At a press conference, Prof. Dr. Etienne Montero, Dean of the Faculty of Law, University of Namur, Belgium, gave an overview of 11 years of euthanasia in Belgium. The proponents of euthanasia in Belgium recognize that most requests for euthanasia are not rooted in physical pain, which can be controlled, but in psychological suffering.
Examples include loss of meaning, loneliness, weariness of life, and need to master one’s death. In situations of suffering, a euthanasia request is understandable, but courts cannot give the right to euthanasia without endangering the lives and security of its citizens. All citizens are at risk of excesses and abuse.
The Belgian experience of euthanasia teaches us that it is an illusion to believe that we can have the right to euthanasia as a well-defined and well-controlled practice.
Once euthanasia is permitted, it becomes very difficult to maintain a strict interpretation of legal requirements. Quickly, restrictions fall away, one after the other, and boundaries become wider and larger. Such an expansion is inevitable due to the intrinsic dynamics of law. Indeed, law is part of a legal system that has its own dynamics, driven by higher principles such as equality and non-discrimination. First, euthanasia, initially reserved for adults, will open to minors. Second, the law initially requires a serious and incurable disease with physical or mental suffering. Applying these same principles, how can a person be denied euthanasia with only psychological suffering, without a serious and incurable disease?
The Belgian experience illustrates the difficulty of adhering to original statements and intentions of the legislator and of ensuring compliance to the original strict legal requirements. It was originally stated that psychiatric, demented or depressed patients would not be targeted by the Belgian law. However, the Belgian Control Commission (BCC) approves euthanasia in such cases today.
Conditions of severe and incurable disease and suffering are also interpreted very loosely. The BCC approves euthanasia at the request of people who suffer from various diseases related to old age, none of which, taken alone, is severe (arthritis or decreasing sight and hearing). It also recognizes the possibility of future anticipated suffering as a condition for euthanasia.
Moreover, how can anyone make sure that the patient is given free and informed consent, without external pressure? How can anyone ensure that the prognostic information (predicting chances of survival) and therapeutic options are correct as well as sufficiently explained and given in an empathetic manner? How reliable is the verification process a posteriori (after the fact) based on a document completed and submitted by the same doctor who euthanized a person (self-reporting)?
Today, the emphasis is on patient autonomy. However, there is a real danger that vulnerable people, faced with declining health, will feel pressured and compelled to be euthanized so as not to be a burden to family or society. There is also a risk that people will be euthanized due to incompetence (i.e. inadequate pain control). Finally, society may be more willing to offer euthanasia as a solution to suffering than to alleviate the suffering.
If Quebec decides to partially open the door to euthanasia, be warned that the door will automatically open wider and wider regardless of initial intentions. This is not pure conjecture, but reality based on the Belgian experience.