The
Belgian law on euthanasia came into force on 23 September 2002. To avoid
misunderstandings or misinterpretations (I have read everything and its
contrary about this law since the last months), it seems important to
stress its main elements:
The
request of the patient is at the centre of the debate. Without this
request, there is no question of euthanasia, defined as: the act, performed
by a third person, in order to end the life of a person at the request
of this person. Actually, it uses the same definition as the Dutch
law. This is not surprising since we made use of the Dutch experience
as much as possible. Nevertheless, the Belgian legislation is not
at all a copy of the Dutch one and takes account of our own specificities.
Belgium's
Criminal Code remains unchanged but this specific law introduces the
decriminalization of euthanasia if the physician follows the pre-conditions
foreseen by the law.
To
avoid prosecution, the physician and he/she only has to
respond only to the voluntary written, well thought-out and reiterated
request by an adult patient who is in a serious and incurable medical
condition, in a hopeless medical condition and experiences unbearable
physical or mental suffering.
The
physician must also inform the patient of the state of his/her health
and of his/her life expectancy, of the possible therapeutic measures and
the available palliative care.
The
physician must also hold a consultation with a second physician.
If
the death is not expected within a short period of time in other
words, for not terminally ill patients, the physician must request a consultation
with a third physician, either a psychiatrist or a specialist of the patient
's pathology. In that case a delay of at least one month between
the request and the euthanasia has to be observed.
Watchdogs
Like
the Netherlands, Belgium has a system of control. The physician
has to declare the act of euthanasia to a Federal Commission composed
of 8 physicians, 4 jurists, and 4 persons from environments entrusted
with the problems of patients suffering from an incurable disease.
This Commission has a second mission: to establish every other year
a statistical and evaluation report and to suggest recommendations.
The
living will called "anticipated declaration" is officially recognized
but strictly limited to the state of irreversible unconsciousness of the
person.
Freedom
and self-autonomy are the cornerstones of this law. No physician
is bound to perform euthanasia.
But
a physician who, calling upon his right of freedom of conscience, refuses
to perform euthanasia, must transfer the patient's medical record to a
colleague of the patient's choosing.
The
law refers explicitly to the concept of euthanasia without allusion to
"assisted suicide". In Belgium, for cultural reasons,
it is very difficult to speak about suicide because it invests incurable
illness with a different meaning.
Thus
the law does not specify the method to be used by the physician,
even though he must describe it in the official form to be forwarded to
the Control Commission. The future declarations may show us that
if it is the wish of the patient, and if the physical condition of the
patient allows this solution, a lethal oral ingestion may be chosen instead
of an injection.
Another
question raised frequently: can citizens of foreign countries come
to Belgium for euthanasia? The pre-conditions and procedure of the
law clearly establishes the principle of a strong doctor-patient relationship.
Outside of this long-standing personal contact, it is not possible to
consider a legal euthanasia.
We
made a tremendous important step for the right to choose but we have to
remain vigilant. Around the enforcement of the law, opponents have already
let hear their voices, especially about the voluntary death of Mario Verstraete
on 30 September of this year.
Mario,
member of the board of the Dutch-speaking Association for the Right to
Die in Dignity, was the only patient who was heard first-hand during the
hearing in the Senate. He was suffering from Multiple Sclerosis.
In full serenity, he spoke of his life and of his wish that his request
to die in dignity be respected when he so decides.
And
he made his decision after the vote of the law in May but had to wait
until the enforcement. But because he made public statements, there
were some criticisms, some of them very objectionable, to the effect that
people like Mario who live until the last second in full respect of their
convictions, should hide themselves and die in the shadows.
Good-bye,
Mario! You were a fighter for this law of freedom and maybe the
first to call upon it. I shall remember you as a real lover of life.
Jacqueline
Herremans
President,
ADMD-Belgium.
Member of the Federal
Commission of
Control on Euthanasia.
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