Tuesday, September 9, 2014

Belgian Euthanasia Control and Evaluation Commission broadens euthanasia law.

The European Institute of Bioethics reported on the latest data release on the incidence of euthanasia in Belgium. (Google translated from French)

Belgian Euthanasia Increases by 89% in four years.

The Act of 28 May 2002 concerning euthanasia stipulates that the Federal Committee on Oversight and Enforcement, shall biennially report to the legislature. Here is the sixth report, covering the years 2012-2013.

The report comprises firstly a statistical element, which we note here that the number of reported euthanasia has almost doubled in four years (an increase of 89%), from 953 reported in 2010 to 1,807 in 2013 euthanasia. The Commission considers that this increase is due to the "gradual release of information to the public and physicians." The deaths caused today represent 1.7% of all deaths in Belgium.

More and more people have also asked to be euthanized when their death was not expected in the short term (13% of euthanasia). These figures, however, should probably be revised upward to include some cases of euthanasia practiced, based on early reports of the end of life on irreversibly unconscious people. Indeed, the report ranks arbitrarily all these cases in the category of death in the near future, when the deadline is sometimes indeterminate ("When euthanasia was performed in a patient irreversibly unconscious on the basis of an earlierstatement , the deadline of death was undetermined if it was classified brief.").

The report then describes the application of the law which highlight the following:

• About the people who were euthanized when they were not at the end of life, the report mentions some cases of early cancers but specifies that some people were euthanized who had non-terminal diseases or conditions. This is particularly true for patients with neuropsychiatric disorders (4%) or people with "multiple conditions" specific to advanced age (5% of cases). In this regard, the Commission notes that the number of euthanasia performed for multiple pathologies is "significantly higher" in 2012-2013 than in 2011 (going from 23 in 2011 to 109 in 2013). The report underlines in this regard that there was a difference of opinion within the Commission as to the justification for euthanasia for these non-terminal disease and "normal" age-related patient.

     2004 2005 20062007 2008  20092010 2011  20122013 
     Neuropsychiatric disorders 6 5 4 13 21 25 33 53 67
     "Multiple Pathologies" 911 10 12 18 16 23 57 109 

• Of the patients euthanized, 75% of them were between 60 and 89 years , and there is an increasing proportion of euthanasia in nursing homes and / or care.

• In 4% of cases (73 euthanasia), the report does not indicate the diagnosis justifying euthanasia. While in most cases, the physical pain is present, however, there were 68 cases where the patient did not express (figures 2013).

• The report notes again, as in previous years, the strange disparity between the high number of declarations on euthanasia filled in Dutch-speaking Belgium (1454 2013, or 80% of the acts) next to the smaller number of returns filed in French-speaking Belgium (353 in 2013, representing 20% of total), but no study has yet been taken to account for this discrepancy.

• Regarding the statements of euthanasia, arguing duty to die, the Commission asked for comments or clarification from the reporting physician, "confidentially" in 14% of the cases. But just like the previous 12 years, the Commission has not sent any suspected case to justice, as well as stating that it believes everything is completely under control, at least for the cases that were reported by respondents. "No representation with elements raising doubts about compliance with the essential requirements of the law, no case has been forwarded to the courts."

• About the forward declaration at the end of life (living will), several members of the Commission have lamented the complexity (writing, recording and renewal) of the process. They said that they would make it "more effective." About the obstacles and difficulties emerged in some nursing homes and care when there was a request for euthanasia, it seems that "everything has been settled." The report did not give details.

• The Evaluation Committee considered it within its jurisdiction and its powers to endorse the practice of assisted suicide, arguing that the law "does not impose how the euthanasia should be practiced," provided it is under medical supervision. This is clearly at odds with the legislative history of the law decriminalizing euthanasia. Parliamentarians, in fact, reserved decriminalizing the act homicide made ​​by the physician, not the patient.

• Concerning the training of doctors, the Commission considers that the curriculum of medical studies should cover the practice of palliative care but also "the proper implementation of euthanasia." "Likewise, the various postgraduate education and recycling business cycles (for general practitioners) should be encouraged to include such training."

• In Annex 4 (Brochure for the medical profession), the report insisted the concept of independence in respect of the patient and the attending physician, the consultant called to verify the correct application of the legal requirements for the planned euthanasia. There can be no domestic relationship or hierarchical relationship of subordination between the consultant and the treating physician. However, it is not specified that they can not belong to the same organization or association. So nothing prevents two doctors who belong to the same association - EOL (End of Life) or LEIF (Life End Information Forum), for example, one and the other sponsored by the Association for the Right to Die in dignity - to cooperate, as an attending physician and consulting physician, euthanasia of a patient.

• Reaffirming that only the patient can judge the unbearable and insatiable nature of his suffering, but he has the right to refuse any treatment would alleviate this suffering, the Commission takes the example of the case of this 54 year old man suffering from multiple sclerosis: unrelieved suffering is rooted in the fact that "He does not want to depend on others." Note also that the patient must remain master of the treatment he receives, it is not a question of imposing palliative care, even though they have precisely the effect of reducing suffering.

• As for products necessary to euthanasia, the Commission recommends to facilitate the availability of public pharmacy. But it was silent about the current lack of control from the same pharmacies.

Some members of the Commission believe that the last notion of irreversible unconsciousness is interpreted by physicians in a limited way (coma). They argue for a less restrictive interpretation, allowing a wider practice of euthanasia.

Finally, we note that the Belgian Euthanasia Control and Evaluation Commission, established by the legislature to monitor closely the implementation of the law, increasingly assumes the role of an interpreter of the law, broadening its applicability. So much so that one can legitimately ask whether it does not tend to become over the years a promoter of euthanasia.

Links to further information on Belgian euthanasia.

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