Individuals with autism and intellectual disabilities euthanized over loneliness

A study out of Kingston University found that several individuals with learning disabilities and autism were euthanized or died by physician-assisted suicide in the Netherlands, simply because they felt unable to "cope with the world" and struggled with "loneliness."

Key Takeaways:

• The study found 39 individuals over nine years who were killed solely due to factors related to autism or intellectual disability.

• More than two-thirds of the case reports made no mention of the patients' families or other significant people in their lives.

• The case reports show that many of the individuals died because of loneliness and an inability to cope or form relationships.

• Study author Baroness Sheila Hollins testified that there was "very little attempt" to discern if the individuals had the capacity to choose an assisted death.

The Details:

A study published in BJPsych Open searched 927 euthanasia and physician-assisted suicide case reports from 2012-2021 for individuals with intellectual disabilities and/or autism spectrum disorder. They reportedly found 39 individuals who were killed solely due to "[f]actors directly associated with intellectual disability and/or ASD..."

Study author, Baroness Sheila Hollins, testified, "They only published about 4% of the cases, and over a four-year period, we found 39 cases ... of people with intellectual disability and autism who had been euthanized. But there seemed to be very little attempt to understand whether they had the capacity for this to take place."

According to the study:

We searched the database for case reports involving people who had intellectual disability and/or ASD by using the following Dutch keywords: verstandelijk [mental], verstandelijke beperking  [mental/intellectual disability], intellectuele beperking [intellectual disability], zwakbegaafd [mentally disabled], verminderde intelligentie [low intelligence], autisme [autism], ASS [autism spectrum disorder], Asperger. Case reports where the person did not have an intellectual disability or ASD (for example, they had cognitive limitations due to dementia, or they had been assessed for ASD but found not to have it) were excluded from the results. This left a total of 39 relevant case reports for inclusion in the study; reportedly, 15 people had intellectual disability, 20 had ASD and 4 had both intellectual disability and ASD (Supplementary File 2).

Nearly half of the individuals were under the age of 50, and 13% were under the age of 30. Forty-nine percent (49%) had an intellectual disability, and 62% had autism, while 10% had both.

Also notable was that 64% had psychiatric conditions, with depression being the most common, affecting 31% of the group. In addition, 44% had suicidal thoughts and 18% had childhood trauma, including abuse and neglect.

In addition, for 21% of the patients, the only cause of suffering that led to euthanasia was directly related to their intellectual disability or autism.

The study noted that information on the support the patients received was limited. It said, "More than two-thirds of the case reports made no mention of the patient’s family or other significant people in their lives. Of the 12 case reports (31%) where family was mentioned, only half (15%) indicated that EAS discussions had involved family or that family was present at the death. The others mentioned the existence of family just briefly..." One such case report stated:

‘The patient was unable to make friends and had become isolated, including within her own family’ (2017–80, female, age 18–30, ASD).

Another case reported said of the patient:

‘As he had never been able to keep up with society, he had become insecure, with recurring depression. Due to his intellectual disability, he felt a great pressure of the world on him which he could not handle. His autistic traits made it increasingly difficult for him to cope with changes around him’ (2020–27, male, 70s, intellectual disability and ASD).

Another report said of an individual:

‘The patient mainly suffered from anxiety, compulsive complaints and loneliness due to the limitations that arose from ASD, obsessive–compulsive disorder, acquired brain injury, and personality disorder’ (2020–150, male, 40s, ASD).

Seventy-seven percent (77%) of the patients listed "social isolation/loneliness" as a factor in euthanasia, the most commonly listed factor. Forty-six percent (46%) listed "loss of hope."

One report said:

‘The patient had felt unhappy since childhood and was persistently bullied because he was just a bit different from others [ … ] [He] longed for social contacts but was unable to connect with others. This reinforced his sense of loneliness. The consequences of his autism were unbearable for him [ … ] The prospect of having to live on in this way for years was an abomination to him and he could not bear it’ (2021–26, male, 20s, ASD)

Other reports revealed that some of the patients were not provided strategies to cope:

‘The patient had insufficient strategies to cope with his illness’ (2018–27, male, 70s, intellectual disability)

Another said:

‘With her limited thinking abilities, the patient was only focused on the complete removal of the tinnitus. The moment she realised “I will never get rid of it”, her suffering had become hopeless and unbearable for her, and she was only focused on euthanasia’ (2015–83, female, 60s, intellectual disability)

The Bottom Line:

When euthanasia is first legalized in any nation or state, its proponents promise that only the terminally ill will qualify, and that evaluations will determine if the person is of sound mind to make the decision to die. It is clear that ultimately, legalized assisted suicide and euthanasia will be used on anyone who is considered to be suffering in any way, even if they are incapable of fully consenting.

In Canada, euthanasia has become a way for the government to save money, making anyone who has an illness or disability requiring care a target for discrimination that leads to death.