament this week, the Dutch Minister for Health, Ernst Kuipers, has reported on the problems associated with the backlog of euthanasia requests by mental health sufferers (inc those with dementia) in the Netherlands.

Reports such as this are a key element in the Netherland’s commitment to transparency in the system.

Ernst Kuipers writes:

Since 2010, there has been an increase in the number of euthanasia in cases based on mental suffering. In 2021, there were 115 euthanasia deaths, representing 1.5% of the total number of euthanasia deaths in the Netherlands.

In the vast majority of those cases (83 out of 115), the euthanasia was performed by a doctor affiliated with the Euthanasia Expertise Centre, (EE), rather than by the treating psychiatrist.

The Euthanasia Expertise Centre’s own study of this target group has shown that 70% of those who applied in the period 2012 – 2018 were rejected: mostly due to the requirements of the Termination of Life on Request and Assisted Suicide Act (Wtl) were not met.

A further 20% of patients voluntarily withdrew themselves from the process. However, the majority of those who made a request to the EE for euthanasia were rejected.

Backlog of Euthanasia Requests by Mental Health Sufferers

The number of requests received by the EE from people with mental suffering has increased to such an extent that the demand for help and the supply of care are out of balance. There is now a waiting list of around two years.

This has not only led to too high a workload at the EE, and the Centre believes that it would be better if the patient were helped by their own practitioner.

In this regard, the EE is working actively to ensure that more people are helped in regular mental health (mental health) care. This will help reduce the waiting list.

In 2021 there has been some progress in this regard with more euthanasia deaths occurring place outside the EE. Also in 2021, mental health practitioners sought the help of an EE counsellor (28% more often in 2021 than in 2020).

Cooperation and exchange in knowledge and experience between the EE and the mental health field has been strengthened by the deployment of an EE relationship manager who actively seeks contact with regional mental health organisations and highlights the EE as a source of advice, support and training.

However, in practice, patients are still being referred to the Euthanasia Expertise Centre too often and too quickly. Reluctance and hesitancy to act on the part of mental health practitioners and other doctors who have received a euthanasia request from a patient.

A request for euthanasia may be a symptom of the psychiatric illness. This may affect the person’s capacity to consent to a euthanasia request. The death wish may vary in intensity but be persistent.

When a persistent death wish develops into a euthanasia request based on psychological suffering, Kuipers notes that it is ‘important to carefully explore and assess this request’.

While most Dutch psychiatrists support the idea of euthanasia for psychological suffering, there remains a reluctance among psychiatrists to explore and assess a euthanasia request or to perform euthanasia themselves.

Kuipers reports that this is related to the fact that psychiatrists very rarely have to deal with a euthanasia request from their patients (ie. a few times in their careers and thus remain relatively inexperienced in the process).

Indeed, research from the Euthanasia Expertise Centre has shown that a significant proportion of referrals to the EE were made because the psychiatrist did not consider him/herself competent to make the assessment or perform the euthanasia.

In addition, there is a reluctance because psychiatrists consider the assessment of a euthanasia request on psychological grounds to be exceedingly complex.

Backlog of Euthanasia Requests by Mental Health Sufferers

Kuiper’s concludes that it is against this background that the policy vision of providing timely and appropriate care to people who, because of their psychological suffering request euthanasia, must be fulfilled.

‘People with a persistent euthanasia request on psychological grounds should be able to count on help at the right time, in the right place and preferably without a (long) wait’ he says.

Read the full report (in Dutch) on the Riksoverheid website.