In her diary, Godelieva De Troyer classified her moods by color. She felt “dark gray” when she made a mistake while sewing or cooking. When her boyfriend talked too much, she moved between “very black” and “black!” She was afflicted with the worst kind of “black spot” when she visited her parents at their farm in northern Belgium. In their presence, she felt aggressive and dangerous. She worried that she had two selves, one “empathetic, charming, sensible” and the other cruel.

She felt “light gray” when she went to the hairdresser or rode her bicycle through the woods in Hasselt, a small city in the Flemish region of Belgium, where she lived. At these moments, she wrote, she tried to remind herself of all the things she could do to feel happy: “demand respect from others”; “be physically attractive”; “take a reserved stance”; “live in harmony with nature.” She imagined a life in which she was intellectually appreciated, socially engaged, fluent in English (she was taking a class), and had a “cleaning lady with whom I get along very well.”

So begins this week’s reading, an essay by writer Rachel Aviv that was just published in The New Yorker.

It’s a moving and tragic story of a woman who struggles with low mood. If she dreams of fluent English and a cleaning lady, her life takes a turn for the worse: after a breakup, she “feels black again.” Loss and estrangement replace hope and love. After years of struggling, the near elderly woman ultimately chooses to end her life. But she doesn’t die by her own hand; she dies in a clinic at the hands of a physician. To us Canadians, this is a story that is both familiar – involving psychiatry and medications – and unfamiliar – euthanasia and state-sanctioned doctor-assisted suicide.

De Troyer’s life and death occurs an ocean away, in Belgium. But, in light of a recent Supreme Court of Canada ruling in Carter v. Canada, a question to ask: how will doctor-assisted suicide reshape psychiatry in this country?

Here’s the link:

The essay focuses on De Troyer’s son, Tom Mortier. By his own description, this chemist never paid much attention to the discussion about voluntary death in Belgium, his home. As he noted in an interview for another publication:

I was like just about anyone else here in Belgium: I didn’t care at all. If people want to die, it’s probably their choice. It didn’t concern me.

Life changed when he was informed that his mother was dead – and that she had chosen her death.

As is often the case when a relative dies unexpectedly, there are unanswered questions. For Mortier, these questions and the circumstances around her death are haunting, leading him to review his mother’s medical files, to meet the doctor who euthanized her, to speak out on this issue – it’s a journey described by Aviv.

Tom Mortier

The article isn’t written for a psychiatric journal and the author isn’t a psychiatrist. It’s a moving story of loss and societal values. The writer clearly sympathizes with Mortier – not necessarily in his political views, but in his pain. As a psychiatrist, I wonder about De Troyer’s diagnosis (she sees a psychiatrist but there is no DSM-5 diagnosis mentioned) and her treatment (she has been prescribed medications, but we never find out which ones, though we do learn that she has never had ECT).

Aviv makes several points about euthanasia and assisted-suicide:

· “In the past five years, the number of euthanasia and assisted-suicide deaths in the Netherlands has doubled, and in Belgium it has increased by more than a hundred and fifty per cent.”

· “Although most of the Belgian patients had cancer, people have also been euthanized because they had autism, anorexia, borderline personality disorder, chronic-fatigue syndrome, partial paralysis, blindness coupled with deafness, and manic depression.”

· “Last year, thirteen per cent of the Belgians who were euthanized did not have a terminal condition, and roughly three per cent suffered from psychiatric disorders.”

The point of a Reading is to spark discussion, not to offer a viewpoint. This topic is heavy. For some, the concepts of doctor-assisted suicide and euthanasia are deeply upsetting, an affront to their sense of religion and/or ethics. For others, the issue is one of personal freedom, consistent with their understanding of rights.

But regardless of your personal views, this essay has relevance in this country. In February, the Supreme Court of Canada ruled on Carter v. Canada, a case involving an elderly woman, Kay Carter, with intractable pain secondary to spinal stenosis.

Justices of the Supreme Court of Canada

In their unanimous ruling, the Justices open:

It is a crime in Canada to assist another person in ending her own life. As a result, people who are grievously and irremediably ill cannot seek a physician’s assistance in dying and may be condemned to a life of severe and intolerable suffering. A person facing this prospect has two options: she can take her own life prematurely, often by violent or dangerous means, or she can suffer until she dies from natural causes. The choice is cruel.


We conclude that the prohibition on physician-assisted dying is void insofar as it deprives a competent adult of such assistance where (1) the person affected clearly consents to the termination of life; and (2) the person has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition. We therefore allow the appeal.

The ruling was suspended for 12 months, giving the government time to amend its laws.

Grievous and irremediable medical condition… that causes enduring suffering that is intolerable to the individual… – the House of Commons has not drafted legislation responding to these words but it is difficult to see how such words would not cover people who struggle with the sort of “dark gray,” “black,” and “very black” moods of De Troyer.

Reading of the Week. Every week I pick a reading — often an article or a paper — from the world of Psychiatry.