Adriana Geerts, whose sister Cornelia Geerts, 59, was so desperate to die that she asked her psychiatrist to kill her
GHENT, Belgium: After struggling with mental illness for years, Cornelia Geerts was so desperate to die that she asked her psychiatrist to kill her.

Her sister worried that Geerts’s judgement was compromised. The 59-year-old woman was taking more than 20 pills a day, including antidepressants, an opioid, a tranquilliser and two medicines often used to treat bipolar disorder and schizophrenia.

But about a year later, on October 7, 2014, Geerts received a lethal dose of drugs from her doctor.

“I know it was Cornelia’s wish, but I said to the psychiatrist it was a shame that someone in treatment for years could just be brought to the other side with a simple injection,” said her sister, Adriana Geerts, who believes society should try harder to accommodate the mentally ill.

Cases like Geerts’s reveal how difficult it can be to navigate the boundary between individual freedom and protecting vulnerable patients when it comes to euthanasia.

Aside from Belgium, euthanasia is also legal in Canada, Colombia, Luxembourg and the Netherlands. Only Belgium and the Netherlands allow euthanasia for people with mental illness. In most cases, it is performed on people with a fatal illness like cancer, who have only weeks to live.

Euthanasia is not permitted in the US but six states and Washington DC allow assisted suicide, where doctors provide people with a deadly dose of medication. People must be terminally ill.

The procedure is forbidden for psychological suffering.

“I always regret that we couldn’t do something else,” said Dr Lieve Thienpont, one of the psychiatrists who signed off on Geerts’s death. “At the same time, I feel I’m part of the relief for the patient.”

Like many in Belgium, Thienpont believes that when modern medicine can’t relieve pain, euthanasia, which allows doctors to actively administer drugs to kill patients, should be an option.

Colleagues say Thienpont appears more inclined than most to approve euthanasia.

The way she manages her euthanasia requests led to a rift with Dr Wim Distelmans, chairman of Belgium’s Euthanasia Control and Evaluation Commission, earlier this year.

Internal correspondence shown to the AP shows that Distelmans and some of his fellow practitioners believe they were being used as a rubber stamp to approve euthanasia for patients referred by Thienpont.

Belgium requires that people seeking euthanasia for psychiatric reasons get an independent consultation from at least two other doctors. The doctors don’t have to agree; the law says only that objective assessments must be sought.

“We found several times that you had already made promises to patients who were referred to us,” Distelmans and colleagues wrote, complaining that such promises undermined their own attempts to engage with patients and determine if euthanasia was justifiable.

“We want to distance ourselves from this way of working,” he wrote, adding that they would no longer accept patients from Thienpont.

She said the letter raised problems only about how patients were referred, not how she and her colleagues were practising euthanasia. She also blamed the patients for not describing events accurately.

“These patients are very desperate and stressed,” she said. “They say things that are not always correct.”

Some experts say the split between Thienpont and Distelmans raises alarm about euthanasia in Belgium, especially since the dispute has not been publicly disclosed by the commission overseeing it.

“That suggests some cases of euthanasia have proceeded that have not met the statutory, legal requirements,” said Penney Lewis, co-director of the Centre of Medical Law and Ethics at King’s College London. “The idea that this is happening behind closed doors is very worrying.”

Distelmans did not respond to requests for an interview.

Mental health experts say balancing the finality of euthanasia with the transient nature of many psychiatric illnesses is extraordinarily difficult.

“I’m convinced that in Belgium, people have died where there were still treatment options and where there was still a chance for years and even decades of (quality of) life,” said Dr Joris Vandenberghe, a psychiatrist at the University of Leuven, who is working on new euthanasia guidance for the Flemish Psychiatric Association.

Some patients, though, say that knowing that euthanasia is possible can prolong life.

Amy De Schutter, who endured years of failed treatment at psychiatric institutions, spent months deliberating the best way to kill herself.

She had already picked the day of her suicide, but one month before her intended death last year, she was approved for euthanasia.

“It felt like 10000kg was just (lifted),” De Schutter said. Being cleared to legally die at home was comforting enough that she didn’t set an immediate date for euthanasia.

But for some bereaved relatives, the loss of their loved one is compounded by a belief that doctors should have focused on keeping patients alive.

“I think if the doctors had tried to help (my sister) more, or proposed other things, she might have felt there was another solution,” said Adriana Geerts, who accompanied her sister to the euthanasia clinic despite her own misgivings.

“I wish there had been another way,” she said.