An interview with the French news service, Atlantico, with Carine Brochier, Director of the European Bioethics Institute, Brussels.

41% increase in euthanasia in 4 years: an appalling excess due to the legislation on assisted death in Belgium 

In 2014 to 2015, nearly 4,000 individuals resorted to euthanasia in Belgium, of which 124 due to "behavioral, mental or psychological disorders".

In Belgium, patients afflicted with dementia, psychological disorders, Alzheimer's disease and depression were euthanized. The figures are alarming: specifically, in 2014 and 2015, 124 people were euthanized for mental disorders.

Atlantico: According to the analysis by the European Institute of Bioethics , euthanasia is up 41% over the last four years in Belgium. Are the reasons given for euthanasia always legitimate? What main misuses should we worry about?

Carine Brochier: These figures tell us about official euthanasia acts.

Of course, it is impossible to give figures for the real number of euthanised people and of those for whom the physician did not fill out a euthanasia statement, which violates the law of 2002. This point is important, since certain physicians, by their own admission, sometimes take liberties with the law. These figures then reveal only part of the truth about euthanasia in Belgium.
If, despite this, one accepts the figures in the Commission Report as a working hypothesis, two main conclusions can be drawn.
First, many of the "medical disorders" that are frequently invoked to request euthanasia are difficult to define.

I shall take just one example: "multiple pathologies ". These account for a considerable proportion of the total euthanasia acts over the two years 2014 and 2015 (385 people).

In practice, we are speaking about situations in which people, mainly because they are growing old, are prey to the numerous physical failings that accompany advanced age and that, cumulatively, cause them to suffer and become dependent on family and friends. One thinks, for instance, of osteoporosis, hearing loss and failing eyesight. These medical afflictions are common; they are part of life when the body ages. In our circle of family and friends, we all know some elderly people who slowly or suddenly see their health deteriorate.

In some cases, this new situation makes the people in it increasingly dependent on those around them and on their home environment. With time, isolation can result: social contacts gradually diminish; family and friends make it to their bedside less often than they would like. So in the wake of physical pain comes loneliness.

In combination, physical and psychological suffering can lead to the wish to end it all. This is what the official report of the Commission refers to as "despair".

Over the last 14 years, have you noticed a shift towards euthanasia becoming commonplace?

It's quite a striking question/ because, originally, euthanasia was intended only for exceptional use, under conditions which the legislature intended to limit stringently. Despite this, in practice, the terms of the law have allowed an ever wider interpretation because, from the start, they were vague: the law speaks of "constant, unbearable and unrelievable suffering", "death expected in the short term", etc. The Commission itself acknowledged this legal grey area when it pointed out that suffering is a highly personal concept and that only the patient can judge its intensity and determine whether, in his/her view, it is bearable or not.

We now see just how thoroughly we have failed to enforce the "stringent conditions" of the law. This failure also explains why requests, once judged as in no way admissible, are now endorsed by the Commission in charge of monitoring the application of the law as well as by many physicians and most Belgian citizens.

Making euthanasia routine is what can, and must, be strongly denounced, in a word. This law, which, in its use of eminently vague or subjective qualifying terms, has always contained the seed of widespread extension, brings us ever closer to a form of euthanasia on demand. They say that supply creates demand, don't they?

The figures also show that 63% of euthanised people are more than 70 years old.

The person suffering from multiple pathologies is in fact in the current situation of many of the elderly: the body ages, health problems accumulate, dependency on others increases and, if we don't remain alert, feelings of loneliness and of loss of direction also grow.

Faced with this, in the name of evident despair linked to the medical afflictions of the sufferer, euthanasia has been embraced as one approach to a solution. Initially envisaged as a natural consequence of old age coming up against the limits imposed by the body, now euthanasia is touted as a possible response. We urgently need to consider the attention and accompaniment we give to our elderly relatives, and more generally, the policies we want, so that we may give priority to truly integrating the elderly into our daily lives by creating many more organisations that are designed to take in people who are not necessarily at the end of their life, but who need social ties and our affection.

You spoke of a second point to note in the Commission's Report. Would that be the rising number of acts of euthanasia for psychological disorders, so those performed on mentally fragile people?

Indeed, in those two years, 124 people with "mental and behavioral disorders" (depression, Alzheimer's disease, dementia, etc.) were euthanized. This means that, despite these patients' unsound minds, doctors acceded to their requests.

The international press, in particular, the Washington Post last October, seized the opportunity to publish many expressions of bewilderment at this practice. The general stance can be summarized by this question: "What on earth is Belgium doing?" Some Belgian and international psychiatrists' associations have mobilised to respond as well. A group of over 80 public figures has formed in Belgium to sound the alarm. 

Why? Because these people with mental and behavioral disorders were not terminally ill— far from it. But some physicians felt that they had tried everything and, on the principle of patient autonomy, could accede to patients' requests and so induce their death.

All these people's dreadful suffering and their family's distress are undeniable.

Nevertheless, doesn't this raise some fundamental questions? As we examine our ways of living together as a society, can we accept that, on the principle of a frail and fragile person's omniopotent autonomy, we must resign ourselves to a request for death and "obey" it? Euthanasia ultimately reveals our inability to persevere in caring for people, doesn't it?

