Crushing resistance, one clause at a time

For those tempted to think that a euthanasia or assisted suicide law, once passed, is cast in stone, recent events in Belgium will make you think again.

The statute been subject to continual re-interpretation since it was passed in 2002. Now euthanasia for psychological reasons is now taking place and the lower age limit has been removed to make children eligible for euthanasia.

And more changes are coming.

How does this happen? While the words of a statute may stand, the conversation about interpretation never stops. This is not evidence of a sinister plot. But while the lines may have been drawn, medical issues are rarely neat and a clear line in theory may well be blurred in practice. Add to that pressure on doctors, pressure on the family, pressure on the person themselves and even the ideal of informed consent will fade. It is simply not possible to construct a law that can resist these pressures.

Consent has been a tricky business for Belgium’s euthanasia law since 2002. Section 4 deals with a request for euthanasia via an advanced care directive. This document expresses clearly a person’s wishes should he ever lose capacity to express himself.

The problem with this are numerous. My primary concern is that the acceptance of such a document circumvents a doctor’s role in confirming that a request was made voluntarily and with a sound mind. The Belgian law sunsets an advanced request for euthanasia after five years. In other words, if the advance request was made in the proper form more than five years ago and the patient loses capacity, the request for euthanasia cannot be granted.

This may change. On February 23 former deputy prime minister and minister of social affairs and public health Laurette Onkelinx (Socialist Party) tabled three private member’s bills. The first bill addresses the issue of advance directives and the five-year sunset clause.

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