In most assisted dying appeals, people say it is the psychological suffering, rather than physical pain, that motivated them
Photo: iStock As organisms genetically wired to strive to survive, the concept of wishing for death despite being physically healthy can be confounding, even for the most pro-choice individuals, although the euthanasia debate has been around since the 1870s.
Next month, 28-year-old Dutch woman Zoraya ter Beek will be administered a sedative by a doctor at her home. Moments later, she will be given a medication to stop her heart from functioning. Although the process is entirely legal, the news naturally created a stir.
Her boyfriend, who she lives with along with their two cats, will bury her ashes in a spot she chose inside a forest near their home, the media reported.
Ter Beek is physically healthy, according to doctors. She has lived with autism her entire life and has been suffering from debilitating depression and borderline personality disorder. When doctors confirmed that there is no further line of treatment that can ease her suffering, she applied for euthanasia on grounds of crippling mental ailments.
Despite the decades-long moral battle on the topic, applications for euthanasia / assisted dying have been on the rise in the countries that have legal provisions for it – in 2022, euthanasia cases in the Netherlands (total over 8,500) grew by 1,000 since the previous year. In Canada, cases jumped 31.2 per cent to 13,241, compared to 2021.
Also, more countries are considering policies that respect people’s will to end their lives, albeit with strict conditions and medical review. After Netherlands and Belgium legalised voluntary euthanasia / assisted dying in 2002, as many as five countries followed suit and some others are negotiating the bill in the parliament.
The role of climate change cannot be ruled out in this trend of more people seeking medical assistance to end their lives. In 2017, a 68-year-old Howard Breen in Canada appealed for 'Medical Aid in Dying' citing unbearable mental suffering stemming from concerns over climate change and its impact on the planet and future generations. Though his request was declined as one of the assessing doctors did not consider ‘eco-anxiety’ an eligible condition, his case brought the mental agony wrought by climate change into the main discourse.
Apart from his case, establishing a direct link of euthanasia appeals and climate change has been difficult. But a closer look at the main reasons cited by people applying for euthanasia / assisted dying shows how many of them are proven to be influenced by environmental reasons.
Most patients seeking euthanasia suffer from terminal cancers, amyotrophic lateral sclerosis, multiple sclerosis and severe chronic obstructive pulmonary disease (COPD), and some report mental health disorders.
All of these health conditions have been observed to have been worsened by exposure to pollution, fluctuations in temperatures and humidity, extreme weather events triggered by climate change, among other environmental factors.
But, like the latest case, most euthanasia seekers reported that it is the psychological suffering, rather than physical pain of their disease, that motivated them, according to a report.
There have been instances in Belgium and the Netherlands, where individuals suffering from severe, untreatable depression and anxiety have applied for euthanasia / assisted dying and have been allowed. These cases often involve patients who have undergone extensive treatment for their psychiatric conditions without relief, leading to a determination that their suffering is unbearable and without prospect of improvement, a scientific study established.
A study in the Netherlands examined 1,122 patients with psychiatric disorders who requested euthanasia or assisted suicide between 2012 and 2018. It found that requests were often made by patients with depressive disorders.
Across the world, a link has been established between climate change and higher suicide rates. A 2018 Stanford study showed that by 2050, climate change could lead to 21,000 additional suicides in the United States and Mexico if current warming trends continue.
Air pollution and ambient temperature are potential environmental factors affecting suicide, according to a 2021 study published in the International Journal for Environmental Research and Public Health. The report noted:
Exposure to traffic-related air pollution may cause defects in neural maintenance / regeneration and structural abnormalities in the brain through decreases in brain-derived neurotrophic factors. Particulate matter and ozone (O3) were reported to activate hypothalamic-pituitary-adrenal stress response axis and overactivation or dysfunction of the hypothalamic-pituitary-adrenal axis can lead to depressive behaviors. High air pollution levels are associated with inflammatory effects on the brain involved in the pathogenesis of neurotoxicity. Diesel exhaust particles and O3 may decrease serotonin levels leading to aggressive and depressive behaviors.
High temperature might be associated with higher levels of aggression, which is associated with elevated suicidal behaviors, it added. “The experience of sudden warmth in the daytime after cold nights can trigger temperature-related overreaction in brown adipose tissue, intensify anxiety, leading to suicidal behaviors.”
Climate change and air pollution feed into each other. Thus, incidence of all mental health conditions like schizophrenia, bipolar disorder, major depression and personality disorder that are significantly more likely to occur in people exposed to toxic air, is further heightened because of climate change.
Moreover, eco-anxiety is a serious threat and is being scientifically studied worldwide. Large-scale studies showed at least half the respondents, mostly young people, were severely worried about climate change.
The American Psychological Association described eco-anxiety as ‘a chronic fear of environmental doom’, ranging from mild stress to clinical disorders like depression, anxiety, post-traumatic stress disorder and suicide, and maladaptive coping strategies such as intimate partner violence and substance misuse.
Studies have also established that climate anxiety and trauma may even have intergenerational effects, especially where environmental damage involves loss of a way of life or culture. The rising figures of climate migration adds to this concern.
Emotions such as fear, anger, powerlessness and exhaustion can shore up with gradual, long-term changes in climate, noted a 2019 study by the American Psychological Association. It mentioned cases “in which fear of extreme weather approaches the level of phobia and the ‘unrelenting day-by-day despair’ that can be experienced during a drought”.
The report also cited research that showed some people are “deeply affected by feelings of loss, helplessness, and frustration due to their inability to feel like they are making a difference in stopping climate change”.
The scientists also described a psychological phenomenon called ‘solastalgia’ – the stinging feeling of loss people experience when their home environment is irrevocably altered. The authors compared it to the sense of desolation experienced by people forced to migrate out of their home. “Solastalgia may have a more gradual beginning due to the slow onset of changes in one’s local environment.”
They referred to a 2013 paper that recorded the emotional experience among residents of Ghana who were forced to move from the northern region of the country to the capital, Accra, because local conditions no longer supported their farming practices. The “respondents expressed nostalgia and sadness for the home left behind and helplessness due to changes in their environments, such as deforestation, that were described as sad and scary”, the authors noted.
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