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Issue Date:  September 23, 2005

Death over the counter

With 'euthanasia packs,' Belgium takes a step down the slippery slope

Brussels, Belgium

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 d’Etudes 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 university’s “great chancellor,” likely protected the university.

In a 1998 interview, the university’s 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 Lancet’s 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 commission’s 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 king’s 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 Alzheimer’s 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.

Euthanasia in Belgium

Belgium legalized active euthanasia in May 2002 after a year of debates in Parliament that featured copious testimony from experts of various disciplines.

Euthanasia is allowed for an adult with “an incurable accidental or pathological illness” and “constant and insupportable physical or psychical sufferings” who has made “voluntary, reflected, repeated demands, without pressure taking place.” The euthanasia act foresees a minimum interval of one month between the first demand and the euthanasia. In theory, family members cannot ask for euthanasia for relatives.

The act does not define a “terminal phase,” because its sponsors wanted to give maximum latitude to the physician. In theory, a patient with two years of life expectancy might be euthanized, provided that the other conditions are fulfilled.

When death is not expected in a short time, a second physician (a psychiatrist or pathologist) also has to conclude that the illness is serious and incurable.

Euthanasia is available for people who are unconscious on the condition that they wrote a living will, asking to be euthanized. The doctor then has to verify the incurability of the illness and the irreversibility of the situation and then consult with a second physician.

The control commission issued a report on euthanasia 15 months after the law came into force. In that period, it had received reports on 259 patients being euthanized. However, a forum held by physicians on euthanasia in 2003 estimated that that about 1,000 patients are euthanized in Belgium every year, which suggests that not all cases are reported to the control commission -- a situation very similar to the Netherlands.

-- Marc Mazgon-Fernandes

Euthanasia in Europe

Belgium and the Netherlands are the only countries in Europe that have legalized euthanasia. Nevertheless, the drive toward legalized euthanasia is taking place in other countries with varying degrees of success.

In France, the government and the parliamentary majority refused to legalize active euthanasia but last year passed a law allowing doctors to interrupt care to a dying patient under certain conditions.

The Socialist government of Spain is considering legalizing euthanasia, especially since the pro-euthanasia film “Mar Adentro” by Alejandro Amenabar played to wide public success.

Switzerland allows assisted suicide; assisted suicide differs from euthanasia in that the physician only provides the person with the means of committing suicide. As a consequence, Switzerland has seen an upswing in “suicide tourism,” with citizens of other nations traveling to the Alpine country to end their lives.

Earlier this year, a bill was introduced in the British House of Lords that would authorize “assisted dying,” which covers both assisted suicide and euthanasia. The House of Lords recommended that the bill be debated in the next parliamentary session.

In 2002, a chamber of the European Court of Human Rights rejected a plea by a British woman who asked the court to recognize a right to assisted suicide, though it expressed sympathy with her predicament. In April, the Council of Europe, which represents 46 countries and which hosts the European Court of Human Rights, entertained a resolution in favor of euthanasia. While the council rejected the resolution 138 to 26 with five abstentions, the stage seems set for protracted battle over euthanasia in Europe.

-- Marc Mazgon-Fernandes

National Catholic Reporter, September 23, 2005

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