Distelmans' 'bait and switch' as calls for 'dialogue' in Belgium continue to grow
by Paul Russell:
'But let us into the debates play the ball instead of the man.' Says Dr Wim Distlemans in De Morgen in reply to Professor Theo Boers' observations in yesterday's Belgian press about the bungled operation of the Belgian Euthanasia Review Commission under Distelmans' leadership.
Boer, a Dutchman and former member of the Dutch euthanasia review system for nine years entered the debate by reflecting the Dutch standards against the Belgian laisse-faire operation. Boer is critical of Distelmans' public advocacy role in promoting euthanasia and sees it as contrary to the role of co-chair of the commission charged with reviewing each and every case - including Distelmans' own cases.
Distelmans in reply, does what he accuses others of and 'plays the man'. He then tries desperately to deflect Boer's criticisms by attempting to refocus the debate in other areas. For mine he fails dismally.
He seeks to smear Boer by association, claiming that Boer is being intellectually dishonest by not declaring an association with the anti-euthanasia group Euthanasie Stop, which Distelmans describes as 'an organization made up of well-known Catholic personalities and militants who are almost professional in their anti-euthanasia battle.'
Does the saying 'the pot calling the kettle black' translate well into Flemish? Boer's only 'association' with that group, if you can call it that, is that they have republished one of his articles. Death by google search!
Distelmans continues his poor form by crying in his Belgian beer over what he claims have been very 'hurtful' articles and comments in the local and international press in recent times.
Honestly, if you are going to do senseless and offensive things like take a tour to Auschwitz with your colleagues to proclaim that there is 'no better place than Auschwitz to reflect on dying with dignity, to ponder the meaning of dignity' then you need to learn to expect criticism. If you take upon yourself the public mantle of 'euthanasia-promoting rock-star' while at the same time taking on the supposedly grave task of reviewing all reported euthanasia cases all the while ignoring known cases of non-reporting, you have to expect criticism. Boer is right to criticise for every good reason; he deserves better in response than a blubbering, emotive, personal attack.
Distelmans' article appears along with another on the same matter by geriatric psychiatrist Dr An Haekens. She is calling for Distelmans to dialogue on the idea of euthanasia for psychiatric reasons. The story does not indicate whether she had the prior opportunity to read Distelmans' contribution, but I doubt that the opportunity would have changed anything.
Haekens observes that there may be reason to believe that the practice of euthanasia has overtaken the law when considering the many thousands of files that the Belgian review committee has passed over with only one ever being referred to the judiciary. She notes that the consideration of the term 'medically hopeless' in Belgian law does not mean that there are no therapeutic options left to consider (as one might expect) but that there are no options that the patient wishes to consider. It has always been the case that no-one can be forced to accept any particular treatments, but in consideration of euthanasia for psychiatric reasons, the patient, as Haekens notes, is not in a deteriorating physical situation as they would be with a disease. It becomes a question then of due care.
Like Boer, Haekens points out that the situation over the border in The Netherlands is quite different; the Dutch Psychiatric association having issued guidelines for dealing with assisted suicide requests in psychiatric patients 'years ago.' She closes by asking for a new and substantive debate on euthanasia for psychiatric reasons.
And in a clear sign that the issue is building, some of the same medical professionals who authored the original open letter on psychiatric euthanasia published only days ago were published again in De Morgen replying to criticism that they were trivializing psychological suffering; a charge they deny.
They provide a more detailed explanation of their reasoning which deserves to be read in full:
'The person who plunges into a depression falls prey to a real feeling of lack of perspective. Clinical and research experience show, however, that even a succession of major depressive episodes doesn't imply that the suffering is hopeless.
'Suppose someone says, "I have failed in all areas of my life, professional, personal, familial," and the therapist thinks otherwise on the basis of various specific elements that the patient previously mentioned. Is the only way to avoid being paternalistic or pedantic to simply respond to this patient: "Yes, You are right."? No, the therapist will both respond to the reality that the patient experiences while also gently suggesting other angles. Clinical care is empathic, indeed, but it is also thoughtful empathy, which involves a gently invitation to entertain a different perspective. Here clinical ethics requires to be receptive to the feeling of hopelessness and to acknowledge it, without abandoning the ethical duty to also explore the horizon of other options.
'Not trivializing psychological suffering means precisely this: taking account of its uniqueness. The course of a cancer is indifferent to the way the oncologist listens and speaks. Research shows that with mental problems, the relationship between patient and therapist is a decisive factor for the success of the treatment. That constitutes the fundamentally different reality of mental illness. The patient who suffers psychologically is fundamentally attached to the words of the therapist, while the cancer does not care about what the oncologist says.
'This brings us to the crux of the ethical basis of the euthanasia legislation: the centrality of the value of autonomy. Testimonials from euthanasia cases involving patients with purely psychological suffering indicate that patients sometimes ask at the last minute: "You are sure, doctor, aren't you, that nothing more can be done to help me?" Or "You really can confirm that my disease is incurable, isn't it doctor? "'
They close with a very clear caution about the different nature of euthanasia for psychiatric suffering with a shot across the bow of Distelmans et al who seem to value only diligence and autonomy without any nuance or thought given to circumstance:
'Obviously, this problem presents itself in the context of every euthanasia request, but in the context of physical conditions there is an unambiguous limitation as a result of objectively determinable irreversibility. This crucial containment factor is missing here. We are therefore concerned about how the law assigns a position of medical expert to the doctor in the context of issues that primarily concern interpersonal relations. The debate about euthanasia on grounds of mental suffering alone cannot be settled simply by referring to the virtue of diligence and the value of autonomy.
'Moreover, it is precisely because of the importance of autonomy as a core value that we have to be very careful with how we assign in our legislation an exceptional position to experts.'
This debate seems far from over. The Belgian experiment with patient-killing is fast becoming a tragic farce and one, unfortunately, that is making the Dutch experiment look reasonable by comparison when both have significant problems. This has the potential for further embarrassment.
The call, yesterday by Christian Democrat MP, Els Van Hoof, for a parliamentary review needs to be heeded lest the notional and implied negligence of Distelmans' committee extend ipso facto to the Belgian government. The case for negligence would be made by that silence.