Separating fact from fiction about euthanasia in Belgium

As a Belgian social scientist working on the topic of end-of-life care and decision making for the last ten years, a lot of my research has concerned the practice of euthanasia, which my country legalised in 2002 for incurable patients with severe suffering.

Though there are issues around euthanasia in Belgium, the view from the outside is often heavily biased toward problematising our euthanasia law and practice. Let’s consider some of the most prominent concerns and whether they’re justified.

‘They now put down children in Belgium’

Journalist Caroline Overington said on the ABC’s Q&A program on Monday that

Belgium introduced a law which allows for assisted suicide, and now that law has been extended to children, so they now put down children in Belgium.

Yes, in 2014 the Belgian euthanasia law was expanded to include competent minors.

At first, that may sound outrageous. But it helps to know the underlying rationale for lifting the age barrier.

Referring to someone’s age as a measure of competence – a central condition for an eligible euthanasia request – is inaccurate and unfair to minors who do have competence and would otherwise fulfil the legal requirements. Belgium policymakers have decided it is better to assess the minor’s competence directly instead of assuming their incompetence based on their age.

For minors, the eligibility requirements are restricted to terminal illness. There are also extra requirements such as competence assessment by a child psychiatrist, and the parents’ consent is needed.

So far there have been no reported cases of euthanasia for a minor.

Who decides?

Overington also raised concerns that in Belgium, people were euthanised who did not themselves decide that they wanted to die, a doctor decided on their behalf.

Yes, administering drugs intended to hasten death without the patient’s explicit request occurs in Belgium, in under 2% of all deaths.

However, there is no causal link between legalising euthanasia and doctors ending a patient’s life without request.

These practices occur as well in countries without legalised euthanasia, wherever research has been done on end-of-life practices, including in Australia and New Zealand.

Since legalisation of euthanasia, the occurrence of these practices in Belgium and the Netherlands has dropped significantly.

They are thus not the product of legalisation of assisted dying. The Belgian and Dutch experience rather suggests that legalisation of assisted dying decreases the occurrence of these practices.

Also, upon closer analysis, many of these cases do not fit the label of “non-voluntary life-ending”.

This is because the drugs and doses used (such as low-dose morphine) made hastening death highly unlikely. Or because the act was in accordance with the patient’s wishes, in the form of a previously expressed wish to die albeit, rather than an explicit request required by the euthanasia law.

Out of control expansion?

Another oft-voiced criticism is that euthanasia in Belgium is out of control, with the criteria for euthanasia expanding beyond the legal limits.

Yes, access to euthanasia in Belgium has been “expanding” from almost exclusively terminally ill cancer patients in the first years under legislation to a more diverse mix of patients in recent years. This includes a low but increasing number of cases of non-terminally people who are primarily suffering psychological illnesses, such as long-standing severe depression or personality disorder.

In 2013, 67 cases of euthanasia for neuro-psychological illness were reported in Belgium.

However, this does not mean that the legal limits have now suddenly been transgressed. Rather, unlike during the first years, the full scope of the euthanasia law is now used more often.

Yes, this has produced a few highly controversial cases seeping through in the international media. This small handful of cases needs to be seen in perspective, though. They don’t reflect the vast majority of cases and the wider practice of euthanasia in Belgium. Also, a complete and truthful account of these cases is rarely conveyed in media reports.

Having concerns is quite natural, and these concerns continue to exist in Belgium.

The topic understandably generates strong reactions but balanced, accurate and complete information in the debate on euthanasia is essential.