Euthanasia has become normalised in Belgium. Accounting to official figures, about 1 death in 50 is due to euthanasia – and a large proportion are not officially reported.

Despite the steady increase in the number of euthanasia deaths – or perhaps because of it — the picture conveyed by the media and by the Belgian euthanasia commission is melancholy but positive. Many miserable people are released from their suffering, surround and supported by their loved ones. All doctors comply fully with the law and there are no difficulties or abuses.

This picture is changing. A complaint about the euthanasia of a woman named Tine Nys in 2010 has cast shadows over this placid panorama. Her two sisters pursued three doctors through the courts for ten years until they were put on trial in 2020 for unlawfully poisoning her. The sisters contended that she was not terminally ill, even though she was suffering from serious depression. All three doctors were acquitted.

That might seem like a happy outcome for doctors involved in euthanasia. However, it was the first time since euthanasia was legalised in 2002 that doctors had appeared in the dock. It showed that euthanasia doctors were not beyond reproach, or even above the law.

This has apparently emboldened the relatives of other people who were euthanised – and their lawyers. There has been an explosion of lawsuits which is intimidating doctors.

Last week a doctor spent a night in jail following a complaint that he had unlawfully euthanised a 91-year-old man in the Jan Palfijn hospital in Ghent. The relatives were apparently happy with the procedure. Who lodged the complaint is unknown.

An article in the Belgian magazine Knack a couple of months ago describes the case of Karel (a pseudonym), a Belgian man in his 50s who was severely handicapped after a brain haemorrhage. He asked for euthanasia on the basis of physical and mental suffering and the doctors agreed.

However, on the appointed day, the euthanising doctor received a stern letter from a lawyer acting on behalf of Karel’s two estranged sons and his ex-wife in the United States. It demanded that the doctor desist. It said, in part, “If you nevertheless proceed to perform this euthanasia, I have been ordered by my clients to immediately file criminal charges for murder.”

There was consternation. This had never happened before. The doctor and Karel’s carer were shocked. They thought that this was absurd — but they complied. Karel still wants to proceed with the euthanasia, but in this state of legal uncertainty the doctor is unwilling to help him.

Knack interviewed Christophe Lemmens, a health law specialist and a member of Belgium’s euthanasia commission. Mr Lemmens says that families often oppose requests for euthanasia and engage lawyers to dispute the issue. This is a new development after the Tine Nys case – and it has gone unnoticed in the international media. Knack gives no figures. Mr Lemmens says that there are not “hundreds” of cases – but even a few dozen are probably enough to spook doctors.

The threat of prosecution for murder, or manslaughter by poisoning, is a powerful one. According to Dr Wim Distelmans, who is both Belgium’s leading euthanasia doctor and the co-chair of the Federal euthanasia commission, 78 percent of euthanasia doctors are less willing to perform euthanasia or even give advice nowadays, especially for psychiatric disorders.

Most of the threats involve patients who want to be euthanised because of “unbearable” psychological suffering. Their relatives believe that the doctors’ assessment is wrong – and it is very difficult to prove either way, which must make for a lawyer’s breakfast.

Mr Lemmens contends that the law is clear: the only voice that counts in choosing euthanasia is the patient’s. It is his decision and his alone. His relatives have no authority whatsoever to stop him. “It may be appropriate in some cases to involve relatives, but only the patient decides and no one else,” he told Knack.

While that may be true, it has not stopped lawyers from harassing doctors. They can always claim that the patient was not mentally competent. And in the case of euthanasia for psychological suffering, this can be quite plausible.

Behind some, even many, euthanasia cases in Belgium there must be relatives who believe that the patient should not die and that he or she is clearly not in full possession of his senses. Will litigation become a powerful weapon to bring the steady advance of euthanasia to a shuddering halt?

Michael Cook

Michael Cook is the editor of MercatorNet.