By Richard Egan (with the Australian Care Alliance)Every two years the Belgium Federal Commission on the Control and Evaluation of Euthanasia presents a report detailing statistics and developments in the practice of euthanasia in Belgium.
The report is currently only available in French and Dutch. However, in this article, with the help of Google Translate the information from 2016 and 2017 has been extracted.
Overall, the impression is that euthanasia practice in Belgium continues on the path of normalising euthanasia as the go-to response to an ever increasing range of circumstances including children with disabilities, uncompleted suicides and victims of child abuse.
=Belgian 2017 euthanasia report. Deaths by euthanasia continue to increase and children are being killed.
Increase in numbers
Deaths by legal euthanasia have increased nearly tenfold (982%) from 235 in 2003 – the first full year of legalisation – to 2,309 in 2017. From 2016 to 2017 alone the increase was 13.85%. Officially reported euthanasia accounted for 2.1% of all deaths in Belgium in 2017.[1]
Organ donation
The 2016-2017 report notes that some patients wish to donate their organs and help others in this way. Doctors are not required to mention organ donation in the document recording. Organ donation has been reported in 8 patients for the years 2016 - 2017. Patients had either a nervous system disorder or a mental and behavioral disorder. The majority of them were Dutch speakers, aged 50 to 69, female and their deaths were not expected in the near future.
Death not expected in the short term
In 2017 there were 375 cases of reported euthanasia of people whose deaths were not expected in the near future. This represents 16.2% of all cases of reported euthanasia.[2]
In 2017 there were 181 cases of reported euthanasia for “polypathology” – two or more conditions none of which in itself is sufficient ground for euthanasia - where death was not expected soon, accounting for 7.83% of all reported cases. This represents a 69.1% increase in just two years from 2015.[3]
In 27 (7.2%) of these cases the mandatory one-month waiting period between the written request for euthanasia and its execution was not complied with by the euthanasing doctor. The Euthanasia Evaluation and Control Commission took no action on these cases other than sending the offending doctor “a didactic letter to remind the doctor of the procedure to be followed in case of unexpected death in the short term”. [4]
No physical suffering
In 2017 some 87 (3.76%) cases involved no physical suffering at all. This included 14 cancer cases and 15 other cases of physical illness. There were also 18 cases of “polypathology” as well as 40 cases of mental ill health.
The psychic suffering, apart from psychiatric conditions, included “addiction, loss of autonomy, loneliness, despair, loss of dignity, despair at the thought of losing ability to maintain social contacts, etc.”.[5]
Three children
Three children have so far been killed under the Belgian law in 2016 and 2017. These were a 17-year-old child who was suffering from muscular dystrophy; a nine-year-old child, who had a brain tumour, and an 11 year old child, who was suffering from cystic fibrosis.
Luc Proot, a member of the Belgium’s Federal Euthanasia Evaluation and Control Commission, commented to Charles Lane of the Washington Post that he “saw mental and physical suffering so overwhelming that I thought we did a good thing”[6] As Lane points out, he is referring to the Committee approving the cases after the fact based on reports from the doctors who carried out the killing. It is curious that Proot refers to “mental and physical suffering” when the Belgian law specifically refers only to “unbearable physical suffering” in relation to children -- in contrast to a reference to “unbearable physical or psychological suffering” for adults. This comment raises a doubt in relation to each of these three cases of child euthanasia as to whether there was “unbearable physical suffering” that could not be alleviated.
Good palliative care can relieve the various forms of physical suffering associated with end-stage brain tumours.[7]
Life expectancy for people with cystic fibrosis (CF) is increasing significantly in response to developments in treatment regimes. In the United States the median predicted age of survival for people with CF has now increased to 47 years.[8] It is by no means clear that the 11-year-old child euthanased in Belgium in 2016 or 2017 was facing imminent death. He or she may have had years to live. Depression is also a particular issue with CF.[9] The “mental suffering” mentioned by Luc Proot may have been relievable through appropriate treatment.
The 17-year-old child had Duchenne muscular dystrophy (DMD). “Until relatively recently, boys with DMD usually did not survive much beyond their teen years. Thanks to advances in cardiac and respiratory care, life expectancy is increasing and many young adults with DMD attend college, have careers, get married and have children. Survival into the early 30s is becoming more common, and there are cases of men living into their 40s and 50s.”[10] On the available information it is not clear whether in this case the child was both imminently dying and experiencing unbearable physical suffering that could not be alleviated.
