Friday, June 26, 2015

Belgium: ‘Euthanasia leads to the decline of a society?

This article was published on the HOPE Ireland website.

Dr Kevin Fitzpatrick
Dr Kevin Fitzpatrick is the director of HOPE Ireland.

Hermann de Dijn, emeritus professor of philosophy at the Belgian University of Leuven, says: ‘Once the law is there, you have people asking themselves new questions… ‘Do I really have quality of life? Am I not a burden on others?’

De Dijn believes that ‘human dignity should include not only respect for personal choices but also for connectedness to loved ones and society.’ The concept of human dignity in Belgium has been ‘reduced to the ability to have certain experiences’.[1]

He is absolutely right of course. The concept has been stretched beyond its limits. It has lost all meaning in Belgium.

We must now, ever more urgently, return to clear ground, to be sure we are really speaking about dignity, not some corrupted notion which has no actual bearing on what should be our proper concerns.

If the questions are not exactly new, the locus of them is: Belgium’s veneration of death – the lazy moral thinking in a whole society which has allowed itself to be led on a leash to accept the idea that death is, and should be, the default ‘treatment’ for all ailments. This is the societal tectonic shift that allows a young woman, just 24 years old, with apparently serious mental health issues, to apply for and be granted a euthanasia death (believed to be scheduled for August this year), and to say she finds ‘euthanasia a nice idea’.
I was under the impression that children do not form a concept of death until about the age of 7 years, yet this young woman speaks about wanting to die at 4 years old. I can’t buy that. Language development is essential to intellectual development. We cannot form concepts for which we have no words. Early years’ development in children is sufficiently academically explored to make me very suspicious at least, of this ‘memory’.

Personal experience is not scientific, but it is still evidence. I know the interventions of some psychiatrists actually do more damage than good. I want to ask: is her memory then ‘recovered’ memory – false memory? It is very difficult to be clear. It is entirely possible that she genuinely feels the way the short piece I could read indicates.

But in most other healthcare the first response to suicidal ideation is suicide prevention, not a ‘validating’ white-coated arm around the shoulder from a supposedly trusted professional, a doctor who says; ‘Well we can help. We have euthanasia.’

I wonder who is really leading the push for euthanasia from this young woman; herself or those around her? Are they constantly reinforcing the idea with her that there is no hope, no way to accommodate her mental health issues, so that they are quietly or proactively encouraging her to die by euthanasia? How does she come to see euthanasia as a nice idea? Has no-one told her…?

Belgium built ‘existential suffering’ into their law from the beginning, as a sufficient criterion for euthanasia. Their leading euthanasia doctor says: ‘As long as people still jump in front of a train or from an apartment, euthanasia is not being discussed enough.’[2] So euthanasia is suicide prevention?! What is he really saying? ‘We can avoid traumatised train-drivers, having to clean up the pavements’? Where is the discussion of the horrors that drive people to jump? He asks: how do you decide someone is ‘bright enough’ to decide about their own death?’ Bright enough? Superior intellectual capacity is a new criterion to me.

Every time he speaks, Distelmans reveals the depth of his moral confusion, even his own intellectual failures. Tom Mortier discovered amongst his mother’s papers Distlemans’ approving reference to the passage in Thomas More’s famous Utopia where More describes the pressure put on patients to die by euthanasia. Nothwithstanding the many problems More highlights in that passage, has no-one told Distelmans that More’s work was satire?

To die for a lie…or for such a crass error…the unthinkable really has become not just thinkable – it has taken the form of a new ‘religious cult’ amongst some Belgian doctors and supposed thinkers.

Those of us who oppose such a decline in cultural norms, and the sheer laziness of moral examination, are all too aware of the building blocks, steps so often taken in apparent isolation, far back enough in time, not to be noticed. But notice them we must.

It is more than forty years since the Quality Adjusted Life Year, QALY, and its later version Disability Adjusted Life Years, DALY, was developed as a way of allocating scarce health resources. The idea is simple enough: calculate the value of the health intervention on the ‘quality’ of the patient’s life against the cost. The UK body which advises on the use of health technologies seems to have been using ‘£ per QALY’ to ‘evaluate their utility’ since at least 2013. I would suggest healthcare services were infected by this nonsensical idea long before then.

Utilitarianism (calculating utility, sometimes reduced to ‘the greatest happiness for the greatest number’) is a corrupt moral philosophy. Yet it is used across health and other policies in so many governments, for so many decisions – even going to war.

The worst aspect of the changes in ‘resource allocation’ in health services since at least the seventies, has been the acceptance of the idea that we can ‘calculate’ anything here – the value of an intervention, cost-effectiveness or lack of it, the value of one human life over another: your grandmother over my child. This is so fundamentally undermining of what it means to live a human life, whether a disabled life or otherwise. I am convinced most untutored people would see that as no conundrum at all – the child must come first – and think that is a genuine, even the only moral choice, based only on the single detail I gave to the hypothetical, age. Develop the example a little, the child is a neonate with no cranium and little brain formation, the grandmother is 60 years old, and leading the field in cancer research, and people start to hesitate.

The truth is there can be no quality measurement, there is no scientific method which can determine the value of one life against another, and the pretence that there is has led to the simplistic, wide and I repeat, lazy acceptance that such exist and are easily, uncontroversially applied in Belgium.

Recently the results of a European Commission Project, ECHOUTCOME recommended we stop using QALYs in health decision-making after establishing that the four theoretical assumptions underlying QALYs are invalid.

At last. I have been saying this for years.

The idea that ‘quality of life’ is a something – when in reality it is a chimera – is one of those worst building blocks that Belgium now simply accepts. That and other specious arguments are driving their whole society into what is in danger of becoming a terminal decline. ​

In some populations there are almost no children with Down Syndrome now, as a result of deliberate policy of eradication before birth. What will Belgium do when there are no more disabled people, no older people with dementia, and all those with cancer, or mental health issues have been euthanized? Who will be next? The poor? You?

[1] From the New Yorker ‘The Death Treatment When should people with a non-terminal illness be helped to die’ June 22, 2015 – the article documents Dr Tom Mortier’s story, which he shared at our Hope Ireland inaugural conference June 6, 2015 in Dublin.

[2] ‘Euthanasia is not being discussed enough’ De Morgen June 20, 2015

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