New study on Belgian doctors medical practice at the end-of-life creates more concerns

What is really going on in Belgium? The longer the practice of euthanasia develops both in Belgium and in the Netherlands, the more obvious it becomes that the illusion of regulatory control, ethical behaviour and limitation on who qualifies blurs and collapses in upon itself.  The following report by Michael Cook from
MercatorNet echoes almost precisely the earlier data from The Netherlands on the use of Terminal sedation.
 
More questions about Belgian euthanasia

by Michael Cook

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Assertions that euthanasia in Belgium is safe and voluntary have been undermined by a recently-published study in the Journal of Medical Ethics. A survey of end-of-life decisions made by Flemish doctors in 2007 has found that in nearly 80% of cases of terminal sedation, there was no explicit request from the patient. Terminal sedation, or relieving the distress of dying patients by heavily sedating them, accounts for nearly 10% of all deaths in Flanders.
 
In such a controversial area, precision is important. In many cases of terminal sedation, the intention of the doctor is to make patients as comfortable as possible, not to kill them. It is not necessarily "slow euthanasia".
But it can be. In nearly 22% of terminal sedation cases, the doctor explicitly intended to end the life of the patient. In other words, the patients were euthanased, even if death did not happen immediately. If this is true, the real proportion of euthanasia cases in Flanders nearly trebles, to 3.3%, not just 1.26%, as reported in the study. Or at least that was the figure seven years ago, in 2007.
 
Even the authors seemed a bit rattled by the fact that in 79.7% of cases of terminal sedation, there was no explicit request from the patient. These were not necessarily unethical. There could have been proper reasons why no consent was given: patients could have been unable to give consent because they were in a coma or demented; relatives may have given consent by proxy; or there may have been a living will.
 
What concerns the authors is that many Flemish doctors do not understand what palliative sedation is. They conclude by recommending more education so that doctors will act within ethical and legal limits:
 

"Physicians seem to use 'palliative or terminal sedation' as an umbrella term to capture a wide variation of end-of-life practices. … the ambiguity of the use of the term can also be a barrier to a responsible, justifiable and reliable sedation practice in end-of-life care. Better knowledge of palliative sedation, including its procedural and ethical requirements and boundaries, may be necessary and would allow physicians to provide appropriate medical treatment at the end of life."

But wait: there's more!

Wesley Smith explains in his blog Human Exceptionalism the problems with terminology around end-of-life sedation and the reality that, in both Belgium and The Netherlands, this is masking a significantly higher rate of euthanasia that the official statistics report:

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As I explained in more detail here, there is a difference between "palliative" and "terminal" sedation, properly understood, and the article mentions some confusion in terms by Flanders' doctors in this regard.
 
The former does not aim at ending life, but keeping a patient comfortable. It can be titrated to allow greater and lesser states of awareness as needed. Palliative Sedation is a legitimate medical treatment. In PS, the patient dies of the underlying disease.
 
On the other hand, terminal sedation is a blunt instrument that puts a patient unconscious until death, sometimes accompanied by denying food and water to make that happen. In Terminal Sedation, the patient often dies of the sedation or dehydration.The abstract appears to indicate that nearly 22% of all sedations are of the terminal variety.
 
In all cases–whether lethally intended or not–consent should be given. But once killing becomes an acceptable "treatment," what's consent got to do with it? 
 
One last point: Legitimate Palliative Sedation is needed in, maybe, 2 or 3% of cases. But in the Netherlands, about 13% of patients die while sedated, meaning about 10% are Terminal 
Sedation cases. When euthanasia, assisted suicide, termination without request or consent, and TS are added up, it amounts to about 14% of deaths in the Netherlands caused by intentional killing by physicians.
 
The toll is probably higher in Belgium, which has enthusiastically embraced the euthanasia culture of death.
 

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