This man euthanised because of "unbearable psychological suffering".

Nathan Verhelst died on Monday.

The physically healthy 44-year-old was injected with a lethal substance by Dr Wim Distekmans on the grounds that he no longer wished to live due to “unbearable psychological suffering”.

Nathan used to be Nancy.

Nancy was born as the only girl child of parents, who showed a clear preference for boys. When explaining his choice to end his life via euthanasia, despite not suffering from a terminal illness, Nathan said of his childhood:

“I was the girl that nobody wanted… While my brothers were celebrated, I got a storage room above the garage as a bedroom. ‘If only you had been a boy’, my mother complained. I was tolerated, nothing more.”

In 2009, aged 40, Nathan began undergoing the hormone therapy required to become a man. This therapy was followed by surgery to construct a penis and remove his breasts in 2012.

Unfortunately though, the surgery was botched and the outcome was far from what Nathan had desired. He told a local Belgium newspaper:

“I was ready to celebrate my new birth… But when I looked in the mirror, I was disgusted with myself. My new breasts did not match my expectations and my new penis had symptoms of rejection. I do not want to be… a monster. “

Euthanasia, where carried out by a doctor at the request of a patient is legal in three European countries, Luxembourg, the Netherlands and Beligum. So the procedure that Dr Wim Distekmans carried out was perfectly legal, even though there was no immediate threats to Nathan’s physical health.

Dr Distekmans agreed to conduct the procedure on the basis of what he believed was ‘incurable, unbearable suffering’. He explained in the UK’s Telegraph:

“The choice of Nathan Verhelst has nothing to do with fatigue of life… There are other factors that meant he was in a situation with incurable, unbearable suffering.”

“Unbearable suffering for euthanasia can be both physical and psychological. This was a case that clearly met the conditions demanded by the law. Nathan underwent counseling for six months.”

Dr Distekmans is no stranger to the stark spotlight of the media. Earlier this year he agreed to euthanaise two adult Belgian twins, aged 45, who were born deaf and did not want to continue living after learning that they would soon go blind.

After a local hospital refused to carry out the mercy killing at the request of Marc and Eddy Verbessem, Dr Distekmans stepped in.

Dr Distekmans was forced to defend his decision to legally end the lives of the Verbessem brothers. He said at the time that:

“It’s the first time in the world that a ‘double euthanasia’ has been performed on brothers,” he said. “There was certainly unbearable psychological suffering for them. Though there is of course it always possible to stretch the interpretation of that. One doctor will evaluate differently than the other.”

Euthanasia remains an incredibly contentious issue globally, with only seven jurisdictions permitting its legal practice. Here in Australia, euthanasia was briefly legal in the Northern Territory back in 1996 before the law was overturned by the Federal Government.

This month a new bill will be introduced into the Tasmanian Parliament, which will once again seek to make voluntary euthanasia legal. Andrew Darby from Faifax media explains that:

The Voluntary Assisted Dying bill will be argued in the Tasmanian Parliament this month. At this point, the predictions are that it will fail…. Under it, a patient must request assistance in dying three times over a period of at least 10 days, and be assessed by two medical practitioners separately. Anyone, including health professionals, and the patient, can withdraw from the process at any time.

Many people argue that while euthanasia can seem like a mercy act, that it is simply too difficult to police.

How do we ensure that people who are mentally vulnerable or suffering incredible pain are not pressured into ending their lives by those around them?

Finding a balance between protecting the right to life and an individual’s dignity and right to be free from pain, has always been fraught.

The idea that physically healthy individuals like Nathan Verhelst and the Verbessem twins, are also now accessing legal euthanasia, is a difficult concept to grapple with ethically.

These circumstances naturally lead to the question of: where someone is suffering extreme mental anguish, can they really be properly equipped and rationally able to make such a significant decision?

Figures released last week show that since legislating to permit euthanasia, the number of people being killed by intentional medical means in the Netherlands has doubled. In 2012, 4,188 Dutch people ended their lives via medical euthanasia.

Similarly, Belgium has seen a 25 percent increase in the number of deaths caused by medical euthanasia in the past year alone, with 1432 Belgians allowing a doctor to end their lives in 2012.

The future of medical euthanasia in Australia remains unclear.  What we do know, is that this is certainly not a debate that is likely to go away any time soon.

Where do you stand in the euthanasia debate?  Do you think euthanasia should be available for people who are physically healthy?