Euthanasia to complete failed suicide attempts
Between 2014 and 2017 two patients who were in an irreversible coma after a suicide attempt were euthanased based on an advance directive 5 months and 35 months respectively before the suicide attempt.[11]
Euthanasia for psychiatric conditions and dementia
A total of 201 people with psychiatric disorders were killed by euthanasia in Belgium between 2014 and 2017 including for mood disorders such as depression, bipolar disorder (73 cases); organic mental disorders, including dementia and Alzheimer's (60 cases); personality and behavioural disorders (23 cases); neurotic disorders, and disorders related to stressors including posttraumatic stress disorder (16 cases); schizophrenia and psychotic disorders (11 cases); organic mental disorders, including autism (10 cases) and complex cases involving a combination of several categories (8 cases).[12]
Of these 201 cases there were 25 cases of people under 40 being killed by euthanasia. In relation to these troubled young people the Commission observes “In the group of patients under 40, it is mainly personality and behavioral disorders. All these patients have been treated for many years, both outpatient and residential. There has always been talk of intractable suffering. For this type of disorder, serious psychological trauma at a very young age have been mentioned several times, such as domestic violence, psychological neglect or sexual abuse.”[13]
Belgium seems to be treating the victims of child abuse by domestic violence, neglect and sexual abuse by killing them.
Between 2014 and 2017 there were 60 cases of people killed by euthanasia for dementia. Of these cases death was only expected in the short term for 9 cases.[14]
A case of euthanasia without request
One case reported in 2016/2017 concerned an interruptive act of life without request from the patient.
In this complex case where the patient had not made an explicit request, some members of the Commission felt that the law on euthanasia had been violated and that the file should be sent to the public prosecutor. Indeed, demand is one of the essential legal conditions. However, other members considered that a referral to the prosecution was not appropriate. The two-thirds majority, legally required for referral to the King's Attorney (see Article 8 of the law) was not reached (9 for referral to the King's public prosecutor, 7 against).[15]
This high threshold of two-thirds majority of the Commission for referral to the public prosecutor helps explain why only one case has ever been referred (in 2015).
Euthanasia tourism
The place of residence is only required to be reported in the second part of a euthanasia report filed by the doctor performing euthanasia. This part is only opened when questions arise. However, in 2016 and 2017 doctors did refer in the first part of the report to people who were foreigners who came to Belgium to seek euthanasia. There were 23 such cases reported in this way but there may be many more. Of the 23 reported cases “More than half of the deaths were expected in the near future” meaning several were cases where death was not expected in the short term.[16]
Richard Egan has been observing international practice on euthanasia and assisted suicide for over 30 years. He blogs on this and related bioethical issues at defendhumanlife.blogspot.com.
Deaths by legal euthanasia have increased nearly tenfold (982%) from 235 in 2003 – the first full year of legalisation – to 2,309 in 2017. From 2016 to 2017 alone the increase was 13.85%. Officially reported euthanasia accounted for 2.1% of all deaths in Belgium in 2017.[1]
Organ donation
The 2016-2017 report notes that some patients wish to donate their organs and help others in this way. Doctors are not required to mention organ donation in the document recording. Organ donation has been reported in 8 patients for the years 2016 - 2017. Patients had either a nervous system disorder or a mental and behavioral disorder. The majority of them were Dutch speakers, aged 50 to 69, female and their deaths were not expected in the near future.
Death not expected in the short term
In 2017 there were 375 cases of reported euthanasia of people whose deaths were not expected in the near future. This represents 16.2% of all cases of reported euthanasia.[2]
In 2017 there were 181 cases of reported euthanasia for “polypathology” – two or more conditions none of which in itself is sufficient ground for euthanasia - where death was not expected soon, accounting for 7.83% of all reported cases. This represents a 69.1% increase in just two years from 2015.[3]
In 27 (7.2%) of these cases the mandatory one-month waiting period between the written request for euthanasia and its execution was not complied with by the euthanasing doctor. The Euthanasia Evaluation and Control Commission took no action on these cases other than sending the offending doctor “a didactic letter to remind the doctor of the procedure to be followed in case of unexpected death in the short term”. [4]
No physical suffering
In 2017 some 87 (3.76%) cases involved no physical suffering at all. This included 14 cancer cases and 15 other cases of physical illness. There were also 18 cases of “polypathology” as well as 40 cases of mental ill health.
