Family Therapy and Euthanasia for Psychiatric Suffering: Reflections on the Person of the Therapist

In Belgium, euthanasia may legally be requested on the grounds of unbearable and irremediable suffering caused by a psychiatric disorder. Although such cases remain relatively rare, their number is steadily increasing, raising profound questions for healthcare professionals.

A request for euthanasia can polarise family relationships. The person who is suffering may experience death as the only remaining way out, while parents, partners or siblings continue to hope that life can be sustained. At the same time, the wish to die is rarely straightforward. It may be marked by ambivalence and intertwined with feelings of guilt, burdensomeness, loyalty and concern for loved ones.

Drawing on clinical experience in Belgium, this workshop explores the possible contribution of family therapy in this complex context. The family therapist has no role in assessing the legal or medical eligibility of the euthanasia request or in deciding whether it should be granted. Instead, the therapeutic focus is on facilitating dialogue, attending to the experiences of all family members, and creating space for grief, anger, guilt, hopelessness, love and conflicting loyalties.

Particular attention will be given to the person of the therapist, including the therapist’s own ethical position and the challenge of remaining present and responsive to all family members. The workshop will also address families’ often painful experiences of long and unsuccessful mental health treatment trajectories, as well as ways of speaking about hope without denying the severity or persistence of the suffering.

Through clinical reflection and case material, participants will consider how family conversations can help relatives remain in dialogue despite radically different positions. These conversations may create opportunities to speak about what has happened, what still needs to be said or heard, how family members want to relate to one another during an uncertain process, and how the person requesting euthanasia wants to be known and remembered.

Although the workshop is grounded in the Belgian legal and clinical context, the central questions are relevant beyond Belgium: How can therapists remain present when hope and hopelessness coexist, when respect for autonomy conflicts with relational responsibility, and when family members must find ways of staying connected in the face of a possible death?