Monday, November 25, 2013

Tom Mortier warns of "Slippery Slope" as euthanasia is normalized.

The National Post is publishing a series of articles on euthanasia. The following article was written by Graeme Hamilton and published on the front page of the National Post on November 25 under the title: Death By Doctor: Belgium's Slippery Slope.

By Graeme Hamilton - National Post, November 25, 2013.

Tom Mortier
Tom Mortier never paid much attention to the discussion about euthanasia in his country. “I was like just about anyone else here in Belgium: I didn’t care at all,” he said in a recent interview. “If people want to die, it’s probably their choice. It didn’t concern me.”

Then in April 2012, Mr. Mortier, a university lecturer, got a message at work. His 64-year-old mother, in the throes of severe depression, had been euthanized the previous day. He would need to make arrangements at the morgue. His mother, Godelieva De Troyer, had largely broken off contact with her family but informed him by email three months earlier that she was looking into euthanasia. He never dreamed her request would be granted because she was in perfect physical health.

His mother’s death has transformed Mr. Mortier, 37, from a typically indifferent Belgian into a critic of the country’s euthanasia law, which came into force in 2002. “This is suicide with the approval of society,” he said of her death. “This has nothing to do with euthanasia.”

When Belgium legalized euthanasia, there were assurances that it would be tightly controlled and limited to exceptional cases. But the number of cases rises every year – reaching nearly 2% of total deaths last year — and the definition of what is acceptable is expanding. The country’s Senate is currently debating a proposal to permit euthanasia of minors with a “capacity of discernment” and of people suffering from dementia.

The Belgian experience is of particular interest in Quebec, where a bill to legalize euthanasia passed second reading last month and is now undergoing detailed study in committee. Architects of the Quebec legislation, Bill 52, were inspired by the Belgian example. Last year, a special committee of the Quebec legislature studying euthanasia and assisted suicide visited Belgium and reported back in glowing terms. “Everyone agrees that there has been no abuse. No slippery slope has materialized,” the committee concluded. If there was any problem in Belgium, it was insufficient euthanasia: Patients were being denied euthanasia because of doctors’ “personal reluctance,” the committee said.

Étienne Montero, dean of law at Belgium’s Université de Namur, has looked at Quebec’s legislation and sees clear similarities to the Belgian law.

The Quebec bill says that to qualify for euthanasia a patient must:
  • suffer from an incurable serious illness; 
  • suffer from an advanced state of irreversible decline in capacity; and 
  • suffer from constant and unbearable physical or psychological pain that cannot be relieved in a manner the person deems tolerable. 
Before performing euthanasia, a doctor needs a second opinion from an independent physician confirming that the criteria for euthanasia have been met.

That echoes the wording in Belgium, where euthanasia is legal if a patient:
suffers from a serious and incurable accidental or pathological condition;
is in a hopeless medical condition; and
suffers constant and unbearable physical or mental pain that cannot be relieved.

An independent physician must be consulted, and in cases where death is not imminent, a third physician must also be consulted, either a psychiatrist or a specialist in the patient’s condition.

Mr. Montero’s warning to Canadians is that once euthanasia is allowed, even supposedly for the most exceptional cases, it opens a crack that will widen over time. “I believe that once you accept the principle of euthanasia, we do not know how to set the limits or how to assure control of its practice,” he said. “We set strict conditions but we do not stick to them, not at all. Why? I think because euthanasia is made banal. It becomes a dignified exit. It becomes more and more normal.”

The normalization of euthanasia is something Jacqueline Herremans, president of Belgium’s francophone death-with-dignity association, welcomes. And opinion polls suggest she has the population behind her. A survey last month for the newspaper La Libre found that three-quarters of Belgians want the law extended to cover children with an incurable illness and adults with advanced dementia. The Brussels lawyer noted how the culture has changed in the 11 years since euthanasia became legal. New rituals have emerged, such as the last supper before a lethal injection.

“With a euthanasia, we prepare our mourning well in advance. We get ready for the separation. We try with the loved one to multiply cherished moments,” she said. “This means that when the action is taken, it is easier to turn the page. It was her will, she has left serenely, and now we can think about the good times. The mourning has been done before.”

She spoke of a friend suffering from Parkinson’s disease who died by euthanasia three years ago. “She loved sweets, so the night before she went to one of her children’s homes and they had a crepe evening,” she said. “The day itself, she went with her daughter to get her hair and nails done so she would be completely beautiful.”

Michèle Coerten, 73, is preparing for her own euthanasia. A retired union activist, Ms. Coerten has been diagnosed with terminal cancer and two months ago she decided to stop all treatments. Her hope is to spend one more Christmas at home with her husband.

