Belgium nurses are involved with euthanasia without request - nearly half of the time.

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

A recent study that was published in the May 17 edition of the Journal of the Canadian Medical Association states that nearly half of the euthanasia deaths in Belgium that directly involve nurses are done without the consent of the patient.

The study: The role of nurses in physician-assisted deaths in Belgium, surveyed 1678 nurses in Belgium concerning life-ending decisions. The nurses who responded were protected from legal prosecution. The response rate was 76% (1265 responses) with 128 nurses reported having cared for a patient who received life-ending drugs without consent.

What is particularly concerning is the role of nurses in the euthanasia deaths of people without request.

The data in the study indicates that the nurses participated in 248 euthanasia deaths in 2007 with 120 of those euthanasia deaths being done without the explicit consent of the patient. Further to that, the data indicated that nurses participated in 12% of all of the euthanasia deaths that were done with the consent of the patient and 45% of the euthanasia deaths that they participated were done without the request of the patient.

The authors of the study wondered why nurses seemed more likely to lethally inject a patient without consent than a physician. The study stated:

we wonder why nurses more often administered the life-ending drugs in cases without an explicit patient request than in cases of euthanasia with an explicit request. Perhaps nurses took a more active role out of concern for frailer patients who could no longer communicate, or for very old patients because physicians are more reluctant to give assistance in dying when dealing with these patients. Further, in cases of euthanasia, communication between the physician and the patient is common.

The study also suggested that many of the euthanasia deaths without explicit request or consent are not being reported which correlates with other recent studies that have proven that there is chronic under-reporting of euthanasia in Belgium which is even worse than the recent Dutch studies that indicate that approximately 20% of all euthanasia deaths in the Netherlands are not reported. The study concluded:

By administering life-ending drugs at the physician’s request in some cases of euthanasia, and even more so in cases without an explicit request from the patient, the nurses in our study operated beyond the legal margins of their profession. Future research should closely monitor and examine the involvement of nurses in these practices nationally and internationally to allow comparisons between countries with and without euthanasia legislation.

Dr Peter Saunders

Dr. Peter Saunders, the campaign director for the Care Not Killing Alliance in the UK told the Daily Mail newspaper that: 

"We should take a warning from this that wherever you draw the line, people will go to it and beyond it."

Wesley Smith, bioethicist and anti-euthanasia writer challenged the media reports that missed the obvious point. Smith pointed out the proper summary of the study:


“This study shows that euthanasia poisons everything it touches. Legal guidelines don’t protect vulnerable patients from abuse once euthanasia is legalized. Moreover, nurses are particularly susceptible to being caught up in acts that are illegal when doctors, who many not wish to take the final life-ending act themselves, order them to carry out the termination. We also note that this study demonstrates that once killing becomes part of the medical armamentarium, it leads directly to patient abuse and medical criminality. This study highlights a reason why legalizing euthanasia is bad ethics and ever worse public policy.”

To legalize euthanasia and/or assisted suicide actually means that the law is giving physicians and in this case nurses (and possibly other medical care givers) the right to directly and intentionally take the lives of their patients. When legalizing euthanasia, the law then changes from protecting the lives of their patients to creating a set of rules whereby it is acceptable to kill their patients. Rules change, rules get interpreted.

Wesley Smith

The reality is that it is not ever safe to legalize euthanasia or assisted suicide under any circumstances. The people who die are often vulnerable (dependent on others for their basic care), they are going through a very difficult time of their life, and they are often viewed as expendable by a medical and political establishment that has become focused on cost-containment.

What we need to do is create new and effective ways to care for people and not kill them. We need to create options for families. We need to integrate the care of people with disabilities, chronic or terminal conditions with the wider community. We need to create "safe harbours" for our loved ones.

We need to re-instill the ethic of caring and loving others in our society and reject the concept of killing the vulnerable.

Link to the actual study published in the Journal of the Canadian Medical Association: http://www.cmaj.ca/cgi/rapidpdf/cmaj.091881v1

Link to the article in Daily Mail (UK): http://www.dailymail.co.uk/news/article-1285423/Half-Belgiums-euthanasia-nurses-admit-killing-consent.html

Link to the article from the Australian - Age.com.au: http://www.theage.com.au/world/half-do-not-agree-to-die-20100610-y0dp.html