Symptoms of anxiety, depression, and substance dependence have ravaged my life for 50 years. Suicide? Sure, it’s crossed my mind, but never set up camp. It did in Zoraya ter Beek’s psyche. She’ll die next month. We need to talk about it.
’…there’s nothing more we can do for you. It’s never gonna’ get any better.’
Quick heads up: some may find our subject matter troubling, even triggering. If you’re one of them, please feel free to close the piece. Maybe Bringing light to our darkest days would be a good choice.
Now that medically assisted suicide for those with severe and persistent emotional and mental health challenges (“psychiatric euthanasia”) is legal in a number of countries, the end of life stories continue to pour in.
Intro
Let’s do some table setting before we get rolling…
We’ll be using the term “assisted dying” in our discussion. Medically assisted dying, physician-assisted dying, physician-assisted suicide, medical assistance in dying (MAID), and in this case, psychiatric euthanasia are also used. Just don’t lose the forest for the trees, okay?
Since we’re discussing a case taking place in the Netherlands, you may want to read the Government of Netherlands’ euthanasia information, as well as the Termination of Life on Request and Assisted Suicide (Review Procedures) Act.
Finally, there are two articles here on Chipur that address assisted dying, including ethics and opinions: Assisted dying – psychiatric euthanasia: You okay with it? and Assisted dying – psychiatric euthanasia: You okay with it? Part 2. Both are well worth reading.
The Zoraya ter Beek story
On April 1st, The Free Press published ‘I’m 28. And I’m Scheduled to Die in May.’, written by Rupa Subramanya. The piece is based upon an interview with Zoraya ter Beek.
You may notice that I didn’t include an image of her. Fact is, I don’t have the rights. But even if I did, and even though she came forward, it wouldn’t be here. It’s about discretion and respect.
Who is she?
Zoraya ter Beek, 28, lives in a small Dutch town with her boyfriend and their two cats.
There was a time that she wanted to be a psychiatrist; however, the symptoms of her major depressive disorder, autism spectrum disorder, and borderline personality disorder prevent her from finishing school – even starting a career.
Sadly, she’s tired of living.
Her psychiatrist’s shocking statement
For all we know, Ms. ter Beek would have pursued assisted suicide regardless; however, a shocking statement by her psychiatrist pushed her over the edge.
After pointing out that everything had been tried, the doc said, “…there’s nothing more we can do for you. It’s never gonna’ get any better.” (I’m still shaking my head.)
It was then that ter Beek decided to die, stating, “I was always very clear that if it doesn’t get better, I can’t do this anymore.”
”Tree of life”
Interesting: ter Beek has a tattoo of a “tree of life” on her upper left arm, but “in reverse.”
She explained, “Where the tree of life stands for growth and new beginnings, my tree is the opposite. It is losing its leaves, it is dying. And once the tree died, the bird flew out of it. I don’t see it as my soul leaving, but more as myself being freed from life.”
Death
Ter Beek has decided to die on her living room couch. She says there will be no music. She’s asked her boyfriend to be with her until the end.
Ter Beek detailed, “The doctor really takes her time. It is not that they walk in and say: lay down please! Most of the time it is first a cup of coffee to settle the nerves and create a soft atmosphere. Then she asks if I am ready. I will take my place on the couch. She will once again ask if I am sure, and she will start up the procedure and wish me a good journey. Or, in my case, a nice nap, because I hate it if people say, ‘Safe journey.’ I’m not going anywhere.”
According to ter Beek, her doctor will administer a sedative, followed by a drug that will stop her heart.
Protocol
So ter Beek provided a glimpse of the protocol for ending her life. For learning’s sake, let’s review protocol for a non-psych case in Vermont that took place earlier this year.
Five powerful medications are used, including diazepam, digoxin, morphine sulfate, amitriptyline, and phenobarbital. Death usually comes within 90 to 120 minutes, but can take longer.
When a patient is ready, they, a relative, or friend mixes the drugs with water or apple juice. It’s crucial to drink the entire mixture within two minutes for the greatest efficacy.
Within a couple of minutes, the patient loses consciousness, only the heart and lungs still working. Then comes the waiting for the end.
Postmortem
Back to Ms. ter Beek. When she’s dead, a euthanasia review committee will evaluate her death to ensure the doctor adhered to “due care criteria.” If there are no complications the Dutch government will declare that the life of Zoraya ter Beek was lawfully ended.
There won’t be a funeral, as ter Beek doesn’t have much family and she doesn’t think her friends will feel like going. Instead, her boyfriend will scatter her ashes in “a nice spot in the woods” that they have chosen together.
Ter Beek texted the interviewer: “I did not want to burden my partner with having to keep the grave tidy. We have not picked an urn yet, but that will be my new house!” She added an urn emoji after “house.”
Ter Beek wrapped things up by saying, “I’m a little afraid of dying, because it’s the ultimate unknown. We don’t really know what’s next – or is there nothing? That’s the scary part.”
What to make of it all?
Incredibly intense stuff, isn’t it. I mean, it wasn’t too long ago that I wrote about Shanti De Corte’s assisted suicide – and the complexity and emotional roller coaster ride continue.
My two cents
With a tip of my hat to cultural and spiritual realities, an adult has the right to end their life.
I’ll go out on a limb and submit that very few people would take issue with someone doing it if they’ve been diagnosed with a terminal medical condition.
But when it comes to an emotional or mental disorder – which are medical conditions – things get dicey. And that’s because they aren’t terminal. Now, I suppose one could make the case that they are; however, the only support would be, ironically, the potential for suicide.
Regarding Ms. ter Beek’s case, the symptoms and manifestations of major depressive disorder, autism spectrum disorder, and borderline personality disorder could be a will-breaking load.
Who could blame her for wanting out?
My biggest hang-ups in any psych assisted suicide case are compromised thinking (e.g., cognitive distortions), judgment, impulsivity, and negative environmental factors.
Yes, I realize ter Beek was assessed and received approval from medical and psychological professionals. But when the biggest player says, “…there’s nothing more we can do for you. It’s never gonna get any better.”, I’m not feeling good about it.
And there’s something else that has me scratching my head. I may have missed it, but I don’t recall reading anything about psychotherapy. Was she participating? Was it the right type? Did she have quality clinicians?
Well, look, regardless of my two cents, in several weeks Ms. ter Beek will fulfill the wishes of her mind and soul. No judgment here.
What are your thoughts and feelings?
I’d give anything to chat with her
So Zoraya ter Beek will die next month. Her choice, her right. And the physician facilitating her death will be protected by the law.
It saddens me. In fact, I check every day to see if she cancelled the procedure. Is that selfish?
Pure countertransference: I’d give anything to chat with her and, yes, see if I could change her mind.
Hey, if you or someone you care about are in immediate danger of any form of self-harm call 988 in the U.S. And here’s a list of international suicide hotlines.
Here’s the article from The Free Press: ‘I’m 28. And I’m Scheduled to Die in May.’
Those Chipur inspiration and info articles: plenty of them.
After a decades-long battle with panic, generalized anxiety, fluctuating moods, and alcohol dependence; Bill finally found his life’s passion and work – lending a hand to those in the same boat. At age 49 he hit grad school and earned his counseling credentials. And he continues his service through Chipur and other projects.
