A recently published article in an academic journal has found a "widening" scope and failing safeguards in the provision of euthanasia in Belgium.

The article, "Euthanasia in Belgium: Shortcomings of the Law and Its Application and of the Monitoring of Practice", which was published in The Journal of Medicine and Philosophy this month, has found that the law has been ammended to cover far more cases than the original 2002 Euthanasia Law permitted, and made observations of a "trend" which "exists toward a broader use of euthanasia for an ever wider variety of indications".

The article also found that "several legal requirements of the euthanasia law that are intended to operate as safeguards and procedural guarantees in reality often fail to operate as such".

The authors, Kasper Raus, Sigrid Sterckx and Bert Vanderhaegen are all associated with Ghent University, and neither Raus nor Sterckx are opposed to euthanasia as a matter of principle. To that point, they emphasise that areas they find to be "ethically and legally problematic [...] should be of concern to everyone, regardless of their stance on the ethical justifiability of euthanasia in general".

They continue: "the scope of the Euthanasia Law has been stretched from being used for serious and incurable illnesses to being used to cover tiredness of life".

Euthanasia in Belgium for 'tiredness of life' is not permitted. However, doctors are able to circumvent the law by diagnosing "polypathology" defined by the relevant regulatory body as "the co-occurrence of multiple chronic or acute diseases and medical conditions within one person".

The article found that the conditions that give rise to "polypathology" are understood so broadly that they "affect most elderly patients to at least some degree". As such, "a significant number of elderly patients would in fact qualify for euthanasia based on 'polypathology'."

The authors say: "In 2019, polypathology represented 17.4 percent of all reported euthanasia cases and a staggering 47 percent of all reported nonterminal euthanasia cases".

The authors of the paper say that "the obligatory consultation of one or two independent physicians may fail to provide a real safeguard. Their tasks are quite limited, and, more importantly, their advice is not binding anyway. The final authority to perform euthanasia lies with the attending physician who can perform it even against the (negative) advice of the consulted physicians".

The paper points out that if euthanasia is requested for a psychiatric condition, the requirement that a psychiatrist be consulted can be circumvented by finding another condition from which the patient is suffering. The patient can then be said to be suffering from "polypathology" and the patient's GP can approve euthanasia "without any involvement of a psychiatrist". Given the age and/or poor health of many patients who might request euthanasia, finding some additional condition is not usually difficult.

Finally the paper argues that the Federal Control and Evaluation Commission for Euthanasia (FCECE) "is unable to check the fulfilment of various legal criteria, and it has substantial authority to (re) interpret the Euthanasia Law as it sees fit".

In Belgium, the Euthanasia Law requires that all euthanasia cases be reported to the FCECE.

"This Commission, which is neither a court nor an administrative body, is supposed to check for each reported case whether the legal criteria were met," but the paper points to profound conflicts of interest in the Commission itself as a number of the doctors on the Commission perform euthanasia themselves and they often end up examining each others cases. If the Commission finds malpractice, it is supposed to pass this information on to the Public Prosecutor.

However, as the authors say: "In the 18 years since the law entered into force, only one case has been referred."

"Important to note is that this euthanasia case was televised as an episode of the Australian show Dateline; hence, the specifics of this case came to public attention. Since the TV show made clear that at least one of the legal criteria for euthanasia had not been met, it would seem that the FCECE was left with no alternative but to refer the case to the Public Prosecutor," the paper said. 

Expanding euthanasia law in Belgium

Belgium legalised euthanasia in 2002 and since then, in accordance with the finding of the journal article, the practice has even been extended to children. The current law allows euthanasia if the patient is in a state of constant physical or psychological pain.

There is now a renewed push for euthanasia to be available for those who are healthy but have decided they have a 'fulfilled life'.

The President of Belgium's Liberal Party, Gwendolyn Rutten, told the Brussels Times: "We must be able to choose the right to die not only when we are suffering in an intolerable way but also when our lives are fulfilled and we request to do it explicitly, freely, independently and firmly".

In 2019 there were a total of 2,656 reported assisted suicides in Belgium, up from 2,357 in the previous year. Since 2010, there has been a 178% increase in just 9 years.

Right To Life UK spokesperson, Catherine Robinson, said: "The findings of this paper should make for explosive reading as it essentially amounts to an exposé of a deeply corrupt institutional practice. It has found unaccountable doctors apparently policing themselves and their colleagues with little or no outside scrutiny, as well as laws being expanded as and when wanted. Sadly, euthanasia appears to be so deeply entrenched in Belgian medical culture now that, as the authors themselves lament, it not clear whether anyone will take notice of their shocking findings".

Courtesy of Right to Life UK