The impact of euthanasia for depression in the “tired of living” debate

Belgium has decriminalized euthanasia for constant and unbearable psychological suffering resulting from psychiatric illness, but not for those who are “tired of living.” Depression and “being tired of living” are difficult to differentiate clinically. Some physicians may consider, more or less consciously, a request for euthanasia for mental suffering resulting from “being tired of living” as a request resulting from depression. Is the meaning of this demand a request for death or a way to signify the impossibility of “living like this”? Euthanasia may give these patients the illusion of a controlled death and offer a way of maintaining their decision-making autonomy and thus appear as a safeguard against their own vulnerability. Recognizing “being tired of living” as an age-specific mental disorder would then establish its pathological character and facilitate the acceptance of these requests. Euthanasia for mental suffering is an ethical question in which the physician oscillates between an ethics of conviction and an ethics of responsibility and thus confronts his or her own vulnerability.