For 16 years, Belgium has allowed euthanasia not only for patients with terminal illnesses such as cancer, but also for those with psychiatric ailments found to be incurable and causing “unbearable” suffering. To critics who suggested that this was asking for trouble - that the diagnosis of psychiatric illness is unavoidably subjective, and that psychiatric patients are inherently less capable of informed consent - Belgian medical authorities and, indeed, much of Belgian society, had a ready answer: Don’t worry. There are procedures to prevent anything from going wrong.


Now comes the strongest evidence yet that all is not well with Belgium’s system of euthanasia for those with mental illness.


A court in Flanders, the country’s Dutch-speaking region, has decided to authorize criminal charges against two doctors who facilitated the euthanasia of 38-year-old Tine Nys in 2010, based on a diagnosis that she was suffering unbearably from an incurable condition, autism, and a third physician who actually carried out the lethal injection. If the trial goes forward, and if the doctors are convicted on the specific allegation, “poisoning,” the punishment could be life in prison. One of the accused doctors is Lieve Thienpont, a psychiatrist who has been the country’s leading advocate of euthanasia for those with mental illnesses, and has supervised many herself.


The indictment is by no means a vindication, however belated, of the supposed checks and balances in the Belgian euthanasia system.


To the contrary, as the first potential prosecution after more than 10,000 cases of euthanasia (most of which have been for physical illnesses), it shows that the system only imposes accountability in the face of sustained pressure, specifically, years of complaints by Nys’s surviving family, who took their misgivings about what they say was the hasty, slipshod way Nys had been diagnosed and put to death to the courts and the media - until finally receiving word this week that the doctors could stand trial.


Nys’s family said that not only was the autism diagnosis dubious - they insisted she was depressed over a recent breakup with her boyfriend - but her passing was not a “death with dignity”: The doctor who performed the euthanasia asked Nys’s father to hold the needle in place for the fatal injection, then invited the family to verify with a stethoscope that her heart had stopped.


Yet, at the time, the Federal Commission for Euthanasia Control and Evaluation, Belgium’s top regulatory body for such cases, and the main institutional safeguard, found that everything had been done properly.


When the family insisted later on pressing charges, alleging that there had been numerous “irregularities” in her death, Thienpont emailed to her colleagues: “We must try to stop these people. It is a seriously dysfunctional, wounded, traumatized family with very little empathy and respect for others,” according to a 2017 Associated Press report.


Asked on a recent Belgian TV program how it could be that the regulatory commission signed off on what a court regards as at least a possible crime, Wim Distelmans, the panel’s chairman, responded: “The committee only checks whether the basic conditions and procedural conditions have been met,” he said. “If documents show that this is the case, then we have no reason to doubt. We do not judge the professional competence of the psychiatrist or the doctor. It is not for us to judge about that.”


Perhaps these developments signal that Belgium is having second thoughts about euthanizing so many troubled people who are not actually terminally ill.


As criticism in the media has grown over the past two years, doctors have given far fewer lethal injections to psychiatric patients. The numbers plunged from an all-time high of 124 from 2014 to 2015, to 77 in 2016 and 2017.


“There has been a change of mentality and perception due to what is really happening on the ground,” says Willem Lemmens, a specialist in medical ethics at the University of Antwerp and one of Belgium’s leading euthanasia skeptics.


Yet this raises a troubling question: If doctors’ caution varies according to trends in public opinion, how can anyone be sure that the “treatment” was ever being given according to objective criteria in the first place?


This would imply both that Nys is not the only victim, and that her family is not the only family made to suffer needlessly, in the name of reducing needless suffering.


Charles Lane is a Post editorial writer specializing in economic and fiscal policy, and a weekly columnist.