On January 17, 2015, PBS aired a chilling documentary about the physician-assisted suicide of a healthy, thirty-four-year-old Belgian woman suffering from depression. The film opens with shots of Eva, in sweat pants and a T-shirt, petting her affectionate Labrador as she greets the youthful Dr. Van Hoey at her home. “Let’s get on with this,” Eva says as she sits on her patio. “I am looking forward to the rest.” Eva gives a good-bye hug to her brother and sister-in-law, who do not want to be present for her death. She lies down on her living room couch and rolls up her sleeve to receive her injections.

Dr. Van Hoey’s first injection puts Eva into a deep sleep. The second kills her.

“The bond between a patient and doctor gets so strong by the time euthanasia takes place that it is hard,” Van Hoey said, “It is so personal and intimate and beautiful.” But Van Hoey also said that he has administered more than one hundred lethal doses over the past twelve years, and he can talk about them matter-of-factly, “I am quite used to [it],” he said, “It is part of my job.”

In order to qualify for euthanasia in Belgium, a person must suffer from acute and “incurable” physical or mental pain. Polls in Belgium show broad support for euthanasia, and the number of cases has grown steadily every year since it was legalized in 2003. In 2003, there were 235 cases of euthanasia. In 2013, there were 1,816. One out of every twenty deaths in Belgium is now deliberately caused. In 2014, Belgium became the first country in the world to legalize euthanasia for children. If you ask to be euthanized in Belgium today, chances are three in four that your request will be granted. Most of Belgium’s euthanized patients have terminal cancer, but people are also being euthanized for autism, anorexia, borderline personality disorders, chronic-fatigue syndrome, and depression.

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A Culture of Death

Tom Mortier, a chemistry professor at Leuven University College, became a critic of euthanasia following his sixty-four-year-old mother’s death by euthanasia. In April of 2012, Mortier was shocked and traumatized when the University Hospital in Brussels called to inform him that his mother, Godelieve De Troyer, had been euthanized the previous day. The hospital wanted him to retrieve his mother’s body from the morgue. “I am still trying to understand how it is possible for euthanasia to be performed on physically healthy people without even contacting their children,” Mortier said.

De Troyer had been depressed following a failed romance, and she asked doctors not to contact her children. De Troyer’s psychiatrist believed that her depression was treatable, and he refused to help her die. So she went “euthanasia shopping,” looking for a psychiatrist who was willing to authorize the procedure. Dr. Wim Distelmans, an oncologist, administered the lethal injection.

After his mother’s death, Mortier filed a complaint against Dr. Distelmans with the European Court of Human Rights. He also published a series of articles exposing other morally problematic cases involving Dr. Distelmans. In January 2013, Dr. Distelmans euthanized Marc and Eddy Verbessem, forty-five-year-old deaf identical twin brothers who lived together in the town of Putte and worked as cobblers. Villagers reported that they would often see the brothers around town chatting spiritedly in sign language together. The twins were not terminally ill, and they were not suffering from physical pain, but they couldn’t bear the thought that they were going blind. “There was no other solution,” Dr. Distelmans said, “They . . . wanted to stay independent, and when they were becoming blind, independence was no longer possible.” The desire to remain autonomous is the most frequently cited reason for which people request euthanasia.

In February 2013, Dr. Distelmans euthanized a healthy forty-four-year-old woman who suffered from anorexia nervosa. In September 2013, Dr. Distelmans euthanized Nathan (born Nancy) Verhelst, a transgender person who was unhappy with the results of a sex-change operation. Especially frustrating to Dr. Mortier is the fact that Belgium’s sixteen-member Federal Commission of Control and Evaluation, which is supposed to protect the public from abuses, is headed by Dr. Distelmans. Since 2003, it has reviewed 8,000 cases, and not one has been referred to prosecutors.

Emotional Inducements to Suicide

According to Mortier, euthanasia in Belgium has hardened from a medical option into an ideology.

Fundamentalist humanists . . . describe euthanasia as the ultimate act of self-determination. Euthanasia is being promoted as a beautiful and positive way to die. Doctors are transplanting organs from patients who die in the operation. This is said to make their lives meaningful.

Belgian doctors began harvesting organs from euthanized patients in 2008. They described this procedure in the journal Transplant International. “[Organ donation after death] may increase the number of transplantable organs and may also provide some comfort to the donor and her family.”

Wesley Smith, a consultant to the Center for Bioethics and Culture, warns that coupling organ donation with euthanasia creates a strong emotional inducement to suicide, particularly for people who are culturally devalued and depressed and who might worry that they are a burden on loved ones. “People in such an anguished mental state could easily come to believe that asking for euthanasia and organ donation would give a meaning to their deaths that their lives could never have,” Smith writes. Governments and healthcare systems already have a huge financial stake in cutting short the lives of vulnerable populations. Procuring organs from euthanized patients gives them added incentive.

