Issue Date: September 23, 2005
Death over the counter
With 'euthanasia packs,' Belgium takes a step down the slippery slope
By MARC MAZGON-FERNANDES
Earlier this year, the Belgian pharmaceutical firm Multipharma announced that it was placing on the market a euthanasia pack in its 250-odd pharmacies in Belgium.
The euthanasia packs are available only to physicians and cost about $74, which is not reimbursable by Belgian social security. They contain Pentothal, an anesthetic also known as truth serum, which, according to a representative of Multipharma, provokes death in 90 percent of cases. Norcuron is included to finalize the euthanizing act for the remaining 10 percent. (Norcuron is derived from curare, a poison that paralyzes respiration, which is used by indigenous people in the Amazon.) A leaflet of instructions and material for installing a drip are also included.
Reaction to the packs in Belgium, which legalized active euthanasia in 2002, was muted.
In a statement, the Belgian Order of Physicians, a disciplinary body, said it was up to the doctor to choose himself the euthanizing substances and the way of using them. The disciplinary body also said it did not consider euthanasia a medical emergency.
The physicians order had said in 2003 that it had to conform to the law, and that it could not condemn physicians who performed euthanasia. The World Medical Association severely criticized this position of the Order of Physicians.
The Belgian Order of Pharmacists denounced the euthanasia packs as disguised publicity to promote a limited group of pharmacies. The order also worried that the packs violated the discretion and confidentiality of prescriptions that its members pledge to honor.
Subsequently, a bill was introduced in Parliament to exempt pharmacists from prosecution if they sell euthanizing drugs (though most of these drugs are also sold as anesthetics). The bill also sought to ensure the availability of euthanizing substances.
Whether pharmacists can invoke a clause of conscience to refuse filling prescriptions remains an open question.
Professor Etienne Montero lectures in civil law at the Catholic University of Namur and edited a 2004 collection of essays on euthanasia, Suffering in Dignity in the Twilight of Life. He told NCR that the euthanasia packs take away any respect for the intrinsic value of life.
He pointed to the packs as evidence of the trivialization of euthanasia and a sign that Belgium is going down a slippery slope. Legalizing voluntary euthanasia under restrictive conditions was only the first step in an ineluctable evolution toward the euthanasia of people unable to consent, Montero said.
For Jesuit Fr. Thierry Lievens, who teaches moral theology at the Institut dEtudes Théologiques of Brussels, what is frightening is that a technical logic governs these decisions.
The death of another becomes a technical act that is equivalent to building a house, he said. From there, it is logical that a technical act will fall into the commercial domain.
He then quoted St. Ignatius of Loyola: Human nature is such that we give little importance to venial sins, then we give little importance to mortal sins, and this leads to all the perversions.
In 2002, after the adoption of the act permitting euthanasia, the Belgian bishops conference issued a statement decrying that Belgium had become one of the rare countries where it is legally allowed to deliberately kill a human being and that the state believes that some human lives have less value than others.
The church, however, was less strident before the law was passed.
In 2000, the Catholic University of Louvain-la Neuve published an official statement on euthanasia. It said, The first and the last word on the question of euthanasia are not on the side of the prohibition. This prompted calls to strip the university of its Catholic designation, calls that were not answered by the Belgian bishops.
Cardinal Godfried Danneels, who holds the position of the universitys great chancellor, likely protected the university.
In a 1998 interview, the universitys pro-rector of cultural affairs, Fr. Gabriel Ringlete, said the university and the cardinal enjoyed an excellent exchange on ethical and bioethical questions. The university is lucky in having a cardinal who sees problems in this way. ... If there is a bit of storm in the air, our great chancellor protects his university, Ringlet said. And the bishops conference does not stir either.
In 2003, during the Belgian bishops ad limina visits, Pope John Paul II strongly criticized Belgium, saying that its laws questioned the concept of man and of human nature. In his ad limina statement, Danneels justified his silence during the political debate on euthanasia. The church does not have political power, he wrote. It can only be a moral opposition and devote itself to the positive announcement of its message concerning man and a true humanization.
At a conference in Rome in January this year, Bishop André-Mutien Léonard of Namur, Belgium, said he regretted that the Belgian church had not played a more vigorous role in the euthanasia debate. On a panel with Archbishop Paul Cordes, chairman of the Pontifical Council Cor Unum, Léonard said he hoped that debate will be more lively in countries which shall consider legislation [on euthanasia] than it was in Belgium.
In Belgium, news about the euthanasia packs in mid-April came as doctors renewed calls for extending euthanasia to children, which is illegal under the present law.
At about the same time, the British medical journal The Lancet published the article Medical end-of-life decisions in neonates and infants in Flanders. The study looked at the medical records of 253 newborns and infants under 1 year old who had died in a 12-month period.
The researchers found: In 143 [cases] at least one end-of-life decision preceded death, and In 17 cases, lethal doses or lethal drugs were administered.
According to the study, nearly 70 percent of the physicians questioned had either used lethal drugs for this purpose [terminating the life of neonates] or could conceive of situations in which they would use them.
The Lancets study concluded, Physicians involved in the care of dying neonates and infants have developed their own professional and ethical standards.
A bill was introduced in the Belgian Senate last year that would extend euthanasia to patients legally incapable of expressing their will, such as children and patients suffering from dementia or strokes (the latter on the condition that they made a living will).
The bill was stopped; however, some believe that the secular majority in Parliament, a Liberal-Socialist coalition, may try to rush this reform through before general elections, which are due in 2007 but may take place earlier because of tensions within the ruling coalition.
Montero thus finds a need to scrutinize the state.
Doctors who euthanize patients must file a report with the Federal Control Commission, which monitors compliance with legislation. Montero said that the commissions own report on compliance with the euthanasia law found that it was not seriously screening the euthanasia declarations it receives.
He cites the report: Fourteen declarations of euthanasia lacked a written demand from the patient, which is a legal requirement. He said, Despite this, the commission did not transfer the files to the kings prosecutor. On the contrary, the commission suggested that the request of a written demand of the patient be abandoned.
Critics note that the chair of the control commission is Wim Distelmans, a professor at the ultra-secular Vrije Universiteit Brussels and an advocate for extending euthanasia to minors and Alzheimers patients.
Said Lievens: Is the slippery slope leading us toward a totalitarian society? I believe that it still depends on us. We do not believe in mechanical consequences in social sciences. Then he added, And since I met Christ, I cannot despair anymore of human nature.
Marc Mazgon-Fernandes is a freelance writer based in Brussels.
National Catholic Reporter, September 23, 2005
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