The 22-year-old woman who was about to be euthanized – and changed her mind

Romy had set a date for death: June 19, 2023.

After more than a decade of struggling with unresolved childhood trauma, an eating disorder and clinical depression, she had decided enough was enough. And under Dutch assisted in dying laws, which are among the most tolerant in the world, she could do something about it.

Romy, whose surname has been kept secret, first applied at the age of 18 to the Euthanasia Expertise Center – a mobile euthanasia clinic with its headquarters in The Hague. Four years later, at the age of 22, she was given permission for euthanasia by lethal injection.

“My life is not life, it is mainly survival,” she told Dutch journalist Stephanie Bakker, who interviewed Romy numerous times over a period of eighteen months. moving piece in NRC Handelsblad. “I’m still afraid, but I’m more afraid of the life I have to live than I am of death.”

‘I changed my mind at the last minute’

On that summer day last year, Romy lay on her hospice bed in Leiden while the accompanying psychiatrist explained what would happen. “The first injection numbs your vein,” she was told. “The second injection stops your breathing. Then you will die quickly.”

To comply with the euthanasia law, doctors must ask one last time whether the patient is sure they want to die. Suddenly Romy realized that the answer was no.

Her heart pounded. She started to cry. And in that moment she changed her mind. Romy sent a message to her friends and family, whom she had said goodbye to a few hours earlier. The message read: “Dear all, I changed my mind at the last minute and will not die today. “I’m sorry for the panic I caused you,” she said.

Romy’s story of a last-minute change of heart has made headlines in the week that an assisted dying bill was introduced into the British Parliament. The Netherlands is one of three countries where assisted dying is legal for both mental and physical illnesses (along with Belgium and Luxembourg).

Euthanasia (where a doctor administers a lethal drug) and assisted suicide (where the patient administers it himself) were formally legalized in 2002 for psychological suffering, but also for unbearable physical suffering.

Such as the stories of the growing number of other young people in the Netherlands who do opted for an assisted death as a result of a mental illness – Many of them are suicidal young women with eating disorders, depression or borderline personality disorder (BPD). – Romy’s is full of morbid details.

She had her nails painted red for the occasion. She had bought a dress for her funeral. She joked about her coffin and even saw it the day she was to die, when she bumped into the hearse that was taking her away.

Her motto – ‘life sucks’ – was printed on T-shirts for people to wear on the day she died (she chose to wear a white dress). She had the original date for her death, before it was postponed by 24 hours – June 18 – tattooed on her neck.

As Britain grapples with whether to legalize assisted dying, the Netherlands serves as a troubling premonition, and Romy’s story should be taken as a cautionary tale.

Although the assisted dying law itself has not changed in the 22 years since it was legalized, its application has been extended and relaxed to include people with depression but no physical health problems; children and young people under the age of 18; and now, possibly, healthy people over 75 who simply feel that their lives are complete.

‘Dangers for Britain’

Labor MP Kim Leadbeater, who introduced a private member’s bill on assisted dying in Parliament this week, said it contains the “strongest protections and safeguards of any legislation in the world”.

Critics argue that, as the Netherlands example shows, no guarantee is strict enough.

“This case highlights the dangers to Britain if assisted death becomes law,” said Kevin Yuill, director of Humanists Against Assisted Suicide and Euthanasia. “Anyone can develop a terminal illness by stopping eating and drinking, and we know of at least 60 people – mainly young women – who have died by euthanasia or assisted suicide, suffering only from anorexia.

“There is no provision in the current (British) bill to stop this. But I don’t think a bill allowing assisted dying in any form can prevent expansion, because if death is defined as medical treatment, how can you deny it to people who are suffering? The only real guarantee is that it is not legalized in the first place.”

Julian Kiverstein, assistant professor of neurophilosophy at the University of Amsterdam, says the fact that Romy changed her mind at the last minute is good evidence that her case should not have been approved.

“There are good, evidence-based reasons to think that young people with still-developing executive functions are incapable of making informed decisions to end their lives,” he says.

“While I have no doubt that Romy’s suffering was profound at the time she made her request for euthanasia, I think her case and others like hers show that there is often room to question whether all alternative options have been fully explored in case of requests. of young people, and whether young people have the decision-making capacity necessary to make an informed decision to end their lives.”

