Page 63 - IJSA, Vol. 7, No 1, 2024

International Journal of Science Annals, Vol. 7, No. 1, 2024
рrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa

the world due to premature mortality and years of life progressive increase in cases of euthanasia (from 259 in
lived in conditions of suboptimal health) estimated at 2003 to 2,790 in 2021) to which people mainly over 70
46.9 million years (GBD 2019 Diseases and Injuries years old resorted (in 67.1% of cases), and those mostly
Collaborators, 2020). Following the statistical indicators affected by a neoplastic pathology (63.4% of cases),
provided by the World Health Organization (WHO), mainly through administration of barbiturates (99.6% of
there would be over 300 million depressed people in the cases). Very small, but present, mental and behavioral
world (World Health Organization, 2022) with a disorders: this happened in 94 cases in 2021 (1.9% of the
prevalence that can affect one in five people in the total); in 45 cases (equal to 0.9% of the total) this
general population, increasing with age; 31.74% of old occurred due to a personality disorder, a depressive
people (65+ years of age) would, in fact, be affected by a picture and schizophrenia; in 49 cases (1.0% of the total)
depressive disorder and its prevalence would be higher due to the existence of a cognitive disorder produced by
(40.8%) in developing countries (Zenebe et al., 2021), Alzheimer’s disease, vascular dementia or Lewy bodies’
with peaks recorded in Africa – 43.1% (Bedaso et al., dementia. In most patients, different types of suffering,
2022) and in India – 34.4% (Pilania et al., 2019). In both physical and psychic, were present simultaneously.
nursing homes, 18.9% of older adults reportedly suffer The suffering has been described as constant, unbearable,
from major depressive disorder (MDD), as indicated by and unrelievable. Among the most often mentioned
a recent meta-analysis of 32 observational studies physical sufferings are air hunger, digestive obstruction
(Fornaro et al., 2020). with vomiting, constant pain. Among the most frequent
Also in Italy, depression is the most widespread mental causes of psychological suffering, are dependence on
disorder: about 5-6% of the population is affected by it, others, loss of dignity, loneliness, social isolation and
while 10-15% of it would have experienced a depressive despair.
episode at least once in life even if these indicators vary In this article we would like to try to give an answer to
according to the sources and diagnostic methodologies the many problematic questions that the principle of self-
used. Recent studies indicate that MDD could affect over determination raises in the event that the holder of the
7.5 million people (11.4% of the population), mainly right is a particularly fragile, vulnerable, influenced or
women with low schooling and poor economic status (de otherwise suggestible person, and what is the support that
Girolamo et al., 2005). these people must be guaranteed by whoever has the
Not only because of its frequency, depression raises responsibility of care, especially in situations where the
many (complex) practical questions, including juridical good put at risk is the protection of life protected by the
ones (as in the case of patient suicide) (Cupelli, 2013) European Convention on Human Rights (Council of
and, more generally, bioethical ones, often faced with a Europe, 2002).
feeble voice by psychiatrists “whose opinion is only The aim of the study. To consider the exemplary case of
rarely sought but, above all, even more rarely expressed” a Belgian lady, Mrs. Godelieva de Troyer, with a major
(Bersani et al., 2020, p. 57). It is therefore necessary to depressive disorder and the role of doctors in informing
reflect on the impact of depression and the possible the decision about medically assisted death.
impact of cognitive impairment, especially in cases of
severe (major) depression, when important decisions are Materials and Methods
to be taken by the individual affected by it. This is what The Death through Euthanasia of Mrs. Godelieva de
we are meant to do in this short essay, in which we Troyer, which Came before the Examination of the
propose to address the quality and robustness of end-of- European Court of Justice Following the Complaint
life choices given the relationship that exists, especially Presented by Her Son
in old age, among depression, cognitive decline and risk At the material time, Mrs. Godelieva de Troyer was a 64-
of progression from mild cognitive impairment (MCI) to year-old Belgian woman, suffering for over 40 years
frank dementia (Rosenberg et al., 2013). from a depressive disorder generally considered as
We would do so starting from a public matter that has “major” and unresponsive to the pharmacological
recently come under examination by the European Court treatments prescribed by the numerous psychiatrists near
of Human Rights (Judgment n. 78017 of 4 October 2022, whom she was in therapy. She herself had decided to die
Mortier vs. Belgique), immediately acknowledging that by resorting to euthanasia, a practice permitted in that
the regulatory framework which Belgium has adopted for country due to the effects of the law of 28 May 2002, then
the non-punish ability of euthanasia is very liberal modified by the law of 28 February 2014, which
(Cembrani et al., 2014; Dentamaro, 2019): it also allows extended this option to minors with the consent of parents
minors capable of discernment and people affected by a or legal representatives without setting any age limit,
mental pathology who find themselves “in a useless however, as instead requested by the Dutch legislation.
condition of physical or psychological suffering, Dr. G. T., her general practitioner, was informed of the
unbearable and incurable” to access it if adults (Mehlum decision, but declined the woman’s invitation to start the
et al., 2020) provided they are capable of understanding procedure. He advised her to contact Prof. W. D., a
and wanting, with limitations that have however proved Belgian oncologist well known in his country for being a
to be completely insufficient in the face of the strong supporter of euthanasia.
exponential growth of cases. In this regard, the latest According to the reconstruction of the events made by the
Report from the Commission Fédérale de Contrôle et judges of Strasbourg, on 29 September 2011 Prof. W. D.
D’evaluation de L’euthanasie (2023) – documents the spoke to Mrs. de Troyer, learning that she was at that time

61