Category: Belgium

The Belgian Socialist party has submitted proposals to amend the country’s euthanasia law to permit euthanasia of children and persons suffering from dementia. According to news reports, children would have to be suffering from an incurable illness to qualify.[Daily Mail]  The text of the proposed legislation does not yet appear to be available.

However, two bills submitted by Marleen Temmerman to the Belgian Senate in May, 2012 made the same kind of proposals.  Draft law No. 4-431/1 makes euthanasia available to children who are able to “discern” that they want it if they otherwise meet the legal criteria for euthanasia of adults.  Alternatively, their parents can make the request.

Draft Law No. 4-676/1 makes euthanasia available to patients with dementia.  This bill also appears to impose a requirement on conscientious objectors to refer patients to physicians willing to kill them by modifying the existing protection of conscience provision in the Belgian euthanasia law.  The existing law requires an objecting physician to transfer a patient’s medical file to another physician if requested to do so by the patient or surrogate decision maker.  The onus remains on the patient or surrogate diecision maker to find a willing physician.  Draft Law. No. 4-676/1 would add the following provision to the law:

Si aucun médecin n’a été désigné par le patient ou par sa personne de confiance,  le médecin qui refuse d’accéder à une demande d’euthanasie communiquera le  dossier médical à un autre médecin en vue d’assurer la continuité des soins.

If  no physician has been designated by the patient or by his  surrogate decision maker, the physician who refuses to comply  with a request for euthanasia must tranfer medical records to another  physician to ensure continuity of care.(Machine assisted translation)

On the face of it, this does not appear to add anything new.  However, the commentary on the section provided by Temmerman indicates that what she has in mind is the addition of a requirement that an objecting physician find a colleague willing to kill the patient:

La loi sur l’euthanasie n’offre pas de solution pour le cas où le  médecin traitant refuse d’accéder à la demande d’euthanasie, où le  patient n’est plus en mesure de désigner un autre médecin et où il  n’a pas désigné de personne de confiance. Le patient a pourtant  droit à l’exécution de sa déclaration anticipée et à la continuité  des soins. C’est pourquoi le médecin qui refuse d’accéder à la  demande d’euthanasie doit transmettre lui-même le dossier médical à  un médecin qui soit disposé à appliquer la volonté exprimée par le  patient.

The law on euthanasia does not offer a solution for the case in which the doctor refuses to grant the  request for euthanasia, where the patient is no longer  able to appoint another doctor and did not appoint a surrogate decision maker. The patient nevertheless entitled to enforce his advance directive and ensure continuity of care. This is why the doctor who refuses to comply with the request for euthanasia must transfer the medical file to a  medical doctor who is willing to implement the wishes of the  patient. (Machine assisted translation)

In July of this year, the Belgian Federal Commission for the Monitoring and Assessment of Euthansia recommended that medical students should be taught how to kill patients properly, and that continuing medical education should include such instruction:

La commission rappelle qu’elle estime que le curriculum des études  médicales devrait comporter une formation préparant les futurs médecins à affronter les problèmes que pose la gestion de la fin de vie, y compris la pratique des soins palliatifs et la mise en oeuvre correcte d’une euthanasie. De même, les divers cycles d’enseignement  postuniversitaire et les activités de recyclage devraient être encouragés à inclure une telle form. 

The Committee recalls that it considers that the curriculum of  medical education should  include training  preparing future physicians to deal with the problems  posed by the management of the end of life, including the practice of palliative care and the proper implementation of ‘euthanasia. Similarly, the various cycles of postgraduate education and recycling activities should be encouraged to include such training. (Machine assisted translation)

The Commission did not appear to recognize that some medical students might have conscientious objections to a requirement that they be required to kill a patient as a condition of graduation.  On the other hand that Commission may have intended only that medical students be provided with information about how to kill patients properly, without a requirement that they actually demonstrate their competence.