The open letter from medical professionals critical of the application of the Belgian law on euthanasia to people suffering psychologically has re-ignited debate on the safety and practice of the 2002 law.
Following the letter, Christian Democrat MP Els Van Hoof has raised significant further questions in the Belgian journal Knack. Van Hoof is severely critical of the development of the Belgian law and the amendment to include children in 2013 when, at no time over the more than a dozen years of operation has the law been formally reviewed.
“Since 2013 I follow as an MEP intensive debates on euthanasia. At stake in these debates was always the expansion of the existing Euthanasia Act of 2002, which allows euthanasia for adults. I then repeatedly asked the commission why should we decide to expand if an assessment had not been made of the existing law on euthanasia. For it was clear that the law showed serious gaps, particularly with regard to the ‘safety valves’ that are built to prevent abuses.”
Van Hoof says that her repeated requests in parliament for a review were blocked by an opposing majority on every occasion. She acknowledges that she is not arguing for the repeal of the law, but to improve it. Refusing a timely opportunity for review at the moment of a grave debate on child euthanasia would seem negligent.
Van Hoof is critical of the breadth of interpretation of the terms of the original law: “… the terms ‘medically hopeless situation’ and ‘unbearable psychological suffering which cannot be alleviated’ must be interpreted by the physician. In practice, this leads to an extremely subjective interpretation by the clinician, thus reducing the risk exists that it is too early proceeded to euthanasia.”
Van Hoof goes further than the academics in their open letter by also criticising the so-called safeguards in the Belgian law. In respect to euthanasia for psychological suffering, three doctors must be consulted. The problem Van Hoof notes is that opinions to the contrary need not be observed; the reality is that only one positive opinion is necessary – that of the doctor with the needle.
“That threshold is too low in my opinion, an adjustment of the euthanasia law is imperative. Besides … The Constitutional Court recently leaned over the legal extension of euthanasia to minors. The Court also admitted at the time that the conditions for the application of euthanasia should be strengthened, including in terms of the non-binding opinion by the consultant child psychiatrist.”
Not that making a requirement that all three doctors should concur would change much. All the lead doctor would need to do was to ignore a negative opinion and find another.
Van Hoof was joined in her concerns about the work of the Belgian Euthanasia Evaluation Commission by an intervention in De Morgen by Dutch academic and former member of one of the Dutch Regional Commissions. Professor Theo Boer. Boer is critical of the Belgian evaluation system as compared to the system that he was part of for nine years in his homeland.
Boer directs his criticism firstly at co-chair of the Belgian committee, Dr Wim Distelmans. Reading between the lines, it appears that Distelmans’ dismissive comments about the recent open letter, also published in De Morgen (and elsewhere) had spurred Boer to comment. Boer appears to be suggesting that Distelmans was attempting to shut down the debate. The Dutch and the Belgians are known for their deference and willingness to debate and accommodate. To Boer and to many others one suspects, a public guillotine of discussion is, at the very least, a social faux pas.
Boer observes that it is “beyond mandate” for the head of such a commission to be trying to influence debate on euthanasia noting that, “The outgoing president of the Dutch committees, Willie Swildens, appeared only in the media to explain the policy of the review committees. Political and ethical debates they showed to others.”
This is important, in Boer’s view, so that Belgian society at large receives, “an unambiguous signal” that the work of the committee is objective and not bound to a euthanasia lobby group of any description.
(Both Distelmans and his co-chair, Jacqueline Herremans, head up separate euthanasia organisations as does Dr Marc van Hoey who is the subject of the recent referral by the commission to the judiciary.)
Boer’s explanation of the Dutch commission system makes sense. Committee members excuse themselves from considering files where the doctor is a colleague or friend and contentious matters are referred for additional consideration by the other regional committees. As it stands in Belgium, Distelmans is both “judge and party” as Van Hoof puts it, sitting in judgement over his own actions. Boer likens the Belgian system to a butcher inspecting his own meat adding that he also sees it as a stain on the reputation of the judiciary.
This is heavy-duty criticism; especially from Boer who is taking an unusual step of “border crossing” into the affairs of neighbouring Belgium.
Van Hoof calls for action:
“I cannot accept that the legal conditions to apply euthanasia are unclear or undefined. I cannot accept that the control mechanisms put in place to prevent abuse of the law, are completely inadequate in practice. Simply because it is the end of life of a patient and euthanasia is an irreversible process, the threshold for the application of euthanasia should be high. The fact that 65 professors, psychiatrists and psychologists in the field are sounding the alarm, to me is a clear signal that the existing law on euthanasia deserves a thorough evaluation. That this alarm is not heeded, is a sign that we are faced with an ideological ostrich.”