Belgian euthanasia law ‘failing’ say Belgian academics

5 March 2021

Communications Officer Rebekah Moffett comments on a recent study into Belgian euthanasia law, which suggests it is failing.

Studies on euthanasia laws and assisted suicide are not new, although it’s fair to say that, unless you are particularly concerned with that field of study, they usually fly under the radar. Nor is it news that a majority of doctors who work with patients at the end of their life oppose the practices of euthanasia and assisted suicide, although the way this is portrayed by the media and medical institutions might have you believe otherwise.

Yet one new study, Euthanasia in Belgium: Shortcomings of the Law and Its Application and of the Monitoring of Practice, published in The Journal of Medicine and Philosophy (JMP), should make us all sit up and listen – especially those with a vested interest in the subject (UK Court of Protection, I’m looking at you). The authors, Kasper Raus, Bert Vanderhaegen and Sigrid Sterckx are all associated with Ghent University in Belgium, but it’s worth noting that Raus and Sterckx in particular are not opposed to euthanasia as a theoretical possibility. Nevertheless, all three argue that the Belgian euthanasia law is broken beyond repair.

A ‘model’ for other countries

Belgium brought in its first euthanasia laws in 2002. Since then, Belgium and the Netherlands (which also officially legalised euthanasia and assisted suicide) have been hailed as models for legal reform around the world. Canada followed suit in 2016, Portugal is on the brink, and Spain is reportedly moving towards it too.

The law was initially passed with the proviso that the patient must be an adult, clearly able to express his or her wishes to die, and that the request be made voluntarily and repeatedly, without pressure and in writing, and the desire was to be discussed with a second practitioner. ‘Ideally’, the patient requesting euthanasia should be in constant, unbearable physical or mental pain that is unable to be alleviated.

Back in 2002, when the law was first passed, some 24 deaths were accounted to euthanasia. In 2019, that figure had risen over a hundredfold to 2,656. In fact, since 2010, Belgium has seen a 178% increase in euthanasia cases in just nine years. Surely this isn’t a coincidence?

Belgian euthanasia law is ‘legally problematic’

In fact, one of the main concerns that the authors of the JMP article write about is the fact that euthanasia is being underreported. The statistics are likely much higher:

“According to the latest official report, 2359 cases of euthanasia were reported in 2018 and 2656 cases in 2019 (Federal Control and Evaluation Commission for Euthanasia [FCECE], 2020). Given that 108.745 people died in Belgium in 2019, reported euthanasia accounts for 2.4 percent of all deaths. By contrast, the most recent anonymous physician survey study suggests that, for Flanders (the Dutch-speaking part of Belgium) in 2013, the number was 4.6 percent of all deaths (Chambaere et al., 2015). A follow-up study looking more closely into the euthanasia cases reported in the anonymous survey showed that only around 60 percent of them were reported to the FCECE (Dierickx et al., 2018). There is thus a significant extent of underreporting.”

One of the fundamental flaws of the Belgian system is that it relies on self-reporting cases of euthanasia. Previously, one study published in the British Medical Journal found that around 50% of euthanasia cases are unreported, and that it is more than likely that those go unreported are ethically and legally problematic.

The authors of the JMP article find the widening use of euthanasia in Belgium in general “ethically and legally problematic,” let alone the underreporting:

“This is in part related to the fact that several legal requirements intended to operate as safeguards and procedural guarantees in reality often fail to operate as such.”

The academics state – in no uncertain terms – that the commission in charge of overseeing doctors’ compliance with the law is either ineffective or possibly even complicit in a pro-euthanasia and assisted suicide agenda. It draws on academic research from the past 20 years to provide a compelling case.

They conclude:

“We believe this is ethically and legally problematic and should be of concern to everyone, regardless of their stance on the ethical justifiability of euthanasia in general.”

Euthanasia for ‘old age’

The main concern that the research brings out is that the use of euthanasia is being stretched to cover not only incurable illnesses that cause unbearable and lasting suffering, but now also “tiredness of life.” Legally, this is not permitted. However, doctors get round this by diagnosing what they call ‘polypathology’, defined as:

“the co-occurrence of multiple chronic or acute diseases and medical conditions within one person” (FCECE, 2020, 36).”

These multiple ‘chronic or acute diseases’ include simple things such as worsening eyesight, loss of hearing, polyarthritis, early-stage dementia, incontinence, etc. Essentially, symptoms of old age.

