Thursday May 11, 2017: Symposium 15 years Euthanasia legislation
President of the day: Yves Desmet
- 9:45 - 12:30
15 years later
- Facts and figures
- Research results Prof. Luc Deliens, Professor Public Health en Palliatieve Zorg, OnderzoeksgroepZorg rond het levenseinde, VUB
- Findings of the Evaluation Committee Wim Distelmans
- Pioneering role? Joanne Klineberg comments on the recent legislation in Canada
- Monitoring: control, reporting, guidelines,...
Oversight on the euthanasia Act The Federal Committee on Euthanasia Oversight and Evaluation examines whether euthanasia has been carried out according to the conditions and procedure set out in the Act. When a physician performs euthanasia, they need to submit a report to the Committee that considers the procedure that was followed. On this basis the Committee draws up a biennial report in which it gives figures and makes recommendations. What can does an an analysis of this information tell us? Can the reported medical practices lead us to new conclusions or recommendations? There has also been criticism of the composition of the Committee, with questions about its independence. Is this concern justified?
- Practical follow-up: information and training, ethics
Code of Conduction of physicians and care institutions On the one hand, the Euthanasia Act determines that a patient, under certain conditions, has the right to request euthanasia. However, this right is not enforceable. The Patients' Rights Act states that a patient also has the right to be involved in the determination of their care plan and to receive all information about this plan. On the other hand, every physician has the right to refuse to handle a euthanasia request, if this conflicts with their personal moral convictions. So the question is: how do the rights of patients relate to the physicians’ moral freedoms? How can a patient’s rights be assured? And can a care institution pursue its own policy, if it so desires?
Training and information In its report, the Evaluation Committee emphasised that for euthanasia to be performed legally, the citizen, physician and caregivers need to be properly informed. Should the government support more initiatives? Should it provide (more) financial support? Do universities and University Colleges have an enforceable responsibility? Must they be encouraged to pay sufficient attention to questions around patients' end of lives in their lectures? What courses are given on this topic at the moment? Is sufficient information available? Can procedures support caregivers and physicians?
- Wim Distelmans
- Steven Pleiter
- Joanne Klineberg
- Ann Ravelingien
- Evelien Delbeke
- Luc Deliens
- 12:30 - 13:30
- 13:30 - 16:00
TO A NEXT STEP?
- Assisted suicide
- Assisted suicide is not explicitly dealt with in the Act, unlike in the Netherlands and Luxembourg. Nevertheless, regarding this issue, the Euthanasia Act is referred to as a legal foundation and justification by both the Council of State, in its recommendations about the Act, and the National Association of Physicians, who state that ‘from a code of conduct perspective, assisted suicide can be compared to euthanasia, as long as all conditions for euthanasia as set out in the Act are fulfilled’. The Evaluation Committee agrees with this position. So, is there a need to explicitly amend the Act to provide patients and doctors with more certainty about their rights? Could this be a solution for the conflict between the moral freedom of the doctor and the rights of the patient as formulated in the first statement?
- Psychological suffering
- The legislator does not differentiate between types of unbearable suffering, regardless of whether said suffering is psychological or physical. But given the specific nature of unbearable suffering, it is covered by a stricter procedure. Are there sufficient due diligence requirements? Last year, this issue was raised in the media by 65 academics, and it garnered significant press attention. For these academics, the hopelessness of the suffering was not demonstrable. But is suffering objectifiable? It is the patient who is confronted with it. The cases are extremely complex, as the patients have undergone years of therapy, and are often prone to impulsive suicidal behaviour. As the same time, there is also the issue of people who are legally incapable. Because of the complexity of the issue, the Netherlands has drawn up a protocol about this issue for psychiatrists. What are the experiences with this protocol? In the period 2014-2015, psychological suffering was reported as the cause in 3.1% of cases.
- People who become legally incapable
- An advance directive requesting euthanasia, written at a time when a person is legally capable does not allow for euthanasia in the event of severe dementia. However, there is also a negative advance directive that gives patients the right, at a time when they are legally capable, to declare what they want to happen should they become legally incapable. A person cannot ask for life-ending treatment if they have not been able to recognise any of their own family for a long time. Figures show that a number of people with dementia end their life early for exactly this reason, i.e. at the time when they are still legally capable. Should an extension of the Act, especially for cases where patients are no longer aware, and when patients are not aware of their own individuality, be the subject of debate? Once again, the issue is complex and without doubt requires broad societal support.
- Weariness of life versus completed lives
- In the Netherlands, a debate is currently raging about a proposed Act from D66 that makes assisted dying possible for older people (+80) who view their lives as having been completed. Research from EenVandaag shows that 62% of the Dutch population agree with assisted suicide in the event of weariness of life. Does the growing importance of self-determination in our culture put pressure on the Euthanasia Act? Or do we have to ask ourselves what is going on in our society where people are growing increasingly lonely? In the Netherlands, an end-of-life clinic has been set up for patients whose euthanasia request has been denied. This is a current issue in Belgium too. With the reality of an ageing population, should this debate be on the agenda?
- Polypathology is the second-most frequent reason for a euthanasia request, occurring in 9.7% of euthanasia cases. For these patients, the severity of the condition is not down to one single illness but a combination of different serious and incurable illnesses for which an improvement is no longer possible. The majority of these patients are older than 70. This has led to criticism that there is a grey area between such requests and requests on the grounds of weariness of life related to old age, meaning the causal link between the diseases and the suffering can be called into question. Is this a justified concern? When is a euthanasia request considered on the grounds of polypathology? How many cases of polypathology are in essence about terminal patients who have a number of diseases?
- Luc Proot
- Ann Callebert
- Steven Pleiter
- Evelien Delbeke
- Ann Ravelingien
- Koen Titeca
Conclusion and drinks