Last week marked an important step in the integration of euthanasia into the Belgian healthcare. A religious order in the Catholic Church, the Brothers of Charity, which is responsible for a large proportion of beds for psychiatric patients in Belgium announced that it will allow euthanasia to take place in its facilities.
This has been an extremely controversial move because the Catholic Church is unequivocally opposed to euthanasia. In 1995 John Paul II declared that “ euthanasia is a grave violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person”. And Pope Francis described it earlier this year as a symptom of a selfish “throwaway culture”.
The local organisation has clearly split from Rome on this issue. The superior-general of the order, Brother René Stockman, has described the decision as “a real tragedy”.
Euthanasia for psychiatric patients has already happened dozens of times in Belgium. But from now on it will be hard to find an institution in Belgium where euthanasia is not being offered as an option.
In the email interview below, the chairman of the board of the Brothers of Charity in Belgium, Raf De Rycke, an economist who has worked with them for years, explains the point of view of the dissidents.
BioEdge: Is allowing euthanasia as an option a world-first as the official position of a Catholic institution?
Raf De Rycke: That is hard to say because Catholic institutions will not always make such views official and public. Sometimes they have a certain practice but not an official position. Anyway, there is a chance that our position is world-first because there are only a few countries that have a euthanasia bill and not all these countries have a network of Catholic institutions.
What proportion of places for the mentally ill are run by the Brothers in Belgium (and in Flanders)?
The Brothers of Charity run 12 psychiatric institutions in which daily about 6,000 patients are treated. That represents about 25% of these institutions in Belgium (about 30% in Flanders).
The refusal of the Brothers to allow euthanasia in their institutions has been described by critics as a major obstacle to the growth of euthanasia. So will this change in policy, if it goes ahead, have a big impact on psychiatric care in Belgium?
This will not have such a big impact in practice because our first and preferred option remains to focus on the patient's life perspective. At the same time we take the euthanasia request seriously and clarify the patient's underlying motives. However, a request can only be accepted if all the prudential requirements are met.
We have elaborated a series of prudential requirements that enforce the application of the law: three fundamental requirements, five procedural requirements, the determination of the conscientious decision and an additional requirement specific for the residential context.
Finally, the application of these prudential requirements will be critically evaluated by an evaluation committee, which is a completely innovative option in this matter. Our prudential requirements are strict and will not lead to a major change in practice, maybe to some exceptional cases.
What has happened up to now if someone requested euthanasia in one of your hospitals? Did it happen often? Did you allow terminal sedation?
Up to now, we also took seriously a euthanasia request, but we communicated beforehand that euthanasia could not be carried out by the staff and not within the institution. If there was a continuous request according to the conditions of the law, the patient was referred to another psychiatrist or service. Terminal sedation is not a solution to euthanasia in mental illness because these patients are simply not terminal.
Brother Stockman [the superior-general of the Brothers of Charity], not to mention Pope Francis, has often expressed his opposition to euthanasia. Is euthanasia compatible with Catholic, or Christian, values?
This depends on the underlying fundamental ethical view. For some people, values may be absolute, as for instance the inviolability of life. This implies that this value may never be violated and euthanasia is excluded a priori.
But at the same time, other values such as autonomy, quality of life and care relationship may be seriously violated. In our view, values are fundamental, essential cornerstones for making good decisions, but not absolute ones. Values can thus be weighed against each other without prior determination of which value has the priority.
In each situation these values must be assessed. In order to make a responsible decision, the prudential requirements help distinguish how inviolability of life, autonomy, quality of life and the care relationship are at stake.
We work with an open normativity that assesses values in any concrete situation, and not with a closed normativity that knows in advance what consideration should be made at all times, in all circumstances, regardless the intention and the wide range of effects.
The assessment of values we propose, is based on personalism and on proportionalism. Personalism means that the ethical criterion for evaluating decisions is the extent to which these decisions serve the promotion of the human person, adequately considered, in all their constitutive dimensions, and thus not only in the biological dimension.
Proportionalism means that there should be a reasonable proportion of the underlying values, taking into account the intention, the act, the effects and the circumstances, and thus not only the act in itself. Personalism and proportionalism belong, without doubt, to the rich tradition of Catholic moral theology, which includes different approaches.
How was the decision made? Was it taken by the Board running the Brothers’ institutions, or by the religious congregation itself? Was there a split between the laymen and the brothers?
This decision was taken by the Board running the institutions in Belgium, consisting of brothers and laymen. The decision was supported by the Board of the religious congregation in Belgium. The process lasted more than a year and many different groups, such as ethics committees, boards of directors and psychiatrists, were consulted repeatedly. Throughout this process of consultation, these various groups have come to an agreement, although this does not exclude disagreements among individuals. At the Belgian level there is no split between laymen and brothers.