The woman killed by doctors because she was obsessed with cleaning: Just one of growing numbers of D
She is a conventional mother who enjoys life with her two children and husband in a farming town 100 miles away from Holland's razzmatazz capital of Amsterdam. Helena waves her youngsters off to school every morning, puts their dinner on the table at night and strongly values the importance of her close-knit family.
The 40-year-old's gentle lifestyle could not be further removed from the euthanasia industry which has given Holland a notorious reputation all over the world. The latest figures show that last year 5,516 Dutch people — including children — were legally killed by lethal injection administered by doctors trained to do the task with rapid efficiency.
Helena is now dealing with the revelation that her sister Jackie wants to die by euthanasia, too. This follows a traumatic childhood experience when she was sexually abused at five years old and developed depression as a result.
Haunted by the horrific memories, 12 years ago Jackie became so ill that she quit her job as a manager in the pharmaceutical industry. As her mental state got worse, she tried to commit suicide by overdosing on pills and was only saved after being taken to hospital.
Brutal electric shock treatment prescribed by psychiatrists to stop the depression didn't work. Next, Jackie went to numerous mental health clinics but none could find a cure. Her GP could do nothing more.
As her depression worsened, she stopped talking, even to her own family. Slipping into this silent world, her physical strength sapped, too, because she lay in bed and rarely went out.
Now she can take only a couple of steps on her own and relies on a mobility scooter if she makes a rare trip out with family or friends.
Helena told the Mail: 'Jackie is only 45 but dearly wants to die. Our family believes she must be allowed to do so. She approached an end-of-life clinic and it has put her on the waiting list for an appointment.
'Her mood has brightened since. She knows there is an end in sight to her suffering and this has given her comfort.'
Jackie's tragic story emerged after her family put a message on Facebook this week sympathising with a very similar case to her sister's. A Dutch woman, in her 20s, last year opted for euthansia after developing mental health problems brought on by having been sexually abused as a young girl.
According to the Dutch Euthanasia Commission, which monitors the mercy killings, the woman was suffering from a litany of ailments: 'incurable' post-traumatic stress disorder, 'therapy resistant' anorexia, suicidal mood swings, tendencies to self-harm, hallucinations and chronic depression.
Psychiatrists could find no permanent cure.
The woman also became almost entirely bedridden and told doctors that her life was 'unbearable'. They then agreed to give her a lethal injection after a team of independent consultants ruled that she was competent to make the decision to end her own life.
Details of the controversial case were released by the Dutch authorities this week in an effort to prove to critics of the country's liberal euthanasia laws that doctors only carry it out under strict guidelines.
The process involves a patient submitting a request to die to a doctor who, in turn, must agree they are in a medically hopeless condition, suffering 'unbearably', either physically or — contentiously — mentally. Above all, they must have no hope of improvement.
The request then goes to an ethics committee which makes a decision, normally within a week.
Currently, 4 per cent of the 140,000 or so deaths a year in Holland are the result of doctor-assisted suicide and the tally is rising.
In particular, increasing numbers of Dutch people with mental illness demand euthanasia. In 2010, two people with such conditions had their lives ended with the figure increasing to 56 last year.
Of those deaths, 36 were conducted by doctors from Amsterdam's End Of Life clinic which has a lengthy waiting list and sends mobile euthanasia teams across Holland to help patients die in their own homes.
The clinic is run by Steven Pleiter, the former European director of an American IT company, who told me in Amsterdam this week: 'One of the reasons the clinic was set up was to help the 'forgotten ones' who wish for euthanasia but get denied it.
'This is a huge group: those with dementia, the elderly with no clear medical diagnosis and those with psychological problems.'
Soft-spoken and with the air of a doctor (despite his non-medical background), Pleiter says his clinic had 1,234 applications for help last year, a third of them from people with psychiatric problems.
Significantly, many of the mentally-ill patients had already been rejected for euthanasia by their own GPs. He explained: 'If someone has cancer and the prognosis is poor, doctors will shorten their suffering by euthanasia.
'But if you cannot see what a patient is dying of, or know when they will die — it could be many years ahead if the person is mentally ill — then the doctors find it more difficult to decide whether to end a life.'
So Pleiter's team offers to fill this gap. He got into the right-to-die business when his mother suffered a stroke at 80 and was left paralysed down one half of her body. She had always told him that if such an eventuality happened, she wanted to be helped to die.
Her son could do nothing to fulfil that wish, and she struggled on for another four difficult years before getting pneumonia and passing away.
The memory stays with him. 'What our clinic provides is a miracle for some people,' he says. 'They are always very eager when the moment to die comes. The doctor comes in and says it is the time. They find it is a big relief to let go because it is the end of their suffering.'
After the clinic opened in 2012, its first psychiatric patient was a 54-year-old woman who had mysophobia (a pathological fear of germs or dirt). She, like other End Of Life patients, was killed at home after first being injected with a strong sedative and then a muscle relaxant which stops the heart.
