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Ethical Dispute Erupts Over Euthanasia Rules

Although euthanasia has been legal in Belgium since 2002 and has overwhelming public support, critics have raised certain concerns

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An Euthanasia machine, should be used by those who want to use it. Wikimedia Commons
An Euthanasia machine, should be used by those who want to use it. Wikimedia Commons
  • Euthanasia has always been a controversial topic
  • Belgium is one of the few countries where the practice is allowed
  • However, despite that many citizens can’t avail the right to take over their own life

A disputed case of euthanasia in Belgium, involving the death of a dementia patient who never formally asked to die, has again raised concerns about weak oversight in a country with some of the world’s most liberal euthanasia laws.

The case was described in a letter provided to The Associated Press, written by a doctor who resigned from Belgium’s euthanasia commission in protest over the group’s actions on this and other cases.

Euthanasia is legal in Belgium since 2002. Wikimedia Commons
Euthanasia is legal in Belgium since 2002. Wikimedia Commons

Some experts say the case as documented in the letter amounts to murder; the patient lacked the mental capacity to ask for euthanasia and the request for the bedridden patient to be euthanized came from family members. The co-chairs of the commission say the doctor mistakenly reported the death as euthanasia.

Although euthanasia has been legal in Belgium since 2002 and has overwhelming public support, critics have raised concerns in recent months about certain practices, including how quickly some doctors approve requests to die from psychiatric patients.

Dispute revealed

The AP revealed a rift last year between Dr. Willem Distelmans, co-chair of the euthanasia commission, and Dr. Lieve Thienpont, an advocate of euthanasia for the mentally ill. Distelmans suggested some of Thienpont’s patients might have been killed without meeting all the legal requirements. Prompted by the AP’s reporting, more than 360 doctors, academics and others have signed a petition calling for tighter controls on euthanasia for psychiatric patients.

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Euthanasia — when doctors kill patients at their request — can be granted in Belgium to people with both physical and mental health illnesses. The condition does not need to be fatal, but suffering must be “unbearable and untreatable.” It can be performed only if specific criteria are fulfilled, including a “voluntary, well-considered and repeated” request from the person.

The AP revealed a rift last year between Dr. Willem Distelmans, co-chair of the euthanasia commission, and Dr. Lieve Thienpont, an advocate of euthanasia for the mentally ill. Distelmans suggested some of Thienpont’s patients might have been killed without meeting all the legal requirements. Prompted by the AP’s reporting, more than 360 doctors, academics and others have signed a petition calling for tighter controls on euthanasia for psychiatric patients.

Dr. Lieve Thienpont is an advocate of euthanasia for the mentally ill. VOA
Dr. Lieve Thienpont is an advocate of euthanasia for the mentally ill. VOA

The AP revealed a rift last year between Dr. Willem Distelmans, co-chair of the euthanasia commission, and Dr. Lieve Thienpont, an advocate of euthanasia for the mentally ill. Distelmans suggested some of Thienpont’s patients might have been killed without meeting all the legal requirements. Prompted by the AP’s reporting, more than 360 doctors, academics and others have signed a petition calling for tighter controls on euthanasia for psychiatric patients.

Euthanasia — when doctors kill patients at their request — can be granted in Belgium to people with both physical and mental health illnesses. The condition does not need to be fatal, but suffering must be “unbearable and untreatable.” It can be performed only if specific criteria are fulfilled, including a “voluntary, well-considered and repeated” request from the person.

But Belgium’s euthanasia commission routinely violates the law, according to a September letter of resignation written by Dr. Ludo Vanopdenbosch, a neurologist, to senior party leaders in the Belgian Parliament who appoint members of the group.

The most striking example took place at a meeting in early September, Vanopdenbosch wrote, when the group discussed the case of a patient with severe dementia who also had Parkinson’s disease. To demonstrate the patient’s lack of competence, a video was played showing what Vanopdenbosch characterized as “a deeply demented patient.”

The patient, whose identity was not disclosed, was euthanized at the family’s request, according to Vanopdenbosch’s letter. There was no record of any prior request for euthanasia from the patient.

After hours of debate, the commission declined to refer the case to the public prosecutor to investigate whether criminal charges were warranted.

Euthanasia should be allowed to die when they want to. VOA
Euthanasia should be allowed to die when they want to. VOA

Vanopdenbosch confirmed the letter was genuine but would not comment further about details.

Palliative sedation

The two co-chairs of the euthanasia commission, Distelmans and Gilles Genicot, a lawyer, said the doctor treating the patient mistakenly called the procedure euthanasia, and that he should have called it palliative sedation instead. Palliative sedation is the process of drugging patients near the end of life to relieve symptoms, but it is not meant to end life.

“This was not a case of illegal euthanasia but rather a case of legitimate end-of-life decision improperly considered by the physician as euthanasia,” Genicot and Distelmans said in an email.

Vanopdenbosch, who is also a palliative care specialist, wrote that the doctor’s intention was “to kill the patient” and that “the means of alleviating the patient’s suffering was disproportionate.”

Though no one outside the commission has access to the case’s medical records — the group is not allowed by law to release that information — some critics were stunned by the details in Vanopdenbosch’s letter.