Moreover, it is important to remember that the act of euthanasia is not just about the people who submit requests and are suffering. In reality, it also concerns their families and the entire medical profession. At the European Institute of Bioethics, we hear testimonies of caregivers explaining how families, sometimes exhausted, arrive at the point of requesting euthanasia for a close family member who has become dependent on their care. Of course this is completely beyond the bounds of the law. We regularly hear the reactions of unhappy physicians. We listen to these medical teams express their discomfort because they do not want to practice euthanasia but have a hard time resisting the pressure to do so. In a similar vein, nowadays, if you dare to express the view that euthanasia is a bad answer to a good question, it is very badly received. Just wait until you see the comments below (referring to the comments section at the online version)... Isn't that a form of social pressure too?

Yes, the euthanasia mindset is real.

Beside the misuses we have discussed, aren't you afraid of suicide becoming a business? In particular, through the arrival of foreigners in Belgium or Switzerland in order to commit suicide—an expensive procedure...

Up until now, this hasn't been common in Belgium. In one sense, and to speak a little caustically, we have enough to keep our hands full with the Belgians...

Coming from abroad into Belgium in order to be euthanized is not happening yet. In contrast, there are other places—indeed, such as Switzerland—where commercial companies have made a business of this. There is a risk that one day this will also spread to Belgium. On this topic, a physician who practices euthanasia in a Brussels hospital aid that he had been consulted by several French nationals fresh off the train luggage in hand about the possibilities for euthanasia on our territory. Obviously, he was rather shocked. So we have not yet arrived at euthanasia tourism, but we must remain vigilant.

Do these figures reflect reality in terms of the total number of people who were euthanized in Belgium?

As I have already said, these figures are for official euthanasia acts. That means those for which the physician indeed completed the euthanasia declaration and sent it to the Commission within four days after euthanasia. This doesn't always happen. Recently, I was surprised to hear a physician state out loud and very clearly before an invited audience that he did not need a law in order to "euthanise those who request it".

What happens in patients' rooms in one-to-one discussion between them and their physicians is confidential, and fortunately so. This is why we will never be able to put a figure on the total number of acts that caused the death of some people, whether at their behest or not. We cannot quantify clandestine acts. However, in view of euthanasia becoming routine and its acceptance, as widely communicated by the pro-euthanasia movements and their political and media networks, some caregivers—happily not all—seem to have developed a certain "flexibility" towards the criteria for granting euthanasia requests! At the same time, a sort of impunity has arisen in some quarters because, in the 14 years of the law's existence, out of 12,726 official euthanasia acts, just one has been sent to court by the Commission because it found that the conditions imposed by the law had not been met.

What do you think of the way the question is broached in public discussion?

One thing is clear to me: we have to be careful not to make euthanasia a way to resolve the structural problems that confront our society, be they loneliness, the treatment of people with many frailties and of those with dementia, accompaniment/support for elderly or disabled people, etc.

This is a political decision. Nonetheless, it remains vital that citizens ask our leaders to shoulder this responsibility. Euthanasia is not a matter solely for the individual: it has an impact on our coexistence as a society.

When you see how the organisation of palliative care is locked down by budgets that do not increase, or when you listen to home-care teams tell you how they are strangled by the lack of resources available to them, you tell yourself that if only citizens could take full measure of the situation, they would push for support for caregivers and insist on the importance of dignified, well-qualified support in managing all suffering, whether physical, psychological or existential. We must refuse euthanasia as a solution to our funding shortages.

And also probably to our lack of interest in the elderly, whom we abandon on the fringe of Life, with a capital "L".
This is no exaggeration. By way of proof, one year ago, one listener, whose mother had been "placed" in a residence for elderly people afflicted with Alzheimer's disease, stated on prime time radio, that her euthanasia should be authorised because "our mother is devouring our inheritance"!

It is true that proper care requires large financial resources. However, one must also be aware that these organisations create jobs. Good quality organisations already exist and employ many skilled and dedicated caregivers who have made support/accompaniment for suffering people their deeply-held vocation. Are they sufficiently supported? Do they have sufficient resources?

However, to achieve this, first, it is essential to abandon an ideology that presents the individual as the sole master of his/her own life and alone in the world. Society as a whole is impacted by an induced death. To cause the death of a lone, sick, fragile, vulnerable person is to commit an act that wounds any society universally. We dodge this issue by holding that the individual who wants euthanasia is master of his/her life and we consciously or unconsciously obscure the consequences that this entails, namely, post-euthanasia syndrome for the "survivors".

Overall, euthanasia is not good for us. Therefore, it is vital and urgent to dare to look reality in the face, aside from any ideological battles and to embrace reflection with a view to the common good for today and tomorrow.

Thus, having looked cancer, polypathologies, dementia, depression, despair and loneliness squarely in the eye, it will ultimately be possible to offer a solution other than inducing death.

Translation of the Interview published in French 21 October 2016):

Carine Brochier is the director of the European Institute for Bioethics based in Brussels.