On October 3rd, a 25-year-old Belgian woman published a long open letter on Instagram that has sparked intense discussion in the Flemish media. As the main sources of information on this subject are in Flemish, here is a summary produced with the help of ChatGPT and revised by our team:
Siska De Ruysscher, 25, was granted authorization for euthanasia due to psychological suffering deemed incurable after more than ten years of unsuccessful treatments for severe depression, post-traumatic stress disorder, and attachment disorder. She had previously made nearly forty suicide attempts. Her widely publicized case denounces the shortcomings of Belgium’s psychiatric system: long waiting times, lack of follow-up, and isolation.
Supporters believe her choice reflects the right to autonomy and point out that Belgian law strictly regulates such situations (multiple medical opinions and lengthy procedures). Opponents argue that at 25, incurability is difficult to determine, and fear that euthanasia may become a response to inadequate care rather than to illness itself.
This case has reignited the ethical debate in Belgium on the boundary between respecting individual freedom and the collective responsibility to provide truly accessible and effective psychiatric care.
To this day, Siska’s open letter is available only in Dutch on her Instagram page.
Since she invites others to share it, we have translated it for you into English and French in this PDF document:
Siska’s story should make Canadian lawmakers reflect as the debate on federal Bill C-218 resumes this fall. This private member’s bill—introduced in a non-partisan spirit by Conservative MP Tamara Jansen—seeks to amend the Criminal Code to specify that a mental disorder is not a grievous and irremediable medical condition for which a person could receive medical assistance in dying.
This is an important initiative to stop the planned expansion of Canada’s MAiD law, set for March 17, 2027. On that date, MAiD would become available in Canada when a person’s only underlying medical condition is a mental illness.
Do we want a young woman like Siska to be eligible for medical assistance in dying in Canada?
To go further, here are a few translated excerpts from an article in De Morgen:
“I’ve tried everything to get better, but death controls my life”:
Siska De Ruysscher (25) chooses euthanasia due to psychological suffering.
According to Professor Wim Distelmans (VUB), Chair of Belgium’s Federal Euthanasia Evaluation Commission, 55 of the 3,991 Belgians who received euthanasia last year suffered from psychological distress linked to a psychiatric or somatic condition. Among that group, five were under 30, the two youngest being 21.
“Especially in cases involving mental health issues, one must be extremely cautious up to age 25,” explains Distelmans. “Up to that age, the brain is still developing.”
The story of Siska De Ruysscher rekindles the debate over euthanasia for psychological suffering. Several experts are alarmed by the growing number of euthanasia requests among adolescents and young adults.
“How can we reconcile unbearable suffering and despair at a time when the brain and identity are still developing? And how can we prevent young people from being considered ‘beyond help’ too early?” asks psychiatrist Griet Van Hoye.
“A desire for death deserves to be acknowledged,” continues the psychiatrist. “But being told that you have ‘exhausted all treatments’ can be profoundly damaging. Many young people requesting euthanasia feel worthless. They hate themselves, trust no one, and believe the world would be better off without them. The last thing such a person needs is a doctor confirming their hopelessness by saying, ‘There really is no hope for you.’ What they need is someone who says, ‘I understand your pain. You’re not crazy or bad for feeling this way. Let me stay by your side, so you don’t have to carry it alone.’
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Siska is expected to receive euthanasia in early November. She hopes that any outrage will not be directed at her, but at the system itself.
“Maybe I can still make a difference—for young people who are struggling today with mental health problems.”
Indeed, let our outrage not target young people like Siska, but the lack of mental health resources, whose limits in Quebec and across Canada are similar to those in Belgium.
In this context, we hope more than ever that Canada will follow Quebec’s path, which has enshrined in its Act respecting end-of-life care that a mental disorder cannot be considered an illness for which a person may request medical assistance in dying.
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To hear Siska on the Flemish TV program De Afspraak (enable English subtitles):
Summary of discussions on the Flemish channel VRT’s website (page translated into English by Google).
Open letter in response to this interview by Mileen Janssens, psychologist and psychotherapist, published in the daily newspaper De Standaard. Translated excerpts:
You are 25 years old, so I am addressing you as an adult. I heard your testimony on De afspraak on VRT. I work as a psychotherapist and accompany people in long-term therapy. Your story is familiar to me. Listening to you, I hope you are deeply angry about the injustice that has been done to you. I hope you have been able to express that anger, even towards your therapists. You don’t have to be overly understanding when you are in distress.
In Flanders, there is a group of psychotherapists and psychiatrists—of which I am a member—who are campaigning for the continuation of long-term psychotherapy. We are being thwarted by the government, under the pretext of a lack of money. So, from another position, we too have reasons to be angry. But since we are not alone, we are less powerless, and for us, things seem less desperate than for you.
It is scandalous that, in some institutions, psychotherapists can only have a fixed number of sessions with their (young) patients, as determined by protocol, or that hospitalization can only last for the time specified in the regulations—under penalty of reduced funding.
Much of our precious time is spent on administration: registrations, record keeping, forms to fill out. The (anonymous) people who evaluate us and decide on our practices seem to believe that an act only really exists when it is written down on paper. We have only really had an interview with you when we have recorded it, completed it, checked it, dated it, and so on. (…)
You have an intense desire to die. But you also see the failure of an essential pillar of our society—the care of vulnerable people—as another reason to stop searching and living. Not everyone makes this choice. You may not agree, but in a way, society makes it easier for you, because more and more young people are going down this path before you. (…)
OCT
2025