De Hert Marc, Loos Sien, Sterckx Sigrid, Thys Erik, Van Assche Kristof
University Psychiatric Centre, Katholieke Universiteit Leuven, Leuven, Belgium.
Department of Neurosciences, Centre for Clinical Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium.
Front Psychiatry. 2022 Jul 19;13:933748. doi: 10.3389/fpsyt.2022.933748. eCollection 2022.
Belgium is one of very few countries that legally allow euthanasia for suffering caused by psychiatric illness. In the first criminal trial in Belgium of physicians involved in euthanasia, three physicians recently faced the accusation of "murder by poisoning," for allegedly having failed to comply with several requirements of the Belgian Euthanasia Law in granting the euthanasia request a woman suffering from psychiatric illness. Although all three physicians were acquitted, the case generated much debate among policy makers, medical professionals, and the general public.
We use this trial as the starting point for a critical analysis of the adequacy of the three-level control system established in the Euthanasia Law, as it is applied in the evaluation of euthanasia requests from persons who suffer unbearably from a psychiatric illness. This analysis is based on information presented during the criminal trial as well as information on the euthanasia that was published in the press.
Our analysis highlights substantial problems in the assessment and granting of the euthanasia request. The patient was euthanized without it having been substantiated that her psychiatric illness had no prospect of improvement and that her suffering could not be alleviated. The three-step control system enshrined in the Law and promoted by the Federal Control and Evaluation Commission for Euthanasia appears to have failed at each level.
To evaluate requests for euthanasia for mental suffering caused by psychiatric illness, the requirements of the Belgian Euthanasia Law should be complemented by mandating the advice of two psychiatrists, and face-to-face discussions between all physicians involved. In parallel with the process of evaluating the euthanasia request, a treatment track should be guaranteed where reasonable evidence-based treatments and recovery-oriented options are tried.
比利时是极少数在法律上允许因精神疾病导致的痛苦实施安乐死的国家之一。在比利时首次针对参与安乐死的医生进行的刑事审判中，三名医生最近面临“投毒谋杀”的指控，据称他们在批准一名患有精神疾病的妇女的安乐死请求时未遵守比利时安乐死法的多项要求。尽管这三名医生均被宣告无罪，但该案件在政策制定者、医学专业人士和公众中引发了诸多辩论。
我们以此次审判为起点，对安乐死法所确立的三级控制系统在评估来自患有无法忍受的精神疾病患者的安乐死请求时的充分性进行批判性分析。该分析基于刑事审判期间呈现的信息以及媒体上公布的有关安乐死的信息。
我们的分析凸显了在评估和批准安乐死请求方面存在的重大问题。患者在未证实其精神疾病没有改善前景且其痛苦无法缓解的情况下被实施了安乐死。法律所规定并由联邦安乐死控制与评估委员会推行的三步控制系统在每个层面似乎都失效了。
为评估因精神疾病导致的精神痛苦而提出的安乐死请求，比利时安乐死法的要求应通过强制要求两名精神科医生提供建议以及所有相关医生进行面对面讨论来加以补充。在评估安乐死请求的过程中，应确保有一个治疗途径，尝试合理的循证治疗和以康复为导向的选择。
