Euthanasia in Belgium: Shortcomings of the Law and Its Application and of the Monitoring of Practice

A new paper has been published by Belgian authors, who in the past have strongly promoted ‘assisted dying’, which reviews Belgian practice and its shortcomings. In summary:

  • Eligibility for euthanasia by refusing curative or life-prolonging treatment:
    The authors question the concept of ‘patient-subjective interpretation of incurability’.
    “Physicians are involved in euthanasia as both medical experts and moral agents. Their role, in our view, should not be reduced to merely meeting patients’ demands because this would result in a pure instrumentalization of physicians.”
  • Psychological Suffering Caused by a Psychiatric Condition:
    The authors recognise that “the absence of any consensus or legal guidance on how to define psychological suffering makes it possible to use the concept in an increasingly broad way.”
    They also recognise that such individuals need at least a year for assessment but that the time between requests and death is 3 months or less and that “In the latest FCECE report covering 2018 and 2019, the waiting period is no longer reported”
  • Polypathology
    Increasingly the use of combinations of pathologies is being increasingly used as an eligibility criterion. In 2019, this accounted for 17.4% of all cases, and 47% of non-terminal cases. This latter use may be because some are using ‘polypathology’  to include being ‘tired of life’. The authors note that this latter reason: “…is problematic because these cases are likely not to meet the legal criteria.”
  • Medical decisions:
    1. The authors express concern that in ‘polypathology’ cases an additional independent doctor does not have to be a specialist and can be any generalist including a GP such that, in same cases, all the assessing doctors are GPs. The monitoring body does not collect data on this.
    2. The Belgian Constitutional Court recently ruled that the opinions of consulted physicians are not binding. This means that the attending physician can proceed with euthanasia, even if the consulting physician disagrees. It also means that dissenting physicians have no legal recourse to stop an assisted death.
  • Monitoring after an assisted death
    Reporting an assisted death is not obligatory since it was felt that automatic involvement of the public prosecutor “..would make physicians too hesitant to collaborate and to report”. Instead a non-legal, non-administrative body is meant to check each case, but has no data on the number of unreported cases. All reporting data is anonymous and consists of very little data and the advice from the independent doctor is not included. The body only produces a report every 2 years. Studies have estimated that 48% of Belgian assisted deaths go unreported. To date, the monitoring body has only referred one case to the public prosecutor.

The authors conclude:

“Euthanasia, which involves the deliberate ending of a patient’s life, is a far-reaching and irreversible act that should be closely monitored. In this article, we have argued that there are shortcomings in the Belgian euthanasia law, the application of that law, and the monitoring of euthanasia practice.

This leads us to conclude that several of these shortcomings are structural and thus require more than simply increased oversight.”