May 28, 2017 marked the 15th anniversary of the law legalizing euthanasia in Belgium. According to the official data from their Federal Control Commission, euthanasia was performed on 14,753 individuals between 2002 and 2016.
The objective of this publication is to address the multiple issues raised by this significant number:
- the relevant law governing euthanasia
- the current debates to extend euthanasia
- specific statistical data
- cases of abusing the euthanasia law
- reactions to ethical abuse
I – SUMMARY
In 2002 Belgium decriminalized euthanasia for adults. By 2014, the law was extended to minors without specifying an age limit. For the past 15 years, the number of euthanasia cases has continued to sharply increase. Various modifications of the law have extended and facilitated euthanasia.
Several multi-faceted instances of abuse in interpreting and applying the law have been revealed by the available data. Numerous clandestine euthanasia cases continue to be practiced; the criteria to be respected have been incrementally subjected to broader interpretation (especially concerning the nature of “constant, unbearable and unrelievable physical or mental suffering”); as well as: the controversial role of the Federal Control Commission, the progression toward highly publicized assisted suicide cases; organ procurement after euthanasia; plus the pressure to eliminate the conscience clause, etc.
Especially in the Dutch-speaking regions, mentalities are rapidly evolving towards trivializing euthanasia, in the name of human autonomy and “one’s freedom to choose in favor of one’s own life or death”, via an Anglo-Saxon utilitarian perspective of life. Euthanasia is progressively being considered as a right that one can claim for oneself or loved ones, even if the prerequisite conditions are obviously not met.
Nevertheless, confronted with this exaggerated abuse, a genuine opposition has begun to speak out. For example: health professionals have testified to wrong-doings in their department, several films and documentaries have specified the conditions for euthanasia, religious representative have come together to defend the dignity of vulnerable individuals, without mentioning social media which continues to inform and alert on an international level.
II – STATISTICAL DATA
The Belgian Federal Control Commission received 2024 declarations of euthanasia in 2016, compared to 953 in 2010, thus more than doubling the rate in 6 years time.
The reality is even worse since these official numbers don’t account for numerous cases of clandestine euthanasia: estimated at 27% of the total cases in Flanders and 42% in Wallonia (cf § IV-2).
Therefore in Belgium there are approximately 6 « legal » euthanasia cases per day (for a population of 11.3 million, which is less than the Greater Paris region.)
More detailed statistics by region and by pathology are available in the Federal Control Commission’s report. More than 80% of the euthanasia acts took place in Flanders. The latest report published in October 2016 by the Commission includes data for 2014 -2015 (see Summary Table below and page 14).
Titles on the bar chart:
Number of declarations
Declarations by language: French, Dutch, Total
The European Bioethics Institute published a summary with a pertinent analysis and a bar chart.
III – LEGAL ASPECTS
IV – ABUSE RELATED TO NON-COMPLIANCE WITH LEGAL REQUIREMENTS
Several worrisome factors concern non-compliance with legal requirements.
V – A BROAD INTERPRETATION OF THE LAW
1 – From euthanasia to assisted suicide
Belgian law does not require for an individual to be in the terminal phase of an incurable serious disease, or for the medical staff to carry out an objective examination of the patient. For the physicians practicing euthanasia, as for the National Control Commission, the subjective evaluation of suffering has progressively come to be the only criteria taken into account. This leaves the door wide open to broader interpretations and shocking violations, on behalf of respecting individual autonomy.
For example here are some recent cases which could qualify as “assisted suicide”. Nowadays they are easily accepted by the laxest Control Commission, whereas they would have been excluded according to the debates for the 2002 law:
These highly publicized cases in the Belgian media, demonstrate a growing tendency to trivialize the act of euthanasia, and more recently the staging and dramatization of death.
2 – Mental suffering: where are the limits?
Increasing numbers of individuals (124 people in just two years 2014 and 2015) have been put to death by euthanasia for “mental illness and behavioral disorders” including people with depression, Alzheimer’s, dementia, etc. This worrisome trend was analyzed in an interview published by Atlantico in October 2016:“signifying that in spite of having altered mental faculties, doctors acquiesced to their request”.
Nevertheless, certain cases of euthanasia were avoided at the last moment, or may still be pending today. The following symbolic cases highlight the ambiguity of the situation:
3 – Growing pressure for economic reasons
In an article published on January 17, 2017, Dr. Marc Moens warned that “budgetary problems in healthcare for the elderly, may lead to debating euthanasia policies based on socio-economic reasons.” In various media and medical circles “there are open pleas in favor of euthanasia for Alzheimer patients” and demands to stop treating some incurable diseases, to invest healthcare money for patients with treatable conditions. However Dr Moens concludes: “Euthanasia should never become a cost-related solution. However, the “slippery slope” is dangerously close”.
ANNEX : INCREASING COMPLAINTS OF VIOLATIONS
Since euthanasia was legalized 14 years ago, there has not been any strong public criticism, and thus appears to have been progressively accepted. In 2014, Belgian public opinion was rather favorable to extending the law to minors. Recently, however, due to multiple abuses of the law, there have been increasing numbers of initiatives and protests both in Belgium and internationally, that challenge euthanasia as a routine practice.
FOR FURTHER INFORMATION:
- Euthanasia: 10 years of practicing euthanasia in Belgium. A very complete report dated April 2012, from the European Institute of Bioethics, regarding legislation and practices, with concluding remarks on the lack of effective monitoring of the law’s application.
- CCNE Opinion N° 121 on the End-of-Life, dated July 1, 2013. Annex 2 summarizes assisted suicide and euthanasia experience abroad: analysis of Benelux countries pages 73-77.
- Federal Control Commission, Report 2014-2015, published in October 2016: Statistical Summary with detailed data of euthanasia procedures in 2014 and 2015.