For more than half his life, Frank van den Bleeken, a rapist and murderer, has been detained in the Belgian penal system, spending long stretches in solitary confinement in prison psychiatric wings, waiting for treatment of his violent sexual urges.
Now he wants to die.
With little prospect of change, Mr. van den Bleeken has turned to his country's euthanasia law and asked to be killed by lethal injection if he cannot get treatment.
Mr. van den Bleeken's petition is pushing an already divisive and emotional issue further into uncharted ethical areas. His case has shone a spotlight on Belgium's correctional system, which has been censured several times for failing to provide mentally ill offenders with adequate therapy and holding them in squalid conditions.
But it is also of interest for Canada, where the corrections system struggles similarly with how to best deal with mentally ill inmates.
What's more, Quebec's legislature is currently debating a right-to-die bill modeled after the Belgian and Dutch voluntary euthanasia laws.
In Belgium, Mr. van den Bleeken's campaign for the right to die has prompted several other inmates to ask for similar access, said his lawyer, Jos Van Der Velpen.
Another inmate has since been euthanized, last year, but he suffered from an incurable disease. Mr. van den Bleeken's still unresolved case is the latest controversial example of applicants who are not terminally ill but suffer psychological pains.
"Two prominent psychiatrists have seen him and said this is a man who is suffering in an unbearable, enduring way and that his mental condition can never be treated properly. That's why he's asking to be euthanized, because he's suffering in an unbearable way," Mr. Van Der Velpen said.
"It's a medical question that is very, very, very delicate and very difficult."
In Canada, there are laws against both assisted suicide (where another person, for example a doctor or a relative, supplies the means of suicide, such as pills) and voluntary euthanasia (where a doctor or someone else takes a person's life at the person's request).
Bill 52, now debated at the Quebec National Assembly, would allow "terminal palliative sedation or medical aid in dying."
Quebeckers applying for doctor-assisted suicide under Bill 52 would have to be over 18, be suffering from a grave incurable illness or an advanced state of irreversible decline, and face unbearable physical or mental pain. In addition, the application has to be made in a free and informed manner.
Bill 52's template is similar to Belgium's Loi relative à l'euthanasie of May, 2002. That law allows voluntary euthanasia for adults who make informed, conscious requests because they suffer from serious, incurable ailments and "physical or mental" pain that cannot be alleviated.
However, more than a decade after the Belgian was adopted, cases like Mr. van den Bleeken's showcase what critics predicted would be a slippery slope: once it becomes acceptable to kill people for one reason – terminal illness – it opens the door to killing as a solution to other problems, such as the way the prison system failed a mentally ill inmate.
Now 50, Mr. van den Bleeken committed several rapes in the port of Antwerp in the late 1980s, killing one victim, a 19-year-old woman.
At his trial, he was found to be not criminally responsible and was committed to the psychiatric wing of Merksplas, an aging penal complex near Antwerp.
Dirk Leestmans, a television reporter, first interviewed him for a documentary in 2001. He said Mr. van den Bleeken had a troubled childhood, spent in institutional care, where he was sexually abused. This was followed when he got older by a stint as a sex-trade worker.
"Frank is a very intelligent man. He's done horrible things but he's self-aware and lucid," Mr. Leestmans said.
"He is a man who is ill, who can't control himself. … He has sexual fantasies that he can't control."
Even before Belgium adopted its euthanasia law, Mr. van den Bleeken had been asking for the right to die, Mr. Leestmans said.
"My life has now absolutely no meaning. They may as well put a flower pot here," Mr. van den Bleeken told Mr. Leestmans in a documentary aired this fall on the Belgian TV channel Canvas.
"I will never be free," Mr. van den Bleeken added in the same interview. "Rightly so, because I am a danger to society. Outside of these walls there is a great risk that I would do it again and make big mistakes."
For the last five years, Mr. van den Bleeken has been held in another psychiatric wing, at Turnhout, a century-old prison.
Mr. Leestmans said Mr. van den Bleeken is in his cell 23 hours a day. Since he remarked in his TV interview that he might attempt suicide, he is checked every 15 minutes.
A further complication in Mr. van den Bleeken's case is his argument that he is a victim of systemic failings of the Belgian penal system.
Belgium has been cited several times by the European Court of Human Rights for failing to provide appropriate care to inmates with mental disorders. In January, the court ruled in favour of three Belgian inmates and ordered damages be paid, citing a "structural shortcoming" that resulted in about 1,000 prisoners with mental problems being held in aging, overcrowded, inadequately staffed special prison wings.
One option Mr. van den Bleeken and his lawyer sought was his transfer to a Dutch forensic psychiatric clinic. Belgium already has an agreement with the Netherlands to transfer prisoners to alleviate overcrowding, Mr. Van Der Velpen said.
However, officials said there were no protocols to admit a Belgian detainee to a foreign forensic psychiatric clinic.
Mr. van den Bleeken and Justice Minister Annemie Turtelboom are now locked in a court fight over the issue.
Since Belgium decriminalized euthanasia in 2002, there have been applications not only for terminally ill people but also those who face mental suffering.
Earlier this month, Belgian lawmakers raised more controversy when the senate voted in favour of extending to minors the right to euthanasia.
The physician Wim Distelmans, Belgium's foremost euthanasia advocate, has administered lethal injections to Marc and Eddy Verbessem, deaf twin brothers who were going blind, and to Nathan Verhelst, a transgender man who was distressed after a botched female-to-male sex-change operation. All three had asked to die.
Belgian euthanasia applications must be reviewed by a doctor and Mr. van den Bleeken has been assessed for a year now by Dr. Distelmans.
"I could never say that euthanasia is a good option because it's the end of life," Mr. Van Der Velpen said, "but it has to be a humane life."