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“It’s not euthanasia because the patient didn’t ask, so it’s the voluntary taking of a life,” said Dr. An Haekens, psychiatric director at the Alexianen Psychiatric Hospital in Tienen, Belgium. “I don’t know another word other than murder to describe this.”

Kristof Van Assche, a professor of health law at the University of Antwerp, wrote in an email the commission itself wasn’t breaking the law because the group is not required to refer a case unless two-thirds of the group agree — even if the case “blatantly disregards” criteria for euthanasia.

But without a request from the patient, the case “would normally constitute manslaughter or murder,” he wrote. “The main question is why this case was not deemed sufficiently problematic” to prompt the commission to refer the case to prosecutors.

Other problems

Vanopdenbosch, who in the letter called himself a “big believer” in euthanasia, cited other problems with the commission. He said that when he expressed concerns about potentially problematic cases, he was immediately “silenced” by others. And he added that because many of the doctors on the commission are leading euthanasia practitioners, they can protect each other from scrutiny, and act with “impunity.”

Vanopdenbosch wrote that when cases of euthanasia are identified that don’t meet the legal criteria, they are not forwarded to the public prosecutor’s office as is required by law, but that the commission itself acts as the court.

Patients suffering from psychological disorders should be allowed euthanasia. Pixabay
Patients suffering from psychological disorders should be allowed euthanasia. Pixabay

In the 15 years since euthanasia was legalized in Belgium, more than 10,000 people have been euthanized, and just one of those cases has been referred to prosecutors.

Genicot and Distelmans said the group thoroughly assesses every euthanasia case to be sure all legal conditions have been met.

“It can obviously occur that some debate emerges among members, but our role is to make sure that the law is observed and certainly not to trespass it,” they said. They said it was “absolutely false” that Vanopdenbosch had been muzzled, and they said they regretted his resignation. VOA

Next Story

The HIV Spread in Pakistan: Government And UN Investigating Causes

Some also blame unsafe injection practices by quack doctors for contributing to the spread of HIV. Government officials estimate about 600,000 unqualified doctors are unlawfully operating in Pakistan and 270,000 of them are practicing in Sindh. 

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HIV patients take part in an awareness session at Pakistan Society, a nongovernmental organization drop-in center, in Karachi, Nov. 30, 2013. Pixabay

Officials in Pakistan and the United Nations are investigating causes of a new outbreak of HIV infections in a southern district where nearly 400 people have been diagnosed in less than two weeks. Officials confirmed Saturday that nearly 80% of those infected are children, with nearly half of them under age 5.

Local media began reporting about the epidemic two weeks ago from Larkana, a district of Sindh province, which has already experienced three outbreaks in recent years. A local doctor who treated several patients with a single needle and syringe was blamed for spreading the virus, which causes AIDS.

The provincial government rushed teams of public health workers to the district, with an estimated population of 1.5 million, to quickly assess the situation and mobilize resources to curtail further spread of HIV. More than 9,000 people have since been subjected to screening in the affected district, and the process is continuing, Sikandar Memon, the provincial head of the AIDS Control Program, told reporters.

A UNAIDS spokeswoman told VOA that international partners had joined local teams to help quickly carry out an outbreak investigation and address the acute needs of the people infected with HIV, including immediately linking them to treatment, care and support services.

The spokeswoman, Fahmida Khan, said efforts were being made to ensure that unsafe injection and blood transfusion practices were being stopped. She also noted that there were unconfirmed reports of similar HIV outbreaks in surrounding districts.

FILE - Pakistani social activists carry placards during a rally to raise awareness on World AIDS Day in Lahore, Dec. 1, 2016.
Pakistani social activists carry placards during a rally to raise awareness on World AIDS Day in Lahore, Dec. 1, 2016. VOA

Focus of problem

Sindh, with a population of nearly 48 million, accounts for 43% of an estimated 150,000 people living with HIV in Pakistan.

U.N. officials say since 2010, there has been a 57% increase in new HIV/AIDS infections in Pakistan. They noted that among all identified HIV cases in Pakistan, 43,000 are females.

Last year, an estimated 20,000 people were newly identified with HIV in Pakistan and 6,200 people died of AIDS, according to local and U.N. officials.

Khan would not comment on the reasons for the high number of HIV infections among children and the potential causes of the latest outbreak in Larkana, saying “further investigations and epidemiological review is yet required and suggested.”

Provincial authorities also have launched a high-level investigation to ascertain the veracity of the allegations against the local doctor, who already has been taken into police custody.

UN
Pakistani and U.N. officials say the HIV epidemic in Pakistan remains largely concentrated among key populations, including people who inject drugs, the transgender community, sex workers and their clients, and men who have sex with men. Pixabay

Some also blame unsafe injection practices by quack doctors for contributing to the spread of HIV. Government officials estimate about 600,000 unqualified doctors are unlawfully operating in Pakistan and 270,000 of them are practicing in Sindh.

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Critics also blame lapses in Pakistan’s national health system, the low priority given to the problem, corruption, the recent abolition of the federal health ministry and the delegation of its functions to the provinces for the worsening health sector situation and the increase in HIV infections.

Pakistani and U.N. officials say the HIV epidemic in Pakistan remains largely concentrated among key populations, including people who inject drugs, the transgender community, sex workers and their clients, and men who have sex with men. (VOA)