The psychic suffering, apart from psychiatric conditions, included “addiction, loss of autonomy, loneliness, despair, loss of dignity, despair at the thought of losing ability to maintain social contacts, etc.”.[5]
Three children have so far been killed under the Belgian law in 2016 and 2017. These were a 17-year-old child who was suffering from muscular dystrophy; a nine-year-old child, who had a brain tumour, and an 11 year old child, who was suffering from cystic fibrosis.
Luc Proot, a member of the Belgium’s Federal Euthanasia Evaluation and Control Commission, commented to Charles Lane of the Washington Post that he “saw mental and physical suffering so overwhelming that I thought we did a good thing”[6] As Lane points out, he is referring to the Committee approving the cases after the fact based on reports from the doctors who carried out the killing. It is curious that Proot refers to “mental and physical suffering” when the Belgian law specifically refers only to “unbearable physical suffering” in relation to children -- in contrast to a reference to “unbearable physical or psychological suffering” for adults. This comment raises a doubt in relation to each of these three cases of child euthanasia as to whether there was “unbearable physical suffering” that could not be alleviated.
Good palliative care can relieve the various forms of physical suffering associated with end-stage brain tumours.[7]
Life expectancy for people with cystic fibrosis (CF) is increasing significantly in response to developments in treatment regimes. In the United States the median predicted age of survival for people with CF has now increased to 47 years.[8] It is by no means clear that the 11-year-old child euthanased in Belgium in 2016 or 2017 was facing imminent death. He or she may have had years to live. Depression is also a particular issue with CF.[9] The “mental suffering” mentioned by Luc Proot may have been relievable through appropriate treatment.
The 17-year-old child had Duchenne muscular dystrophy (DMD). “Until relatively recently, boys with DMD usually did not survive much beyond their teen years. Thanks to advances in cardiac and respiratory care, life expectancy is increasing and many young adults with DMD attend college, have careers, get married and have children. Survival into the early 30s is becoming more common, and there are cases of men living into their 40s and 50s.”[10] On the available information it is not clear whether in this case the child was both imminently dying and experiencing unbearable physical suffering that could not be alleviated.
Euthanasia to complete failed suicide attempts
Between 2014 and 2017 two patients who were in an irreversible coma after a suicide attempt were euthanased based on an advance directive 5 months and 35 months respectively before the suicide attempt.[11]
Euthanasia for psychiatric conditions and dementia
A total of 201 people with psychiatric disorders were killed by euthanasia in Belgium between 2014 and 2017 including for mood disorders such as depression, bipolar disorder (73 cases); organic mental disorders, including dementia and Alzheimer's (60 cases); personality and behavioural disorders (23 cases); neurotic disorders, and disorders related to stressors including posttraumatic stress disorder (16 cases); schizophrenia and psychotic disorders (11 cases); organic mental disorders, including autism (10 cases) and complex cases involving a combination of several categories (8 cases).[12]
Of these 201 cases there were 25 cases of people under 40 being killed by euthanasia. In relation to these troubled young people the Commission observes “In the group of patients under 40, it is mainly personality and behavioral disorders. All these patients have been treated for many years, both outpatient and residential. There has always been talk of intractable suffering. For this type of disorder, serious psychological trauma at a very young age have been mentioned several times, such as domestic violence, psychological neglect or sexual abuse.”[13]
Belgium seems to be treating the victims of child abuse by domestic violence, neglect and sexual abuse by killing them.
Between 2014 and 2017 there were 60 cases of people killed by euthanasia for dementia. Of these cases death was only expected in the short term for 9 cases.[14]
A case of euthanasia without request
One case reported in 2016/2017 concerned an interruptive act of life without request from the patient.
In this complex case where the patient had not made an explicit request, some members of the Commission felt that the law on euthanasia had been violated and that the file should be sent to the public prosecutor. Indeed, demand is one of the essential legal conditions. However, other members considered that a referral to the prosecution was not appropriate. The two-thirds majority, legally required for referral to the King's Attorney (see Article 8 of the law) was not reached (9 for referral to the King's public prosecutor, 7 against).[15]
This high threshold of two-thirds majority of the Commission for referral to the public prosecutor helps explain why only one case has ever been referred (in 2015).