Romy was abused as a child between the ages of seven and fifteen. Three years later, when she was an adult, she registered with the Euthanasia Expertise Center (EE), which until recently handled the majority of euthanasia cases due to mental disorders. It was founded in 2012 to assist and advise doctors, many of whom felt uncomfortable facilitating euthanasia for patients with mental illness, despite meeting the legal criteria.

In a research article published on EE last year, psychiatrist Damiaan Denys found that over the course of the average two-year waiting period, many applicants changed their minds. However, should a patient find a willing psychiatrist, the entire process, from application to lethal injection, can take place in as little as six weeks.

The number of cases of euthanasia due to psychological suffering has increased since legalization in the Netherlands – slowly, then steadily and then sharply. According to figures from the Regional Euthanasia Review Committees (RTE), only four cases were registered in 2010, eight years after the practice was first permitted. In 2019 there were 68 such cases and by 2023 this had risen sharply to 138.

The EE also accepts direct referrals from patients who have been refused euthanasia by their psychiatrist or GP. Perhaps as a result, the number of questions from young people has increased: in 2023 the center received 322 questions from people under the age of 30, an increase of 50 percent compared to the previous year.

Pandora’s box

The total number of deaths due to euthanasia (including assisted suicide) in the Netherlands has almost doubled in the past ten years. In 2013, 4,829 people died due to euthanasia. The most recent figure for 2023 is 9,068, which accounts for more than 5 percent of the total number of deaths in the Netherlands that year.

Menno Oosterhoffa psychiatrist who has been treating patients in the Netherlands since 2016 who request euthanasia due to mental illnesses is familiar with Romy’s case, but has not treated her directly. “I’ve never heard of anyone withdrawing so late,” he says. “It often happens at the beginning of the process. Out of 100 people who request euthanasia, only 10 will get euthanasia – many of them find a way (to live), and others commit suicide.”

Put like this, a painless end for the few patients who are determined to end their lives does sound humane – and this is an argument that has been adopted by the pro-euthanasia lobby in other countries, including Britain.

However, Oosterhoff has been criticized by colleagues in the psychiatric profession for making access to euthanasia easier, especially for young people with mental illness, by presenting it as an option in the first place. He once told the Dutch talk show Op1 that: “I am not trained to make people better. I am trained to alleviate suffering… that may ultimately include euthanasia.”

“Euthanasia in young adults receives so much positive attention in the media that it is almost no exaggeration to say that it is actively promoted as a treatment option in psychiatry, when it should be an absolute last option once all treatments have failed,” says Kiverstein.

“The situation is being exacerbated by over-enthusiastic psychiatrists… who would like to see regulations around euthanasia significantly relaxed and relaxed. We run the risk here of something equivalent to what has been called the ‘Werther effect’, where the media portrayal of euthanasia in psychiatry encourages people to consider euthanasia or suicide when they otherwise would not.”

Oosterhoff previously admitted that he had doubts about his own practice. “Sometimes I think: have we opened Pandora’s box? How many people will ask for euthanasia? I have no idea. More than the 138 who received it last year,” he told this newspaper in June. “It sometimes scares me that 99 percent of the world will condemn what I do.”

After Romy renounced her decision to die, she felt that her friends and family struggled to understand and distanced themselves from her. She felt abandoned. “When I didn’t die, everyone was angry or went on vacation,” she told Bakker. “Now I feel like I have to die,” she added, “because everyone else is so annoyed that I don’t do it…I’ve been the girl who wants to die all my life. But who am I without my death wish?”

Later that year, she submitted another request for euthanasia while admitted to a psychiatric hospital, but a week later she withdrew her second request from the Expertise Center. For a while, things improved and Romy lived independently, played sports and visited family. Earlier this year she suffered another relapse, but is now attending assisted living and completing a college degree. She says the “normal” aspects of life, like paying the rent, give her hope. She thinks about death every day but is optimistic about the future for the first time.

“I don’t regret the trip because I was so close to death, I see life as something valuable. Things won’t always go well, but I now know there is light at the end of the tunnel,” she said. “I have survived death, so I will survive life.”

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