In the article by Verhofstadt et al, the authors rightly observe that the concept of ‘unbearable suffering’ in relation to euthanasia remains poorly defined in the medical literature.Reference Verhofstadt, Thienpont and Peters¹ We wish to make three observations which may contribute to a better understanding of ‘unbearable suffering’ and highlight the incongruence of considering euthanasia as psychotherapeutic.

First, suffering in one form or another is part and parcel of being human. It is the time-tested signal that something is going wrong. It is also the moment to test the limits of character and affective maturity. This is not to say that suffering is always welcome. Indeed, a sign of human progress is the alleviation of many forms of suffering, and medicine certainly plays a key part in this. Nevertheless, medicine alone cannot be expected to shoulder the burden of relieving all forms of human suffering. Verhofstadt and colleagues identify five categories of unbearable suffering in psychiatric patients: medically related, intrapersonal, interpersonal, societal and existential. It is a fact that modern psychiatry is able to treat many psychiatric disorders, but asking psychiatrists to treat all forms of suffering including existential doubts may be actually leading the profession away from medicine.

Second, suffering is a normal human affective-emotional reaction to a perceived or real threat to the integrity of personhood, following the classic definition by CassellReference Cassell² adapted by Dees et al in their proposal for defining ‘unbearable suffering’.Reference Dees, Vernooij-Dassen, Dekkers and van Weel³ We would argue that suffering is bearable when a person is able to rationalise the perceived threat to integrity in view of a higher end or good. Indeed, many of the greatest figures in history are admired precisely for having suffered for a cause. On the other hand, suffering is unbearable when a person is unable to rationalise the suffering. In other words, it is a suffering that has no meaning for that person. It is unreasonable. The humanisation of suffering is about restoring meaning to suffering, not annihilating the person.Reference Frankl⁴

Third, adding euthanasia to the therapeutic repertoire of psychiatry is in truth an alteration of psychiatry and not an advancement of science. Twenty-five centuries ago, Hippocrates finally managed to separate science from hocus pocus, the doctor from the sorcerer, curing from killing.Reference Levine⁵ Readmitting this vanquished foe to the fold is to change the very character and goals of medicine. Psychiatrists should shun euthanasia as a ‘treatment’ for suffering-in-want-of-a-reason and instead concentrate on what they do best – treating psychiatric disorders and helping patients find meaning for their suffering.