In Belgium, euthanasia between trivialization and questions



The deputy Olivier Falorni does not hide it: his bill to establish a “free and chosen” end of life, examined this Thursday, April 8 at the National Assembly, is largely inspired by the Belgian law on euthanasia promulgated in 2002. Nineteen years later, what conclusions can we draw from current practices among our neighbors?

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“The law has become commonplace and it is rather well perceived by the population”, notes the philosopher and ethicist Laurent Ravez, member of the Belgian bioethics advisory committee. The law “Does not authorize the act, but decriminalizes it”, he says straight away.

What does the text say? Than the doctor who helps a patient to die “Does not commit an offense” on three conditions: if it is certain that the patient, adult or emancipated minor, is conscious at the time of his request; if this request is formulated in a thoughtful, voluntary and repeated manner and is not the result of external pressure; finally, if the patient is in a hopeless medical situation and reports constant and unbearable physical or psychological suffering that cannot be alleviated.

From exception to standardization

“Originally, the law is an exceptional law”, specifies Laurent Ravez. In fact, while 259 patients were euthanized between 2002 and 2003, they were 2,444 in 2020. And even if, for the first time, the number of procedures fell compared to the previous year (health crisis requires ), it remains stable and accounts for around 2% of deaths in the country.

This form of trivialization does not surprise Professor François Damas. Head of department at the Liège hospital, he receives around 100 requests per year. “The majority do not go to the end”, he specifies. But when that happens, he doesn’t see it as a failure, rather an illustration of “Patient autonomy”.

Would euthanasia be a step forward for the rights of the sick? Timothy Devos – who coordinated the book Euthanasia: behind the scenes (Ed. Mols) – does not share this view of things. For this hematologist, opposed to medical aid in dying, trivialization does not prevent questions.

Since twenty years, “There are worrying developments, he argues. Initially, the requests were for serious and incurable illnesses that were life-threatening in the short term.. From now on, they also concern mental (depression) or cognitive (Alzheimer’s) disorders, and since 2014, they have been extended to minors. In 2020, 64% of euthanasia requests concerned people with tumors. In more than 87% of cases, the doctor considered that the patient was condemned at short notice. “

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But “What we are seeing is the growing proportion of euthanasia for multiple pathologies, points out the practitioner. Elderly people with AMD (age-related macular degeneration Editor’s note) or incontinence require euthanasia. However, if these conditions are incurable, they are not fatal. I see drifts there. “

François Damas does not agree. “These people make their decision conscientiously. Who am I to believe that their suffering can be endured, whether physical or psychological? “

Psychic pain, a subjective notion

The “measure” of the incurable nature of psychological suffering is another point that divides professionals. “The notion is very subjective, notes psychiatrist An Haekens. In psychiatry, the evolution of pathologies is very difficult to predict. “ This is why she signed in 2018, with nearly 250 of her colleagues, a forum calling for the removal of mental suffering from the criteria for eligibility for euthanasia.

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In the spirit of the law, euthanasia was seen as a last resort. In fact, palliative care is often “Relegated to the background, also regrets the oncologist Benoît Beuselinck. Assistance in dying is mentioned earlier and earlier in care. Usually in anticipation of the degradation to come… ”

So much so that in many health establishments, palliative care has integrated euthanasia into the therapeutic arsenal. “It distorts them: palliative care is letting them die; euthanasia is killing ”, regrets the doctor. But euthanasia “Is not just a lethal act, challenges François Damas, for whom this act and palliative care can be complementary. Before getting there, we always think about alternatives. “

Safeguards

Concretely, the law provides for a number of safeguards, starting with the conscience clause for doctors. “We will never force a practitioner to perform euthanasia”, remarks François Damas. Caregivers contacted by The cross however recount the small pressures of colleagues, the remarks. “When I refuse to participate in euthanasia, I am told that I lack humanity”, says a nurse.

Another measure, the doctor never decides alone, but must seek the opinion of two colleagues; a federal commission for the control and evaluation of euthanasia (CFCEE) is responsible for verifying the conformity of the acts performed. “Except that it is regularly contested”, assures Timothy Devos. A study published in February in the medical journal The Journal of Medicine and Philosophy regrets, for example, that the commission intervenes a posteriori, or that its 16 members are essentially pro-euthanasia. Another dysfunction pointed out: one in three euthanasia would not be declared, mainly in Flanders, where 75% of requests are concentrated.

Three trials in nineteen years

Result, “The commission, which was supposed to act as a filter between practitioners and the prosecution, acts more as a shield”, deplores the study. In nineteen years, only three cases (closed) have given rise to trials following complaints from the families. “We are vigilant. A quarter of the files are subject to enhanced verification ”, maintains Corinne Van Oost, palliative care doctor and member of the control committee (1).

In 2018, however, a neurologist, a CFCEE member resigned with a resignation, for disagreement. At issue: euthanasia performed on a woman suffering from a degenerative disease, without the patient’s consent. No legal action had been taken. “It was not euthanasia, but sedation, which can be done at the request of the family, to relieve a patient with imminent death, shade Corinne Van Oost. We voted and for lack of a majority in the committee, the file was therefore not sent to the public prosecutor’s office. ” Of “Complacency”, deplore opponents of euthanasia, who call for a reassessment of the law.

In its last report, CFCEE concluded that it was ” in no way opposed to an evaluation of the law of May 28, 2002 […] ” Before adding : “But it is not for him to determine the way in which this evaluation should take place, the content and the modalities of this one. “

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