Belgium: Twenty years after “perfect” euthanasia

In 2022, two decades have passed since the approval of euthanasia in Belgium. When, in 1999, the Christian Democrats were out of government and replaced by a coalition of Socialists, Liberals and Greens, they put the reform focus on certain bioethical issues, and, in 2002, put euthanasia on the scene.

Since then, they have died in this way more than 24. people — it is estimated that those who were euthanized account for 2% of the year’s total deaths. The procedure involves injecting the applicant’s vein with a mixture of sodium thiopental and a muscle neuroparalyser (or morphine and neuroparalyser), or giving him barbiturates to drink.

But to reach this At the moment, the applicant must meet several requirements. These include being mentally competent, suffering from an incurable physical illness, or, in the case of a mental illness, having exhausted all treatment options. It is also considered whether, as a result of these ills, the person concerned is experiencing unbearable suffering, whether physical or psychological, with no hope of improvement.

For those who are in this condition, the law allows the request euthanasia, which you will have to do twice in writing. The doctor then assesses whether there are possibilities for improvement and consults a specialist in palliative care and euthanasia, whose opinion, ultimately, is just that: opinion, as he has no decision-making capacity. If, after all, the doctor in the case decides that euthanasia is appropriate, a month is allowed between the second request and the moment to administer the injection or the lethal drink.

Over the years, several of those who actively fought to make this a reality understand that it was worth it. Dr. Dominque Bron, an oncologist, participated in the drafting of the law. “It took six years to write it. We struggle with every word, with every comma,” she told her in 2021 to The Bulletin magazine. “The law is really excellent from a practical point of view. (…) We can be sure that there are many options for patients, from those who are close to death to those with neurological problems. For me, it’s just perfect.”

But maybe it’s better to avoid absolutes…

Illegal euthanasias?

The “perfect” law does not free the practice of euthanasia in Belgium from black holes, including the possibility of skipping some steps of the procedure, as happened to a young woman, Tine Nys, in 2010: among the irregularities denounced by the family, is that the Federal Commission for the Control and Evaluation of Euthanasia, in charge of this matter at the national level, did not take the expected month to respond to the solicitation; instead, he gave a quick “yes”.

But theoretically there are no flaws. The Commission itself publishes a statistical report annually, and in 2020 it states that “in the last two years the application of the law has not given rise to significant difficulties or abuses that require legislative initiatives.”

Nevertheless, the statement conflicts with the reality that, in addition to the euthanasias officially declared to the Commission, “ scientific studies estimate that between 25 and 27% of euthanasias do not declare themselves (and therefore are illegal )”, writes the lawyer and researcher Léopold Vanbellingen, from the European Institute of Bioethics.

If the figures in the last report are taken into account, corresponding to 2021, it is observed that in that year 2 were carried out.699. If you trust Vanbellingen’s thesis, the real number would be around 4.150.

Commission reports from 2018 to date show an increase in declared euthanasias, with a slight decrease in 2020, the year of the pandemic: in 2018, there was news of 2. 359; in 2014, of 2.693; in 2020 lowered to 2. 044, and the arrow has pointed upwards since last year.

There are several data of interest, such as the most common ailments among applicants. Cancerous tumors are in first place, followed by polypathologies (044, 8% and 000,2% respectively, in the report of 2021).

There are also euthanasias of psychiatric patients (18) and with cognitive disorders (22), a condition that should cast doubt on the decision-making capacity of these people. In none of these cases did the number reach the thirties in the period 2018-2021. In the first group, the report stresses that “all patients had (…) a treatment history of several years, which led to the request for euthanasia. All were evaluated by the doctors of the cases as unfit to be treated”, with which, it seems, the only “exit” that Belgian psychiatric science has for these patients is death.

Euthanasia for minors

Other figures refer to the percentage of those euthanized who had an early declaration of their wish to die, when the moment came when they could not themselves express it. There were very few: only 18 (1%) in 2018 and 18 (0.6%) in 2021. If we know that the vast majority (more than 62%) of those who see their approval request receives a diagnosis of imminent death, it seems that they want to spare themselves a relatively brief suffering that could be avoided with palliative care.

A last detail of interest is how the euthanasia of minors behaved of 000 years, legal since 2014, with no minimum age, and whenever the child or adolescent is “able to discern” what they face.

The possibility of a minor deciding to have his life taken contrasts with the difficulty – evident at the time the law was passed – of providing quality palliative care to younger people. A survey by the doctor in pediatric nursing Marie Friedel attested between 1999 and 2014 the situation of these care in the Brussels region, where more than 18.693 minors had a diagnosis of a complex chronic condition (CCC).

“By comparing the records,” he says, “we found that from 22.533 children and adolescents admitted to hospitals, only 359 (1.7%) had been referred to receive palliative care. Conclusion: in Belgium there are very few indications for minors with CCC to use palliative care equipment to ensure continuous treatment.”

It shows that the urgency is there, not in to make it easier for minors to take their lives, is that in 2014 euthanasia was only applied in one, and in the rest of the years mentioned, in none. It is worth asking, then, what “need” justified removing any age standard.

More Flemish, more women, older

Statistics show that, in the period 2018-2021, more euthanasias were performed in Belgium in women than in men . In all, 5.150 against 4.961. The most frequent age groups are from 044 to 80 years old, with 1999 cases (24, 6%), and from 80 to 89 years old, with 791 (25,3%).

Still, at the regional level, the number of cases in Flanders (from Dutch dialects) surpassed that in Wallonia (French-speaking) by 2.006 The 693. A possible explanation for this is offered by Dr. Wim Distelmans, one of the main supporters of the law of 2002, for whom French-speaking doctors do much more palliative sedation, with what death comes as unwanted effect of treatment. “As the patient did not specifically give permission, it is not euthanasia”, he points out.

©2022 Aceprensa. Published with permission. Original in Spanish.
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