By Michael Cook
A leading academic has published a stinging critique of how Belgium administers its euthanasia law. Writing in the Journal of Medical Ethics, Rafael Cohen-Almagor, an Israeli professor of politics at the University of Hull, says that Belgians should be alarmed by the deliberate shortening of lives of some patients without their explicit voluntary request.
Consent is supposed to be a cornerstone of Belgium’s euthanasia act, but Cohen-Almagor, after surveying reports and articles, believes that the number of patients who are killed outside of the law is disturbing. “Ending patients’ lives without request is more common than euthanasia,” he says. He urges the Belgian medical profession to place reform high on their agenda.
Euthanasia has taken root in the culture of Belgium, he observes. Support for euthanasia among doctors is over 90%. “Social and peer pressure makes it difficult for those who oppose euthanasia to uphold their position in the liberal culture that has been developing,” he says. About 90% of the public also support it.
In this atmosphere, consent seems to have become optional for a particularly vulnerable group, “80-year-old patients or older who were mostly in coma or suffered from dementia”. Killing them is clearly against the law, but Belgian physicians are ignoring its letter and observing its spirit – as they interpret it. “Whether deliberately or not, the physicians were disguising the end-of-life decision as a normal medical practice,” he says, citing a 2010 study.
Cohen-Almagor highlights last year’s position paper by the Belgian Society of Intensive Care Medicine Council. This document says that “shortening the dying process with use of medication may sometimes be appropriate, 'even in the absence of discomfort'”. Furthermore, the final decision for terminal treatment lies in the hands of the medical care team, not necessarily the relatives. He criticizes the paternalism of the statement and points out that it fails to mention the word “consent”.
He concludes by asking:
“If Belgium has been unable to control abuse—and does not seem to have tried very hard—what reason is there to believe it will be controlled in the future?”