Euthanasia tourism
The place of residence is only required to be reported in the second part of a euthanasia report filed by the doctor performing euthanasia. This part is only opened when questions arise. However, in 2016 and 2017 doctors did refer in the first part of the report to people who were foreigners who came to Belgium to seek euthanasia. There were 23 such cases reported in this way but there may be many more. Of the 23 reported cases “More than half of the deaths were expected in the near future” meaning several were cases where death was not expected in the short term.[16]
Richard Egan has been observing international practice on euthanasia and assisted suicide for over 30 years. He blogs on this and related bioethical issues at defendhumanlife.blogspot.com.
A lengthier commentary on euthanasia in Belgium is available at the website of the Australian Care Alliance.
Notes
[1] European Institute of Bioethics, Euthanasia in Belgium : 10 years on, October 2012, p. 3 http://www.ieb-eib.org/en/pdf/20121208-dossier-euthanasia-in-belgium-10-years.pdf ; “Belgian euthanasia cases hit record high”, News24, 27 January 2016, http://www.news24.com/World/News/belgian-euthanasia-cases-hit-record-high-20160127 ; “2024 cases of euthanasia reported in Belgium in 2016”, Genethique: weekly news summary,http://www.genethique.org/en/2024-cases-euthanasia-reported-belgium-2016-67000.html#.WJe2SFN96Uk ; http://statbel.fgov.be/nl/modules/publications/statistiques/bevolking/bevolking_-_cijfers_bevolking_2010_-_2012.jsp ; Commission fédérale de Contrôle et d’Évaluation de l’Euthanasie Huitième rapport aux Chambres législatives années 2016 – 2017, p. 2 https://organesdeconcertation.sante.belgique.be/sites/default/files/documents/8_rapport-euthanasie_2016-2017-fr.pdf
[2] Commission fédérale de Contrôle et d’Évaluation de l’Euthanasie Huitième rapport aux Chambres législatives années 2016 – 2017, p. 3 https://organesdeconcertation.sante.belgique.be/sites/default/files/documents/8_rapport-euthanasie_2016-2017-fr.pdf
[3] Ibid
[4] Commission fédérale de Contrôle et d’Évaluation de l’Euthanasie Huitième rapport aux Chambres législatives années 2016 – 2017, p. 18 https://organesdeconcertation.sante.belgique.be/sites/default/files/documents/8_rapport-euthanasie_2016-2017-fr.pdf
[5] Ibid., p. 21
[6]Charles Lane “Children are being euthanised in Belgium”, Washington Post, 6 August 2018, https://www.washingtonpost.com/opinions/children-are-being-euthanized-in-belgium/2018/08/06/9473bac2-9988-11e8-b60b-1c897f17e185_story.html?noredirect=on&utm_term=.388d76a167e4
[7] See for example: M. Cohn et al., Transitions in Care for Patients with Brain Tumors: Palliative and Hospice Care, 2014 https://www.ucsfhealth.org/pdf/transition_of_care_handbook.pdf ;
Canadian Virtual hospice, What can be expected as brain cancer progresses?, http://www.virtualhospice.ca/en_US/Main+Site+Navigation/Home/Support/Support/Asked+and+Answered/What+to+Expect+with+Various+Illnesses/Cancer/What+can+be+expected+as+brain+cancer+progresses_.aspx
[8] Cystic Fibrosis Foundation, https://www.cff.org/CF-Community-Blog/Posts/2017/Survival-Trending-Upward-but-What-Does-This-Really-Mean/
[9] Cystic Fibrosis Foundation, https://www.cff.org/Life-With-CF/Daily-Life/Emotional-Wellness/Depression-and-CF/
[10] Muscular Dystrophy Association, Duchenne Muscular Dystrophy (DMD), https://www.mda.org/disease/duchenne-muscular-dystrophy
[11] Commission fédérale de Contrôle et d’Évaluation de l’Euthanasie Huitième rapport aux Chambres législatives années 2016 – 2017, p. 14, https://organesdeconcertation.sante.belgique.be/sites/default/files/documents/8_rapport-euthanasie_2016-2017-fr.pdf
[12] Commission fédérale de Contrôle et d’Évaluation de l’Euthanasie Huitième rapport aux Chambres législatives années 2016 – 2017, p. 46, https://organesdeconcertation.sante.belgique.be/sites/default/files/documents/8_rapport-euthanasie_2016-2017-fr.pdf
