EUTHANASIA
SAFEGUARDS IN BELGIUM
Belgium enacted a new law in 2002
that allows
doctors to help their patients to die
by the direct method of giving lethal doses of chemicals.
The physician must administer the deadly drugs.
But the Control Commission later relaxed this requirement.
Thus, in practice, the patient could take the life-ending
chemicals.
The following safeguards were debated by the Belgian
parliament
and then included in the law.
1. The patient must be an adult
or an
emancipated minor,
must be legally
competent,
and must be conscious at the moment of making the request
for death.
The patient's request for death must be in writing,
signed, dated, and witnessed.
If another person does the actual writing of this request,
then that person must be an adult,
who has no material interest in the death of the patient.
2. The patient can also request death under specified circumstances
in an advance
directive for medical care.
In this case, the patient might be unconscious at the end,
which constitutes an exception to the requirement for suffering.
Such a written advance directive also constitutes a power of attorney
for a
named
proxy or proxies, who can request death for the patient.
In an advance directive, one or more person(s) taken in confidence
can be designated in order of preference.
The patient's attending physician, consulting physician,
and the members of the nursing team
may not act as
persons taken in
confidence.
An advance directive must be composed in writing
in the presence of two witnesses,
at least one of whom has no material interest in the death of the
patient.
The advance directive must be signed and dated by the patient.
The witnesses sign to show that they have witnessed this process.
If the patient can no longer draft or sign an advance directive,
this situation will be explained by a designated person,
who will do the writing and signing for the patient.
A doctor's certificate will be annexed to the advance directive,
explaining why the patient was permanently incapable
of drafting and/or signing an advance directive.
The advance directive may be amended or revoked at any time.
All these facts are maintained by the office of the National Register.
3. When a
proxy makes a formal request for death,
he or she shall explain why the patient is no longer capable
of requesting death himself or herself.
In such a situation, the request for death
is drafted in the presence of the physician,
whose name is mentioned in the document.
And this proxy
request for death must be included in the medical record.
This power to choose death by means of an advance directive
expires five years after the last competent re-affirmation of the
document.
Except as rendered impossible by the patient's condition,
the request by proxies shall fulfill all of the other safeguards below.
4. The patient's request for death must be voluntary,
well-considered,
and repeated,
and not
the
result of external pressure.
The request
for death must be in writing.
5. The patient must be in a medically
futile
condition
of constant and unbearable
physical or mental
suffering
that cannot
be
alleviated,
resulting from a serious
and
incurable disorder
caused
by illness or accident.
Existential suffering or being 'tired of life'
do not qualify as
sufficient suffering.
6. The doctor and the patient must discuss
the medical
condition of the patient.
They must explore
other
options
besides euthanasia, such as palliative care.
Both the doctor and the patient must conclude
that no alternatives to euthanasia are available
and that the patient's
request for death is completely voluntary.
7. The physician and patient must have several conversations,
spread over a reasonable
period of time to make certain
that the physical and/or mental suffering continue
and that the request
for death is enduring.
8. A second,
independent physician
must also examine the patient and the medical records
and conclude that the patient's suffering, physical or mental,
is constant and unbearable and cannot be alleviated.
This doctor must be competent in the disease in question.
This consulting physician must report his or her findings,
which will be shared with the patient by the attending physician.
9. The doctor must discuss with the nursing
team
that has regular contact with the patient
the patient's request for death.
10. The doctor will also consult with any family
members
chosen by the patient.
11. The physician must be certain that the patient has the opportunity
to discuss his or her request with any
person
chosen by the patient.
12. If there is sufficient time,
the physician considering granting
euthanasia
must consult with another
physician
who is a psychiatrist
or a specialist in the disorder in question.
This doctor will also examine the patient and confirm that
all
of the
conditions named above have been satisfied.
This physician reports his or her findings.
The attending physician also informs the patients about these results.
13. The physician and patient must wait
at least
one month
between the first written request for euthanasia and granting that
wish.