The article states:

“The latest report (covering 2018 and 2019) shows an increase of reported euthanasia cases not only for unbearable psychological suffering, but also for so-called “polypathology,” which accounts for 17.4 percent of all euthanasia cases reported in 2019 and represents the second most common indication for receiving euthanasia (after cancer, which accounts for around 62 percent of all reported euthanasia cases) (FCECE, 2020).

“Euthanasia following polypathology is becoming increasingly common, and the vast majority of such cases (71 percent) involves patients over the age of 80 (FCECE, 2020). By comparison, when one considers euthanasia cases in general, only about 37 percent of cases concern patients over the age of 80.”

This should concern us. Are Belgian doctors really now saying that old people are no longer worthy of life? Only recently, Belgian doctors came out in support of killing disabled babies after they had been born, as well. The lines of whose life is worth living are being blurred. Who will be next?

Lack of safeguards

The second concern was that the mandatory consultation with one or two independent doctors did not offer any real security. The JMP articles argues that:

“Second, the obligatory consultation of one or two independent physicians may fail to provide a real safeguard. Their tasks are quite limited, and, more importantly, their advice is not binding anyway. The final authority to perform euthanasia lies with the attending physician who can perform it even against the (negative) advice of the consulted physicians.”

The problem is this: if euthanasia is requested for a psychiatric condition, then a psychiatrist must be consulted. This is standard practice. However, firstly, a psychiatrist’s assessment is not binding – which essentially gives a patient’s attending doctor the right to legally perform euthanasia where the psychiatrist has ‘issued negative advice’. Particularly if the patient has another condition; then the doctor can simply diagnose the patient with ‘polypathology’ and ‘get on with it’, as it were.

‘Ineffectiveness’ of checks

Lastly, the academics criticise Belgium’s Federal Control and Evaluation Commission for Euthanasia (FCECE):

“The Commission is unable to check the fulfilment of various legal criteria, and it has substantial authority to (re) interpret the Euthanasia Law as it sees fit.”

The academics argue that the Commission does not act as the filter between physicians and the Public Prosecutor that it should be, but instead acts “as a shield that prevents potentially problematic cases from being referred” to the Public Prosecutor. Only one case has been referred to the Public Prosecutor so far, and that was in 2015.

The issue is that the evaluation committee of the Commission is half made up of doctors, many of whom – including the chairman – regularly perform euthanasia. Essentially, they end up checking each other’s cases for irregularities, and even though they are supposed to take a step back if one of their own cases comes up, they don’t.

Why does this matter for the UK?

While it’s true that euthanasia and assisted suicide are technically illegal in the UK, the truth is that we are seeing an increasing number of people being referred to the Court of Protection by a small minority of doctors who want to end their lives. Only two months ago, doctors at the University Hospital Plymouth NHS Trust were given permission to remove feeding tubes from a Polish man, RS, and allow him to die. What makes his case worse is that he was showing signs of improvement, and where UK doctors were unwilling to foot the bill to treat him, Polish doctors were willing to transport him back to his own country to start treatment there. Yet the Court of Protection ruled it was kinder to allow RS to starve and dehydrate to death than allow him a potentially life-threatening helicopter ride across the continent.

His case is just one of many, where a judge ruled that a person’s life was no longer worth living, no longer valuable. Essentially, already in the UK we are at the very least supporting the principle of euthanasia through our courts – and at most, we’ve already covertly implemented it. We can’t afford to open the door any wider unless we want a Belgian system – and possibly one day the BPAS of euthanasia – running our government policy.

The issue is that in both Belgium and increasingly so in the UK, lives that are seen to be riddled with suffering are deemed not worthy of living. And a small minority of ideological people – like those of the FCECE in Belgium, and those in the Court of Protection in the UK – are given absolute power to terminate life. Then the government relies on those groups as if they’re unbiased experts. They’re not.

Belgium should act as a lesson to us in the UK.

The academics in the JMP conclude:

“Euthanasia, which involves the deliberate ending of a patient’s life, is a far-reaching and irreversible act that should be closely monitored. … The Coordinating President therefore calls for a change in the procedure of referring cases of euthanasia that do not seem to be in conformity with the legal requirements or that are especially controversial, so as to allow greater involvement of the judiciary.”

In the UK, a similar call for action should be heard. The secret Court of Protection should be held accountable for its actions, and must realise that the deliberate ending of a patient’s life should never be the default decision.

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