Euthanasia policy and practice in Belgium: critical observations and suggestions for improvement.

This article investigates and discusses the practice of euthanasia in Belgium. Its methodology is based on critical review of the literature supplemented by interviews I conducted in Belgium with leading scholars and practitioners in February 2003 and February 2005. The interviews were conducted in English, usually in the interviewees' offices. The interviews were semi-structured. I began with a list of twenty-four questions (see Appendix), but did not insist on answers to all of them if I saw that the interviewee preferred to speak about subjects that were not included in the original questionnaire. The length of interviews varied from one to two and a half hours.

After completing the first draft I sent the manuscript to my interviewees as well as to some leading experts for critical review and comments. The comments received were integrated into this final version of the essay. In 2008, while writing the final draft, I approached my interviewees and some other well-known experts and invited their comments and updates. Responses received by mid-January 2009 were integrated into the article.

This article provides background information about the context of euthanasia in Belgium. I then discuss the Belgian euthanasia law and concerns about the law, its practice and interpretations. Finally, I discuss the major developments and controversies since the law went into effect. Suggestions as to how to improve the Belgian law and practice of euthanasia are made, urging the Belgian legislators and medical establishment to reflect and study so as to prevent potential abuse. The Appendix contains my questionnaire.

Background

Organized action in favor of the legislation of euthanasia started in Belgium in the 1980s with the foundation of the Association beige pour le droit de mourir dans la dignite (Belgian Association for the Right to Die with Dignity) (1981) and its Flemish counterpart Vereniging voor bet recht op waardig sterven (Association for the Right to Die with Dignity) (1983). Some ten years later, the debate had reached parliament. During the parliamentary session 1995-1996 euthanasia bills were submitted to the senate by four members of parliament. Indeed, since 1995, legalization of euthanasia has been intensely debated by the media, scholars, the official Advisory Committee on Bioethics as well as by the Belgian Parliament. At that time, the Belgian Comite consultatif de Bioethique (Consultative Committee on Bioethics) was founded to advise the federal and "community" governments and parliaments on bioethical issues. This Committee was composed of thirty-five members and thirty-five substitute members; among them medical doctors, nurses, magistrates, lawyers, social scientists, moral philosophers and theologians. The very first assignment, proposed by the presidents of the Chamber and the Senate, was to give advice concerning proposed euthanasia bills. (2)

Although the members disagreed on the fundamental questions, there was complete unanimity on the following topics: (a) The Dutch definition was adopted: "euthanasia is the intentional taking of someone's life by another, on his request"; (b) It follows that this definition does not apply in the case of incompetent people; there the proposed terminology is "termination of life of incompetent people"; (c) More importantly, the act of stopping a pointless (futile) treatment is not euthanasia and it was recommended that the expression "passive euthanasia" not be used in these cases; and (d) What was sometimes called "indirect euthanasia," increasing the dosage of analgesics with a possible effect of shortening life, is also clearly distinguished from euthanasia proper. (3)

The Dutch experience was considered to be a good example to follow in Belgium. On November 28, 2000, the Dutch Lower House of parliament, by a vote of 104 to 40, approved the legalization of euthanasia. On April 10, 2001 the Dutch Upper House of parliament voted to legalize euthanasia, making the Netherlands the first and at that time only country in the world to legalize euthanasia. Forty-six members of the seventy-five seat Senate voted for the Termination of Life on Request and Assistance with Suicide Act; twenty-eight voted against; one member was not present. A year later, in April 2002, the law went into effect. (4)