14. The patient can revoke
the
request at any time.
If the request for death is revoked,
the document is removed from the medical record
and returned to the
patient.
15. The physician must make a
written
report
of all the facts related to this case,
including all of the fulfilled safeguards named above.
This is submitted to the Federal Control and Evaluation Commission,
which can ask for more information
or even recommend criminal prosecution
if they believe a crime has been committed.
This formulation of the Belgian
safeguards into 15 points
has been adapted from Guenter
Lewy's
Assisted
Death in Europe and America:
Four
Regimes and Their Lessons.
(Oxford University Press, 2011,
pages 74-77)
The English translation of the Belgian law
appears on pages 172-181.
EUTHANASIA
EXTENDED TO CHILDREN IN 2014
A new law extends the right-to-die to children
who
have terminal conditions.
This is a modification of the first point above,
which originally required the patient to be at least 18 years old,
fully capable of making a meaningful request for death, etc.
When the patient is a new-born, a small child, or a
developed minor,
special provisions must be fulfilled for euthanasia to be
granted.
1. The child must be dying.
(Terminal illness is not required for adult patients.)
Several physicians must review the medical condition of the child.
2. The parents of the child who is dying
must give their consent to euthanasia.
3. If the child has lived a few years,
then its "capacity of discernment" will be assessed.
And the child-patient will be consulted as much as appropriate.
A psychological evaluation will determine the degree
of the child's participation in the life-ending decisions.
Whenever possible, the child must be conscious.
4. As with adults, the child-patient must be suffering.
This includes both physical and mental suffering
as the result of a serious and incurable disorder.
IN SUMMARY:
BELGIAN SAFEGUARDS IN ORDER
OF IMPORTANCE:
B. REQUESTS
FOR
DEATH FROM THE
PATIENT
G. UNBEARABLE
SUFFERING
H.
UNBEARABLE
PSYCHOLOGICAL SUFFERING
D.
PHYSICIAN'S
STATEMENT
OF CONDITION AND PROGNOSIS
E. INDEPENDENT
PHYSICIAN REVIEWS THE CONDITION AND PROGNOSIS
J.
INFORMED
CONSENT FROM THE PATIENT
C.
PSYCHOLOGICAL
CONSULTANT EVALUATES
THE
PATIENT'S
ABILITY TO MAKE MEDICAL DECISIONS
A. ADVANCE
DIRECTIVE
FOR MEDICAL CARE
K. REQUESTS
FOR DEATH FROM THE PROXIES
U.
WAITING
PERIODS FOR REFLECTION
INFORMATION
ABOUT
PALLIATIVE CARE
AND
OTHER
ALTERNATIVES TO DEATH
V. OPPORTUNITIES
FOR THE PATIENT TO RESCIND OR POSTPONE
THE
LIFE-ENDING DECISION
N.
STATEMENTS
FROM FAMILY
MEMBERS
AFFIRMING
OR QUESTIONING CHOOSING DEATH
M. STATEMENTS
FROM HOSPITAL OR HOSPICE STAFF MEMBERS
O. A
MEMBER
OF THE CLERGY
APPROVES
OR QUESTIONS CHOOSING DEATH
THE
PATIENT
MUST BE AN ADULT RESIDENT OF THE STATE
W. PHYSICIANS
REVIEW THE COMPLETE DEATH-PLANNING RECORD
X. COMPLETE
RECORDING AND SHARING
OF
ALL MATERIAL FACTS AND OPINIONS
By this count, there are 18 safeguards
mentioned in Belgian law concerning euthanasia.
The above prioritized list
has letters drawn from the list of 26
recommended safeguards.
They retain their original letters from
that list.
And two of the safeguards have no letters,
because these are additional, possible safeguards.
Here is the complete list of proposed safeguards:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/SG-CAT.html
Created
May 28, 2014; Revised 6-10-2014; 11-26-2014; 12-23-2017; 9-15-2018;