Ben Mattlin, who was born with spinal muscular atrophy, writes about how easily suicide can become an obligation in a culture where euthanasia is promoted as a dignified exit. Mattlin calls “the border between coercion and free choice” thin and porous. “How easy it is for someone to inadvertently influence you to feel devalued and hopeless—to pressure you ever so slightly but decidedly . . . to unburden others,” Mattlin writes. For socially marginalized people, there are many subtle forces—like the look of exhaustion in a loved one’s eyes, or the way nurses and friends sigh in your presence—that can send even the most cheerful of optimists into a dangerous depression. “If nobody wants you at the party, why should you stay?” Mattlin asks.

Redemptive Suffering

Opponents of euthanasia argue that there is more to life than just the pursuit of happiness. Life is also a training ground for the human spirit in which suffering enriches our personalities and produces wisdom and compassion. Alison Davis—who led a worldwide campaign against the legalization of euthanasia—is an inspiring and instructive example of this. Davis was born in Bolton, England in 1955 with spina bifida and hydrocephalus. She later developed emphysema, osteoporosis, and arthritis. Confined to a wheel chair from the age of fourteen, she needed full-time care and suffered severe spinal pain on a daily basis. In 1985, following a failed marriage, she attempted suicide. Friends found her in time, and she survived. “I was extremely angry with the friends that initiated life-saving treatment,” Davis wrote. If voluntary euthanasia had been a legal choice, she would have requested it.

Davis’s conversion to Roman Catholicism in 1991 and her subsequent involvement in charity convinced her that her life was worth living. During a pilgrimage to Lourdes, Davis learned that she and other sick people were “very much loved by God in their suffering.” She came to believe that the opportunity to share in the sufferings of Christ was the greatest privilege in the world. During the 1990s, Davis became friends with an American death-row inmate, Sammie Felder, who had been convicted of killing a disabled person in his care. In December 1999, she went to Texas to witness Felder’s execution.

In 1995, Davis travelled to India with Colin Harte, her devoted companion and caregiver. Together, they established Enable, a charity for disabled children in South India. In 2001, the charity opened a home named after Alison Davis. Davis wrote,

Many of the children are so disabled that they can barely manage to crawl in the dust. They are unwanted and unloved by their families, but it is true to say that they saved my life. They hugged and loved me, and as I was playing with them, I suddenly loved them all, overwhelmingly and fiercely, as if they were really my own. When we left, I said to Colin, “I think I want to live.”

Davis writes that a premature death would have robbed her of the best years of her life, and it would have robbed many Indian children of the chance in life that she was able to give them.

Alison Davis died in 2013. Shortly before her death, Colin Harte wrote,

The Church provides a beautiful and profound teaching on suffering . . . Alison’s life of intense suffering—physical, social, emotional, mental, and spiritual—is an exceptional witness to the privilege and dignity of suffering in union with Christ.

A Humanist Triumph?

In Belgium, euthanasia is often described as a humanist triumph over Belgium’s Catholic and patriarchal past. Jan Bernheim, a professor of medicine at the Free University of Brussels, sees euthanasia as part of a philosophy of autonomy in which people improve the objective conditions for happiness. “There is an arrow of evolution that goes toward ever more reducing of suffering and maximizing of enjoyment,” Bernheim wrote. Belgian philosopher Etienne Vermeersch writes that Belgium’s efforts to increasing the store of human happiness and decrease suffering places that country, “ethically, at the top of the world.”

Following the suicides of two close friends, Jennifer Hecht wrote Stay: A History of Suicide to rebut such glamorized perspectives on suicide. Hecht acknowledges that the Enlightenment’s insistence on the rights of the autonomous individual have delegitimized the theological proscription against suicide, but she believes that this proscription can be recovered in a secularized form.

Hecht develops two arguments against secular rationalizations of suicide. First, suicide is not just an act of individual autonomy. Suicide devastates families and leads to more suicide. If a parent commits suicide, his or her children are three times as likely to do so at some point in their lives. According to epidemiological studies, there is almost always a spike in suicides in a community where a person has killed herself. In the month after Marilyn Monroe’s overdose, there was a 12 percent increase in suicides in America. Jennifer Hecht concludes that “Suicide is homicide . . . When you take your own life, you normalize suicide for people who liked you and who are like you.”

Second, suicide is a crime against our future selves. It is based on the false assumption that a depressive mood is permanent. A study of 515 people who were talked down from jumping off the Golden Gate Bridge found that only 6 percent had gone on to commit suicide. Other studies have shown that the overwhelming number of people who have attempted suicide are glad to be alive. “None of us can truly know what we mean to other people, and none of us can know what our future self will experience,” Hecht wrote. Therefore, it is morally imperative for us to “bear witness to the night side of being human and the bravery it entails, and wait for the sun.”