In Scotland, anorexia could soon be a death sentence

At 33 years old, Esther Beukema from Soest in the Netherlands decided she wanted to die. She had suffered with anorexia nervosa since the age of 17 and had long lost all hope that she would ever win her battle against the eating disorder.

Dutch doctors agreed with her. They decided that her anorexia was ‘terminal’ and that she met the requirements for euthanasia. In December 2021, she lay in her childhood bedroom and was injected with a lethal concoction of drugs by a doctor and nurse. Beukema died within minutes.

Beukema’s story may seem shocking to us in Britain. But these kinds of cases, not uncommon in the Netherlands, could soon reach the UK. As reported by the Daily Mail earlier this month, anorexia nervosa might meet the definition of ‘terminally ill’ in Scotland’s new Assisted Dying Bill.

The Assisted Dying for Terminally Ill Adults (Scotland) Bill was introduced in March this year and is expected to be debated in the Scottish parliament this autumn. It is the third attempt at legalising assisted suicide and euthanasia (ASE) in Holyrood.

As the bill currently stands, it would allow Scottish residents over the age of 16 to request assisted suicide if they are terminally ill. However, the bill defines terminal illness in very broad terms: ‘For the purposes of this act, a person is terminally ill if they have an advanced and progressive disease, illness or condition from which they are unable to recover and that can reasonably be expected to cause their premature death.’ That definition might include cystic fibrosis, dementia, rheumatoid arthritis and even type-1 diabetes. As has been demonstrated elsewhere, it can also include anorexia.

In Colorado, one of the 11 US states where ASE is legal, a 36-year-old woman was prescribed lethal drugs after her anorexia was considered untreatable. In 2021, following years of failed treatment for her eating disorder, Alyssa Bogetz was deemed eligible for ASE and given the necessary drugs. However, she passed away from anorexia-related complications before she was able to use them.

In an article published in 2022, Dr Jennifer Gaudiani, the doctor responsible for prescribing the drugs to Bogetz, tried to justify her decision. She also proposed using the term ‘terminal anorexia nervosa’ to describe cases like Bogetz’s and listed other cases that fit this definition. Those patients’ suffering, Gaudiani and her co-author argued, might only be alleviated by ASE.

This caused considerable controversy. As one article in the Journal of Eating Disorders noted: ‘Anorexia nervosa is a treatable psychiatric condition for which recovery may be uncertain. We are greatly concerned, however, regarding implications of applying the label “terminal” to anorexia nervosa and the risk it will lead to unjustified deaths in individuals whose mental illness impairs their capacity to make a reasoned treatment decision.’

In other words, people suffering from a severe psychiatric disorder like anorexia are not in the right state of mind to assess their own potential for recovery. Calling anorexia ‘terminal’ risks colluding with a patient’s disorder. As Phil Mehler, co-founder and medical director of the Acute Centre for Eating Disorders and Severe Malnutrition in Colorado, told the Guardian last year: ‘It’s going to have a contagion effect. Everybody’s going to give up and say, “I have terminal anorexia, just put me in hospice”.’

Angela Guarda, director of the eating-disorders programme at Johns Hopkins Medicine, agrees. She worries that patients will label themselves as terminal and give up all hope. ‘When they’re in the depths of the illness, often patients cannot imagine that they can live without their anorexia’, she said.

This is the problem with categorising a psychiatric illness as untreatable and terminal. In truth, people have the capacity to get better. Cara Neary, a Scottish 22-year-old who has recovered from severe anorexia, is testament to this fact. Neary, who developed the eating disorder aged 14, told the Daily Mail that she likely would have taken the opportunity to die, had ASE been legal when she was at her sickest. ‘I just felt like there was no way out’, she said. ‘Genuinely, I think if I had been given the option at 16, I probably would have taken it, which is terrifying… Dying is not something you can come back from, you can’t undo this, so I think it’s really dangerous.’ Neary now hopes that MSPs will think twice before voting in favour of the Assisted Dying Bill.

In the UK, we still have the chance to reject so-called assisted dying. Scottish politicians can still vote against the proposed law when it comes to be debated later this year. So too can MPs south of the border. Earlier today, parliament debated assisted suicide, in response to a petition promoted by Esther Rantzen. Labour leader Keir Starmer has pledged to give MPs a free vote on legalising ASE if he becomes prime minister. We must hope our politicians see sense and reject these cruel proposals.

Those in favour of bringing ASE to Britain should look at places like Colorado and the Netherlands to see where this will end up – with doctors telling patients that their treatable conditions can be cured only by death. Assisted suicide institutionalises hopelessness and spreads despair. It must be resisted.

Kevin Yuill is an emeritus professor of history at the University of Sunderland and CEO of Humanists Against Assisted Suicide and Euthanasia (HAASE).