[13] Ibid., p. 48
[14] Ibid., p.53
[15] Commission fédérale de Contrôle et d’Évaluation de l’Euthanasie Huitième rapport aux Chambres législatives années 2016 – 2017, p. 30, https://organesdeconcertation.sante.belgique.be/sites/default/files/documents/8_rapport-euthanasie_2016-2017-fr.pdf
[16] Ibid., p.58
Notes
[1] European Institute of Bioethics, Euthanasia in Belgium : 10 years on, October 2012, p. 3 http://www.ieb-eib.org/en/pdf/20121208-dossier-euthanasia-in-belgium-10-years.pdf ; “Belgian euthanasia cases hit record high”, News24, 27 January 2016, http://www.news24.com/World/News/belgian-euthanasia-cases-hit-record-high-20160127 ; “2024 cases of euthanasia reported in Belgium in 2016”, Genethique: weekly news summary,http://www.genethique.org/en/2024-cases-euthanasia-reported-belgium-2016-67000.html#.WJe2SFN96Uk ; http://statbel.fgov.be/nl/modules/publications/statistiques/bevolking/bevolking_-_cijfers_bevolking_2010_-_2012.jsp ; Commission fédérale de Contrôle et d’Évaluation de l’Euthanasie Huitième rapport aux Chambres législatives années 2016 – 2017, p. 2 https://organesdeconcertation.sante.belgique.be/sites/default/files/documents/8_rapport-euthanasie_2016-2017-fr.pdf
[2] Commission fédérale de Contrôle et d’Évaluation de l’Euthanasie Huitième rapport aux Chambres législatives années 2016 – 2017, p. 3 https://organesdeconcertation.sante.belgique.be/sites/default/files/documents/8_rapport-euthanasie_2016-2017-fr.pdf
[3] Ibid
[4] Commission fédérale de Contrôle et d’Évaluation de l’Euthanasie Huitième rapport aux Chambres législatives années 2016 – 2017, p. 18 https://organesdeconcertation.sante.belgique.be/sites/default/files/documents/8_rapport-euthanasie_2016-2017-fr.pdf
[5] Ibid., p. 21
[6]Charles Lane “Children are being euthanised in Belgium”, Washington Post, 6 August 2018, https://www.washingtonpost.com/opinions/children-are-being-euthanized-in-belgium/2018/08/06/9473bac2-9988-11e8-b60b-1c897f17e185_story.html?noredirect=on&utm_term=.388d76a167e4
[7] See for example: M. Cohn et al., Transitions in Care for Patients with Brain Tumors: Palliative and Hospice Care, 2014 https://www.ucsfhealth.org/pdf/transition_of_care_handbook.pdf ;
Canadian Virtual hospice, What can be expected as brain cancer progresses?, http://www.virtualhospice.ca/en_US/Main+Site+Navigation/Home/Support/Support/Asked+and+Answered/What+to+Expect+with+Various+Illnesses/Cancer/What+can+be+expected+as+brain+cancer+progresses_.aspx
[8] Cystic Fibrosis Foundation, https://www.cff.org/CF-Community-Blog/Posts/2017/Survival-Trending-Upward-but-What-Does-This-Really-Mean/
[9] Cystic Fibrosis Foundation, https://www.cff.org/Life-With-CF/Daily-Life/Emotional-Wellness/Depression-and-CF/
[10] Muscular Dystrophy Association, Duchenne Muscular Dystrophy (DMD), https://www.mda.org/disease/duchenne-muscular-dystrophy
[11] Commission fédérale de Contrôle et d’Évaluation de l’Euthanasie Huitième rapport aux Chambres législatives années 2016 – 2017, p. 14, https://organesdeconcertation.sante.belgique.be/sites/default/files/documents/8_rapport-euthanasie_2016-2017-fr.pdf
[12] Commission fédérale de Contrôle et d’Évaluation de l’Euthanasie Huitième rapport aux Chambres législatives années 2016 – 2017, p. 46, https://organesdeconcertation.sante.belgique.be/sites/default/files/documents/8_rapport-euthanasie_2016-2017-fr.pdf
[13] Ibid., p. 48
[14] Ibid., p.53
[15] Commission fédérale de Contrôle et d’Évaluation de l’Euthanasie Huitième rapport aux Chambres législatives années 2016 – 2017, p. 30, https://organesdeconcertation.sante.belgique.be/sites/default/files/documents/8_rapport-euthanasie_2016-2017-fr.pdf
[16] Ibid., p.58
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