By Michael Cook
The outcome was expected, but observers overseas were astonished at the margin of victory. By a vote of 50 to 17 yesterday, the Belgian Senate approved euthanasia for children. When the bill finally passes – which now seems quite certain – there will be no age limit for choosing to die at the hands of Belgian doctor. The next step is a vote in the lower house, which will probably take place in May.
The conditions for euthanasia are vague. Children who are under 18 but who are of sound mind can request death if their situation is “medically hopeless” and if they are experiencing “unbearable physical suffering that within the foreseeable future will result in death.”
Supporters of the bill have argued that there will only be about 10 or 15 cases each year. They contend that terminally-ill children are already being euthanased and it is better for the practice to be regulated.
How will the doctor know if the child is of sound mind? He or she must be examined by a psychiatrist or psychologist. The parents or the legal guardian must also consent.
In November 16 paediatricians urged lawmakers to approve the legislation in an open letter in the press. “Why deprive minors of this last possibility? Experience shows us that in cases of serious illness and imminent death, minors develop very quickly a great maturity, to the point where they are often better able to reflect and express themselves on life than healthy people.”
Christian, Muslim and Jewish leaders rejected this reasoning. “We express our deep concern at the risk that such a grave subject will be increasingly trivialised,” they said in a joint statement. “The euthanasia of fragile people, be they children or incapable, is totally inconsistent with their condition as human beings. We cannot accept a logic which will lead to the destruction of society’s foundations.”
A British barrister and medical ethicist, Charles Foster, has listed four misconceptions involved in extending euthanasia for children. He was especially critical about the issue of informed consent.
“Death, so far as we know, is terribly final. And if you’re opting for death, you need to be sure that you’ve got it right. This demands an understanding of many complex facts (such as prognosis – how your disease or condition is going to pan out – and your therapeutic and palliative options), and an evaluation of their significance. It’s hard for anyone; it’s likely to be impossible for children.
“There’s lots of evidence to show that when we find ourselves in the situations we have most feared (for instance severe disability), we find that those situations are nothing like as unbearable as we anticipated. When we are stripped of much, we value all the more what is left. Try explaining that to a child.”
Unfortunately, there seems to be nothing to restrain euthanasia bracket creep in Belgium. Just over the past year, some appalling revelations have failed to curb support for euthanasia in Parliament and among voters.
Last December, two deaf and dumb brothers chose euthanasia at the age of 45 because they were going blind. In February, a 44-year-old woman with anexoria nervosa chose euthanasia after she had been sexually abused by her psychiatrist (who is still working in private practice). In September, a 44-year-old woman who was unhappy with her life and physical appearance as a transsexual man chose euthanasia.
Patients have volunteered to be euthanased so that their kidneys and other organs can be used. At least one prisoner has been voluntarily euthanased; others have requested it.
The Belgium-based European Institute of Bioethics [IEB] published a report late last year how euthanasia has expanded since legalisation in 2002. It was scathing.
Its central theme was the ineffectiveness and bias of the government body which monitors and controls euthanasia. After 10 years and about 5,500 cases, not one case has ever been referred to the police. It is illusory, says the IEB, to expect doctors to denounce their own failings.
Furthermore, nearly half of the statutory 16-member Commission for Control and Assessment are members or associates of the leading Belgian right-to-die society. This is sufficient to explain, according to the IEB, “the absence of any effective control and the ever‐widening interpretation which the Commission intends to give the law”. A law which permits euthanasia is bad enough, the IEB suggests, but the government is not even enforcing its application.
“As is the case in all penal laws, this law has to be strictly interpreted lest it be stripped of any substance. It is not for the Commission, appointed to control and assess the law, to provide an ever‐widening interpretation of its terms, with this going so far as to negate the initial spirit of the text and of doing away with the control of decisive legal criteria.”
As a result, there are on-going abuses in several areas. Here are a few of those which the EIB singles out for criticism:
· A written declaration of a desire for euthanasia is required, either by the patient or a surrogate. However, the Commission often waives this obligation.
· Initially patients had to have a life‐threatening and incurable illness. Nowadays, the illness need only be serious and debilitating.
· The pain is supposed to be unbearable, unremitting and unrelievable. However, a patient can refuse medication to relieve the pain. The Commission, says the IEB, has “decided not to carry out its mission ‐ so central to the law ‐ of verifying the unbearable and unrelievable nature of the suffering”.
· The ambit of “psychological suffering” is ever-expanding.
Doctor-assisted suicide is not authorised by 2002 legislation. However, the Commission has ignored this and regularly signs off on such cases.
· If a patient is to be euthanased at home, the doctor himself is supposed to fetch the lethal medications at a pharmacy from a registered pharmacist and to return left-over drugs. In practice, family members often get the drugs; unqualified personnel hand them over; and no checks have ever been made about surplus drugs.
In a climate like this, will Belgian children be able to resist pressure from their parents to agree to the idea of euthanasia if they are suffering from a serious illness? It’s not likely. And when the system breaks down, it’s not likely that we will ever learn about it.
Editor’s note. This appeared at www.mercatornet.com/careful/view/13267