A committee of the Belgian Senate has voted 13-4 to approve a bill to authorize euthanasia for children suffering “unbearable physical pain from a serious physical illness without prospect of improvement.” Supporters of the proposal assert that restriction of the present law to adults is “discriminatory.” 16 Belgian paediatricians had written to two national newspapers supporting the bill. [CNN]
Category: Belgium
Objection to euthanasia reported to be minority position in Belgium
Reports from Belgium suggest that objection to euthanasia has become a minority position in the country, and that increasing acceptance of the practice has led to its normalization, evidenced by the development of “new rituals” like a “last supper,” final manicures and other forms of advance preparation. One marker of this is the report that a Catholic priest was present and administered the sacrament of the sick to two deaf twins who were lethally injected because they were going blind; their family was described as devoutly Catholic. For those opposed to euthanasia, increasing acceptance of the procedure demonstrates the existence of a slippery slope. Those who support it believe the phenomenon reflects a natural (and positive) evolution of morality. [National Post, 22 Nov., 24 Nov.]
Belgian euthanatist notes some reluctance among physicians, advocates more euthanasia
Dr. Wim Distelmans is a Belgian physician who is a leading practitioner and advocate of euthanasia. He has provided euthanasia in high-profile cases, like that of the woman who was dissatisfied with the results of sex change surgery, and of deaf twins who did not want to continue to live because they were going blind. He acknowledges having provided euthanasia in “a lot more borderline cases,” but declines to discuss them because of the publicity might have adverse effects on legalization of the procedure elsewhere. He is also co-chairman of the federal commission that reviews reports of euthanasia. In an interview with a National Post reporter, he said that Belgium had “a good law on euthanasia,” but indicated that many physicians, hospitals and nursing homes are reluctant to provide the service. He described them as “still very prudent,” adding, “There are still a lot of people suffering unbearably because they ask for euthanasia and they don’t get it.”
It is not clear to what extent the “prudence” Dr. Distelmans attributes to his reluctant colleagues reflects conscientious objection; it could be simply the result of a more cautious interpretation of the law. In any case, Dr. Distelmans wants the law expanded to permit euthanasia for those suffering from dementia who have made advance directives to that effect before becoming incompetent. He also wants the law extended to allow euthanasia for minors.
Dr. Distelmans implies that a physician has “a medical responsibility” to provide euthanasia in appropriate cases. [National Post]
Impartiality, complicity and perversity
Benjamin Veness weighs in on behalf of the Australian Medical Students’ Association (AMSA) to demand that physicians who believe abortion is wrong should be forced to direct patients to a colleague willing to provide it (“Abortion need not be doctor’s dilemma too.” Sydney Morning Herald, 16 November, 2013).
He and medical students who share his views believe that Victoria’s abortion law is the model that ought to apply throughout Australia. It follows from this that they believe that any Australian physician who refuses to help a patient find someone willing to do a sex selective abortion should be struck from the medical register or otherwise disciplined.
Mr. Veness correctly believes that this would be consistent with Victoria’s abortion law, and he is hardly alone in believing that physicians who refuse to facilitate abortion for reasons of conscience should be disciplined or expelled from the profession.
However, he and the students whom he represents are mistaken in their assumption that a physician who is morally opposed to abortion – whether in principle, or because he has more limited moral objections to practices like sex selective abortion – is not capable of providing information about the procedure and legal options available to a patient. In fact, many physicians opposed to abortion are quite willing to do so for the very reasons given by Mr. Veness: that the patient may ultimately decide not to go ahead with it.
More remarkable is the fact that the outlook of Mr. Veness and the Australian Medical Students’ Association suggests that only people willing to do what they believe to be gravely wrong ought to become physicians. Whether or not this is a condition for membership in the AMSA Mr. Veness does not say, but it is not a policy conducive to the ethical practice of medicine.
What is most striking is Mr. Veness’ belief that only physicians willing to facilitate or provide abortions are “impartial,” as if the judgement that an abortion ought to be provided does not involve a moral judgement. A conviction that abortion is (or can be) a good thing is just as “partial” as the opposite conviction of an objecting physician. Mr. Veness’ mistaken notion of what it means to be “impartial’ is evidence that he and the AMSA are anything but.
For some physicians, referral is an acceptable strategy for avoiding complicity in what they hold to be wrong or at least morally questionable. Others find it unacceptable because they believe that referral and other forms of facilitation actively enable wrongdoing and make them parties to it. Mr. Veness and the AMSA may dispute this, but it is hardly a novel idea. It is reflected, for example, in Section 45 of the Australian Capital Territory’s Criminal Code (Complicity and common purpose).1
More relevant, perhaps, is the broad definition of “participation” developed by the American Medical Association in its prohibition of physician participation in capital punishment. This includes “an action which would assist, supervise, or contribute to the ability of another individual to directly cause the death of the condemned,” and even giving advice.2
Lest the connection with capital punishment be thought out of place here, Australian medical students and physicians should take note that the arguments used to compel objecting physicians to provide or facilitate abortion are the same ones used by euthanasia advocates who would force physicians to lethally inject their patients, or help them find someone who will. That has been obvious in Belgium from the beginning,3 and it has been equally evident in Canada,4 most recently in Quebec.5
What is gradually becoming clear is that policies and laws devised to ensure the “accessibility” of abortion by suppressing freedom of conscience among health care workers lead ultimately to a perverse conclusion: that one can be forced to do what one believes to be gravely wrong, even if that means killing someone else, or finding someone who is willing to do the killing. That conclusion is profoundly inconsistent with principles that ought to inform the laws and policies of a liberal democracy.
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Notes
1. Australian Capital Territory, Criminal Code 2002. (Accessed 2013-11-15)
2. American Medical Association, Policy E-2.06 Capital Punishment (June, 2000) (Accessed 2013-11-15)
3. Murphy, Sean. Belgium: Mandatory referral for euthanasia.
4. A panel of the Royal Society of Canada recommended legalization of assisted suicide/euthanasia. The panel stated that, since physicians who are unwilling to provide what it delicately termed “certain reproductive health services” are obliged to refer patients to others who will (a contested assertion), physicians who refuse to provide (legal) euthanasia or assisted suicide for patients “are duty-bound to refer them in a timely fashion to a health care professional who will.” Schuklenk U, van Delden J.J.M, Downie J, McLean S, Upshur R, Weinstock D. Report of the Royal Society of Canada Expert Panel: End of Life Decision Making. November, 2011, p. 61-62 (Accessed 2011-12-31).
5. Hearings were held recently by a committee of the Quebec National Assembly concerning a bill to legalize euthanasia by physicians. State regulators of the professions of medicine, nursing and pharmacy all stated that their codes of ethics (developed as a result of controversies about abortion and birth control) require objecting professionals to refer or find colleagues willing to provide the service(s) to which they object. It is clear that they mean to apply the same rule to euthanasia, although it is equally clear that this causes some of them some discomfort. See, for example, the statement of Charles Bernard on behalf of the College of Physicians of Quebec at Quebec National Assembly, Consultations & hearings on Quebec Bill 52: College of Physicians of Quebec. Tuesday 17 September 2013 – Vol. 43 no. 34, T#154
Belgium considering euthanasia for children
Belgian politicians are debating a bill proposed by the governing Socialist party to legalize euthanasia for children (with parental consent). The bill would also abolish the current 5 year limitation on advance directives for euthanasia in order to make the procedure available to persons with dementia. [ABC News]