In a telephone interview, she said knowing that euthanasia is available has made it easier for her to live with her illness. “Everyone is afraid of suffering, and the only way to avoid suffering is through euthanasia,” she said. She has asked one of her best friends, a family physician, if she would perform the euthanasia, and she has begun telling friends that she is preparing to end her life. “Everyone receives the news well,” she said. “People say, ‘Yes, Michèle, you are right.’ ”

Kenneth Chambaere, a postdoctoral fellow at Vrije Universiteit Brussel, said Belgians who oppose euthanasia are a small minority. “In Belgium, the fact that the majority supports euthanasia means that it has actually become part of our culture,” he said. “Ethical paradigms change over time. We’ve seen that throughout history.”

The acceptance of euthanasia has been smoothed by a few prominent cases. Christian de Duve, winner of the 1974 Nobel Prize for medicine, died by euthanasia last May at age 95. Though he had cancer, it was not terminal. Rather, it was a fall that left him unable to get up that convinced him it was time to die before he lost his dignity and became a burden. He followed Hugo Claus, a well-known Belgian writer, who received euthanasia in 2008 while in the early stages of Alzheimer’s disease.

Mr. Montero is troubled by the fact that the deaths of Dr. de Duve and Mr. Claus, neither of whom was terminally ill, were portrayed in Belgium as noble examples. “I am persuaded that there are vulnerable people who think today, ‘I must request euthanasia. I represent a burden for my loved ones. I am contributing nothing to society any more,’ ” he said. “What is presented at first as a right is going to become a kind of obligation.”

Belgium’s 16-member Federal Commission of Control and Evaluation is supposed to guard against any abuses, although it only analyzes cases after the patient is dead. It has reviewed more than 8,000 deaths since euthanasia was legalized, and not one has been referred to prosecutors. Critics like Mr. Montero say this is because its membership is heavily stacked with euthanasia advocates who have stretched the acceptable criteria. Wim Distelmans, the country’s leading euthanasia doctor, has been the co-president since its creation.
Tom Mortier's mother

Psychiatric illnesses, such as the depression that afflicted Mr. Mortier’s mother, are now accepted as grounds for euthanasia. The commission also approves euthanasia when a patient has a combination of ailments – none of them life-threatening – that together produce unbearable suffering.

Ms. Herremans, a member of the control commission, elaborated. “Being tired of life is not an acceptable diagnosis,” she said. “But if, for example, someone is afflicted with osteoarthritis, can no longer leave the rest home where she lives, is losing her eyesight, losing her hearing, in that case you have the necessary information about the person’s medical condition.” Having lost a spouse can also be a factor. “It sometimes enters into the consideration of suffering,” she said.

Marc Van Hoey, a physician who performs euthanasia and is head of the Flemish death-with-dignity association, said there has been a shift toward euthanasia of what he called the high elderly. “Recently I went to see a lady of 95 years old, sitting in a nursing home all by herself. All her friends and family had died. The only people she had good contact with were the nursing team. She said every evening she goes to bed, she hopes, ‘Don’t let me wake up any more,’ ” he said. He told her she was a candidate for euthanasia.

“Why do I say that? Because maybe if you say to that kind of person, ‘We are not going to give you euthanasia,’ they open the window on the fourth floor and jump down. And that’s traumatic for everyone.”

Dr. Van Hoey is remarkably frank about how flexible the euthanasia law is. It requires a written request for euthanasia from a patient, but it can be written on a napkin, he said. The control commission has even approved euthanasia when there was no written request, taking the doctor’s word that an oral request had been made.

Assisted suicide — when the doctor prescribes a patient lethal medication instead of administering it himself – is not legal in Belgium. But Dr. Van Hoey said he has aided the suicides of two of his patients, including one a few years ago who had been refused euthanasia. The 56-year-old businessman was half-paralyzed after a stroke and did not want to live, but he had trouble finding a psychiatrist who would approve euthanasia. Dr. Van Hoey said today he would have gone ahead and performed the euthanasia without the approval of a psychiatrist instead of surreptitiously prescribing lethal drugs. He noted that Belgian law only says a third doctor must be “consulted” if death is not imminent. “It is not said [the doctors] have to agree,” he said.

Mr. Mortier remains haunted by his mother’s death, convinced her depression, prompted by the end of a 10-year romantic relationship, would have eventually improved as it had in the past. “It comes and it goes,” he said. “Almost everyone has been depressed. They don’t see the point in life.”

In looking at her medical file, he learned that she had essentially gone euthanasia shopping after initially being refused. Eventually she found a psychiatrist who concluded her depression was incurable and her suffering unbearable, and Dr. Distelmans performed the euthanasia.

“What he created is unbearable suffering for me,” Mr. Mortier said.

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