Physician-assisted suicide

Is the right to die with dignity a civil right?

A provocative new film explores the right of the mentally and physically ill to choose to end their lives
Photo: Moyan Brenn

Au Contraire is a Montreal film festival dedicated to mental illness, and tonight’s penultimate screening features a Dutch film with a controversial message: suicide is a civil right.

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“Letting you go” is short at 18 minutes, but it packs an intense emotional punch. The documentary by director Kim Faber tells the story of 27 year-old Sanne, who suffers from depression and borderline personality disorder. After nine years of intensive treatments which proved unsuccessful, she decided to end her own life in 2014.

The film follows her through the last several weeks of her life, and tells her story through interviews with her and her father Hubert Jansen, who chose to support her decision. “Letting you go” has been screened at a half dozen international festivals, including the prestigious International Documentary Film Festival Amsterdam, and it is a provocative look at the limits society places on free will.

They want to try to make you better, but that's not always possible.

Ricochet sat down with Director Faber and Sanne’s father Hubert today in Montreal to talk about why they think the right to die with dignity should be universal. The film screens tonight at Montreal’s Museum of Fine Arts alongside three other short films about mental illness.

How did you come to this project? What got you interested in this story, and in making this film?

Faber: It started a couple of years ago with the suicide of a friend of my parents. He was suffering from depression all his life, and the last time we saw him in the supermarket was two weeks before he died, and he was really, really happy. He was talking about going on a vacation with his son, and enjoying life, and two weeks later he killed himself.

From the moment we heard he killed himself, we all knew that the only reason he was happy in those weeks before was because he already knew he was about to end his life, and his suffering would come to an end.

That started to make me think, if someone really is done with life, and the prospect of death makes you truly happy, why isn't there a better, more humane way of killing yourself?

I started out to answer this question, more for myself actually, and I started researching on the internet and found that we have regular euthanasia in the Netherlands, doctor's euthanasia, but it is mainly for people who are terminally ill (cancer, etc.). If you have a severe mental illness you won't have access to euthanasia so you need to do it yourself.

If you do it yourself you have several options: jump in front of a train, jump off a building. And there is another option, and that's called self-euthanasia, it's actually suicide but in a humane manner.

Tell me about Sanne, what was her story?

Jansen: When Sanne was 14, she got muscular dystrophy in the legs and arms, and she developed depression. It got worse and worse. Sometimes she had better days, but most days were bad for her. Life was not easy. On January 2, 2014, she came to us and said "I want to stop my life." She had spoken before that about stopping her life, and I always said "don't go in a car, or you'll take a mother with a child with you."

She looked into it, how to end her life in a humane way, and in the Netherlands there is an organization, The Ending, so she got in contact with that organization and she decided when and how to end her life. It's a humane way, like falling asleep.

Faber: I met Sanne through that organization. The Ending has several counsellors who provide information on how to end your life in a humane manner. They don't help you end your life, you have to do it by yourself, because helping someone to commit suicide is a crime in the Netherlands. So you have to do it by yourself, but they give you the information on how to do it. The combination of medicines you can take that's the easy way of dying. They also have an address in China where you can order medications that are the same as the doctor's euthanasia medications. With those medications you just fall asleep and you die in your sleep, so that's really a peaceful way of dying.

You mentioned that euthanasia is available to patients with terminal illnesses, but not for those with mental illnesses. Tell me about that difference.

Faber: The law [in the Netherlands] says you have to be facing unbearable suffering, and not see any way for it to get better. So that's really easy with terminal cancer, because then it's pretty straightforward, it's not getting better and you're going to die anyway. But with mental illness you can't always say that it gets better, or that it doesn't get better.

Jansen: They want to try to make you better, but that's not always possible.

Faber: That's why most of the people with mental illnesses don't have access to regular euthanasia in the Netherlands, because those conditions are too hard to test on people with mental illnesses. There's always another treatment, there's always another combination of pills, there's always another combination of medicine, there's always another way of therapy. But it doesn't always work.

Jansen: In 2012 there were more than 200 people who tried to get help [to die in the Netherlands], but nobody helped them, and 25 per cent died by themselves within a year. We need to help them.

This issue is particularly relevant in Canada because here in Quebec a law was passed last year which legalized doctor-assisted suicide, and a recent Supreme Court ruling struck down the federal law prohibiting it. One argument that we heard often in that debate was that if we allow people the right to die some people, particularly the elderly, could feel pressure to end their lives in order to not be a burden. Do you think that’s a concern?

Faber: I think if somebody truly wants to die, they will find a way. Killing yourself is a huge step, I'm convinced that to kill yourself you need to be absolutely sure, and you can only do it for yourself.

Are you advocating for changes to the law in the Netherlands to make it easier for people with mental illnesses to do this?

Jansen: Yes. When people like Sanne are so concentrated on dying that they don't want to seek out new help or new therapy, then the end is good. You can better live a short life, than a bad long life.

There’s growing international momentum to allow people the right to die, and a number of countries and jurisdictions have legalized it in recent years. Do you think it's inevitable that this change will come everywhere?

Nobody should make you stay in this life longer if you don't want to. It's your own choice.

Faber: Yes. It will probably take a while, but it will come everywhere. It's the same with gay marriage or abortion, it just takes a while for every country to follow, but I think it's the same kind of thing.

So you see it as a civil right?

Faber: Yes. It is a civil right. The right to self-determination. It's your own life, and you can make decisions about your own life. Nobody should make you stay in this life longer if you don't want to. It's your own choice.

Tell me what people can expect to see in this film.

The film actually focussed on Sanne, in the last few weeks of her life. It's about her preparing herself, preparing her house, for her death. She's cleaning everything up, she's making some last arrangements. It's about saying goodbye to life. She visits her grandma's grave for the last time with Hubert. It really is about letting go. There are a lot of interviews in the film between Sanne and I, and we talk a lot about why she wants to do it, if she's really sure she wants to do it, and about what happened previously in her life.

Even though you agreed to support her decision, it must have been so traumatic to go through that, to help your child prepare to die. How did you handle that process?

Jansen: When she told me she was going to do this, she became more peaceful. She didn't have any more depression, it was good. It was also good that she understood that I respected her decision, and that helped her a lot.

Faber: He respected her choice, and that made her decision easier. But even if he didn't support her decision she would have done it anyway.

Jansen: I was worried that if I didn't support her she would want to do it on an autoroute. This way she could speak with her friends and with her family, otherwise she would have had to go within herself to make the decision to jump or... It would have been more difficult for her, and instead it was respectful.

So for you it was about making sure she wasn’t alone in that process?

Faber: That's it. She would have done it anyway, but now she didn't have to do it alone, she could talk with people. Normally with a suicide people don't know that it's going to happen, so somebody dies and you leave a lot of people behind with a lot of questions. Because Sanne spoke to her father and her friends about it, they had a chance to ask their questions before she died.

Jansen: Her friends all asked, "can we do something for you, can we help you to make it better?" But there was no way. For her, she was done.

When you don't know it's coming, you're always left with many questions. "Could I have?" "Why?" "Was there a possibility to do something?" Now for me there are none of those questions. She was ready to die.

Is there anything else you’d like to add?

Jansen: I want to say that when you make the decision to kill yourself, do it in a humane way and like Sanne, talk with your family or friends. In Sanne's last week, her life was good. Her life was good in the end.

Editors’ note: This interview has been edited for clarity and length. For more details on the film, click here.
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