By Alex Schadenberg, Executive Director/International Chair – Euthanasia Prevention Coalition
A recent article written by Raphael Cohen-Almagor examines several problems and abuses of the Belgium euthanasia law. “First do no harm: pressing concerns regarding euthanasia in Belgium” was published in the “International Journal of Law and Psychiatry” [www.ncbi.nlm.nih.gov/pubmed/23859807].
This is an important article since the Quebec government introduced Bill 52, a bill that will legalize euthanasia in a similar manner to the Belgium euthanasia law.
This article simply reports the findings in the article. Cohen-Almagor uncovers several serious problems with the Belgium euthanasia law.
Cohen-Almagor first outlines the euthanasia law in Belgium and then examines the role of physicians and nurses.
The article points out that physicians have indicated that they lack the training to communicate with the dying in relation to euthanasia. The article states:
“They are also required to consult with other specialists, to spend time and better the communication among all concerned. Physicians found this difficult because they did not receive adequate training.”
The article explains that training in palliative care medicine and palliative psychiatry provides those communication skills. The article states:
“Indeed, the importance of palliative care as communicating with patients is a core skill of palliative medicine and palliative psychiatry.”
“First do no harm: pressing concerns regarding euthanasia in Belgium” then looks at the role of nurses in Belgium. The article points out that the law specifically states that it is “The physician who performs euthanasia…”
Cohen-Almagor then examines several recent studies and points out that nurses are euthanizing their patients. The article states:
“[A] recent study shows that 12% of nurses in Flanders administered the drugs, mostly without the physician co-administering (86%)… Another study concerning patients who were euthanized despite not having made an explicit request to die shows that in almost half of these cases (6 of 13) the final drug was given by a nurse.”
Cohen-Almagor then explains:
“Nurses should not perform acts of ending lives even if physicians explicitly order them to do so. Especially worrying is the high number of incidents where nurses administered lethal drugs to patients who did not explicitly wish to die; this was done mostly without the physician co-administering (82%). One may assume that this was no coincidence and that physicians wished to shift responsibility from themselves, by imposing it on nurses who could not refuse the order.”
The article goes on to examine the fact that physicians in Belgium often fail to recognize a euthanasia decision as an act of euthanasia. For instance a 2009 study found that only 21% of the physicians correctly labeled intentionally “ending a patient’s life at that patient’s explicit request, using morphine” as euthanasia.
The article then looks at the requirement in the law that physicians consult an independent specialist. A 2011 study found that 35% of the time a physician did not consult an independent specialist, even though the study also found that when an independent specialist was consulted, 23% of the time the second physician disagreed with the first physician. The reasons that the physician did not consult a second physician included:
– the doctor didn’t consider it a clear case of euthanasia,
– it was a case of euthanasia that was outside of the law,
– because consultation was perceived “too burdensome” and “not useful”,
– the doctor believed that it was up to the patient and physician alone to decide.
The article then points out that a 2010 study found that in 1/3 of the consultations, the consulting physician was not independent from the attending physician. The article states:
“These answers raise many concerns: physicians did not understand the letter of the law; physicians disagreed with the law and were willing to knowingly violate the law; physicians failed to understand the place and the importance of the law in society. They were taking the law into their own hands when the patient’s best interests (privacy, confidentiality, trust between physician and patient) or their own best interest (not filling the burdensome forms) seemed to be more important.”
Cohen-Almagor goes on to examine studies that address the under-reporting of euthanasia in Belgium. The article states:
“Notification of euthanasia to the Federal Control and Evaluation Commission is obligatory, yet 82% of all reported cases came from Dutch-speaking physicians while only 18% came from French-speaking physicians. All-together, half of all euthanasia cases were not reported.”
The article quotes the European Institute of Bioethics who reported one physician stating:
“You are right to say that many euthanasia cases are not [officially] declared. I myself have practiced euthanasia very many times, and I never declared them. It is too personal and a matter between the patient and his doctor. No need to publicise it”
The article then states:
“Indeed, a cross sectional analysis of reported and unreported euthanasia cases showed that unreported cases were generally dealt with less carefully than reported cases: a written request for euthanasia was more often absent, other physicians and caregivers specializing in palliative care were consulted less often, the life ending act was more often performed with opioids or sedatives, and the drugs were more often administered by a nurse, not a physician as required.”
Cohen-Almagor does not suggest that the Belgian euthanasia law must be reversed; he does state that corrective mechanisms need to be inserted, where applicable. He also wrote:
“The Belgian population should be aware of the high level of paternalism among their physicians. One study shows that sixty percent of the surveyed physicians think that they should be able to decide to end the life of a patient who suffers unbearably and is incapable of making decisions.”
This research article confirms that the Belgian euthanasia law is being abused. The fact that Belgian physicians are highly paternalistic is another reason for prohibiting euthanasia.
When dealing with human life or death, what level of abuse, or causing death without request, is considered acceptable? How many lives being taken, outside of the law, are considered too many? No person should be given the right or the power, in law, to take the life of another human being.
Euthanasia has proven to be an unsafe societal experiment.
Society needs to commit itself to caring for every citizen and reject killing its citizen.