2017-08, due care criteria complied with

Non-straightforward notification, no reasonable alternative.

The patient, a woman aged between 18 and 30, had a very extensive history of mental illness, with persistent symptoms of extremely low  spirits (depression), complicated by a chronic eating disorder and an obsessive-compulsive personality disorder. The eating disorder led to various physical symptoms, such as emaciation, debilitation, fatigue and osteoporosis. She also suffered from a genetic connective tissue disorder that particularly affected her joints and skin.

The patient was trapped between her eating rituals and untreatable low spirits. She felt as if she had died five years previously; since then she just felt like an empty husk. She said the emptiness was ‘filled’ by the eating disorder. She was not interested in anything and hardly had the energy to undertake any activity. Most of her time was taken up by her eating and vomiting rituals.

Her physical deterioration also played a part: she was underweight, and felt tired and dizzy. And although she had creative talents and was interested in animal care, she hardly had any opportunity to pursue these hobbies due to her eating rituals and their undermining effects on her health. In the end, her physical condition deteriorated rapidly. According to the patient, she was suffering the most from her depression.

The patient had been treated for her depression in hospital and at home, with all types of medication, talk therapy and ECT (electroconvulsive therapy, whereby the patient is anaesthetised and an electric current is passed across the brain through electrode patches). She received intensive treatment (counselling) for the eating disorder in specialised clinics. The patient cooperated actively with all forms of treatment offered.

The treatments had a positive but temporary effect on her eating disorders and her depression. After the treatment and/or her stay in a 2017 clinic ended, however, both problems soon returned. The patient’s condition was incurable. All that remained was experimental forms of treatment. Therefore, despite her youth, there were no longer any realistic treatment options available to her.

Around four months before the termination of life, the physician asked an independent psychiatrist to assess whether the patient’s suffering was without prospect of improvement and to assess possible treatment alternatives. This independent psychiatrist established, as had those who treated the patient previously, that she was severely dysfunctional in all aspects of life and that her situation was characterised by a hopelessness and lack of prospect of improvement that had led to her sustained and consistent wish to die.

The depression did not respond to treatment in accordance with protocol, and this led the independent psychiatrist to suspect that the patient had a genetic vulnerability. The independent physician, too, was of the opinion that the patient was suffering unbearably without prospect of improvement. He saw a young woman with severe mental illness. She had tried in many ways to improve her mental health, but to no avail. He concluded that the due care criteria had been complied with.

The committee noted the following as regards the existence of a reasonable alternative: since her early youth, the patient had been treated exhaustively for both her eating disorder and her depression. Despite her extreme youth, there were no more realistic treatment options available. The independent physician and the independent psychiatrist confirmed the physician’s assessment that further treatment  would not result in any lasting improvement and that there were no longer any realistic alternatives for her. The other due care criteria were also fulfilled, in the committee’s view.