Gerty Casteelen, one of the clinic's psychiatrists, conducted eight hours of interviews with her before deciding that she really wished to die. 'It was a long process', the medic recalls. 'I came to understand that her fears completely controlled her life.
'All she could do all day was clean. It was impossible for her to maintain a relationship. Her whole development had stalled.'
The patient wanted to die in the evening, at 11 minutes past eight, in her own home. (She chose the very precise time for reasons she kept to herself.)
She had already prepared the invitation cards for her memorial and had bought champagne for the four women who would watch her death. The quartet were psychiatrist Ms Casteelen who would kill her, an assisting nurse from the End Of Life clinic, the patient's GP and a close friend.
Ms Casteelen recalls that the patient was wearing grey pyjamas and says she was happy and relaxed.
'At eight o'clock, I said: 'We have to start preparing things now. She replied: 'No. I would like another glass of champagne.' We asked her if she still wanted to die. She told us how she had been looking forward to this moment; how she was going to be free.'
Ms Casteelen then went about her work. She began to put a sedative drip in the woman's arm. 'We wished her well on her journey. She fell asleep very quickly. That's when I put the muscle relaxant into her.'
This week, another of the End Of Life clinic's psychiatrists, Paulan Stärcke, spoke at a pro-euthanasia conference in Amsterdam attended by doctors and scientists from all over the world.
Her speech was entitled 'Condemned to live with unbearable psychiatric suffering, or allowed to die?'
Ms Stärcke showed a film featuring the family of a Dutch woman with post-traumatic stress disorder, chronic depression and a personality disorder, who — aged just 34 — chose euthanasia even though her own daughter was a toddler aged only three. She explained that the little girl was living with her father, whom her mother had divorced. After the woman's euthanasia, her toddler daughter attended her mother's funeral.
Ms Stärcke says that she was sure that the woman 'would commit suicide if I didn't help her to die'. The psychiatrist continued: 'I talked to her parents a year after her death.
'They expressed gratitude that their daughter's life ended in this way and not in a violent one (by suicide).
'You can prepare for death by euthanasia, you can say goodbye. It can be a loving memory, not only hurt, as suicide is only hurt.
'Euthanasia is a good death for the person who dies and it carries out the wish of the patient.'
The way these medical experts speak makes euthanasia sound as simple as any other hospital treatment. Yet is there another, much more worrying, side to all this?
Many people are appalled, fearing that legalising mercy-killing is a slippery slope, leading to many more deaths than law-makers intend. They say that this is why it was right that British MPs rejected Lord Falconer's Assisted Dying Bill last year.
The measure would have made it legal for a terminally ill person to request assistance with ending their life in Britain if diagnosed as having less than six months to live.
There is another worrying issue. Research shows that 70 per cent of those with psychiatric problems which the Dutch clinic helps to die are women. A quarter of them are under 50.
Many of the clinic's mentally-ill patients — male ones, too — have already tried to commit suicide on numerous occasions, and more than 30 per cent have been refused help to die by doctors in the past, often because that desire may be linked to their psychiatric disorder.
Earlier this week, alarm bells sounded in Britain when the Mail revealed details of the young Dutch sex abuse victim's decision to die in her 20s.
Tory MP Fiona Bruce, the chairman of the Parliamentary All-Party Pro-Life Group, said: 'This tragic situation shows why euthanasia should never be legalised in Britain. What this woman needed, at a desperate point in her young life, was help and support to overcome her problems, not this option.'
Labour MP Robert Feldo said the 'horrendous' case 'sends out the message that if you are the victim of sex abuse and, as a result, you get a mental illness, you are punished by being killed; that the punishment for the crime of being a victim is death'.
For their part, the right-to-die campaigners argue that Lord Falconer's Bill proposed more safeguards than exist in Holland.
They claim that every fortnight, one Briton has to go abroad to use a euthanasia clinic (normally in Switzerland or Belgium), and this 'death tourism' will continue unless the UK has its own assisted dying law.
They believe it would not result in more people being killed, but fewer people suffering.
In contrast to Holland, only those who are deemed mentally competent would be allowed to end their lives prematurely in the UK.
Which brings us back to Helena, whose depressed sister Jackie plans to die soon with the help of doctors from the End Of Life clinic in Amsterdam.
For many years, her family have lived in dread of a police officer arriving at their door to tell them that Jackie had committed suicide.
Helena says: 'We are sure what my sister wants is a good thing for her. Our own doctors say her condition is untreatable and there is no cure for her.
'She has the right to make up her own mind about dying and the clinic has offered her hope of peace at last.'
That may be the case for Jackie, but it will give no peace of mind to those who have profound worries about any prospect of large-scale, state-sanctioned, euthanasia in this country.
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