Can a Belgian hospital or nursing home refuse to take part in euthanasia deaths? The law can determine the answer to that question entirely by a decision of the parliament or the courts. The hospital, the aged care facility or, more appropriately, the network to which they belong, may also decide for themselves. If that decision is at odds with the law, then there may be consequences - but that does not take away the institution's right to make that determination. What most certainly may be at peril in such circumstances would be the institution's right to make such a decision without loss of freedom or privilege on a par with similar other institutions that have taken the opposite view.The newly installed Archbishop of Mechelen-Brussels, Jozef De Kesel, has prized open this 'can of worms' in Belgium in his recent statement asserting the right of Catholic hospitals and aged care services to refuse to co-operate. That they currently do co-operate - many under formal protocols - is a significant concern but not the focus of this article. Continue reading

"there is no free choice as there is only one choice." The newly installed Archbishop of Mechelen-Brussels, Jozef De Kesel has begun his time as the leader of Belgium's Catholics in what is seen by some as a controversial manner.Installed on the 12th of December, in one of his first interviews with the media, the new Archbishop asserted the Church's opposition to both abortion and euthanasia.No controversy there. Like it or not, no-one will be in any doubt that De Kesel was simply stressing the 'party-line', as it were. What is controversial, though it should not be so, is that De Kesel stressed that Catholic hospitals and care institutions have the right to refuse to co-operate with both euthanasia and abortion. Continue reading

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. Continue reading

Belgian MP calls for a review of the euthanasia law The open letter from medical professionals critical of the application of the Belgian law on euthanasia to people suffering psychologically has re-ignited debate on the safety and practice of the 2002 law.Following the letter, Christian Democrat MP, Els Van Hoof, raises significant further questions in the Belgian journal Knack. Van Hoof is severely critical of the development of the Belgian law and the amendment to include children in 2013 when, at no time over the more than a dozen years of operation has the law been formally reviewed. Continue reading

Paul Russell The Flemish Newspaper, De Morgen published an open letter by a distinguished and long list of 65 Belgian Psychiatrists, Psychologists, Philosophers and others calling for the 2002 law on euthanasia to exclude euthanasia for psychological suffering.Triggered on this occasion by two contemporary situations, it follows an earlier letter in September 2015 published in the medical magazine Artsenkrant where the group warned doctors about the uncertainty of legal protection for euthanasia for these same reasons. That letter responded an academic paper published in the British Medical Journal in July 2015 by Dr Lieve Thienpont reviewing euthanasia requests from 100 Belgian patients. Thienpont, notably, was involved in the approval of all 48 successful requests (and also that of 'Laura' - see below). Continue reading

De Standaard newspaper is reporting today that, for the very first time since its inception in October 2002, the Belgian Euthanasia Commission has referred a reported euthanasia case to the judiciary for review. The case in question is well known as it was recorded by the Australian SBS TV Network reporter, Brett Mason, in a Dateline documentary aired in Australia in September. As Mason reported:"Simona de Moor is a physically healthy 85-year-old. She lives in a care home in Antwerp, but is still active and on no medication. Continue reading

by Paul Russell: "When you break the big laws, you do not get freedom; you do not even get anarchy. You get the small laws." G.K. Chesterton.Such are the consequences of breaking down the prohibitions on killing and assisting in suicide.Western democracies seem more and more these days to have forgotten that the big statute laws such as the prohibitions on homicide are really about the state codifying immutable truths as custodians of genuine, equal and inalienable rights. The principle error in places like The Netherlands and Belgium with euthanasia was the acceptance of the false principle that, in all things, the state is a law unto itself; that it can define and redefine the nature of things by its own will.There are always consequences. When we change from 'do not kill' to 'only kill in some circumstances' we necessarily need to define those circumstances; the 'small laws'. These 'small laws' lack the precision of the 'big laws'. In terms of euthanasia and assisted suicide, they rely on subjective assessment. Whereas the 'big laws' are clear and allow for our courts to assess the circumstances, attendant penalties and the application of mercy, the 'small laws' such as who might qualify for state sanctioned death, are really little more than unenforceable guidelines.The moral code prohibiting homicide - which the law had previously endorsed and enforced - is breached. The 'small laws' that follow are entirely consequential and support Chesterton's hypothesis. Indeed, it can be observed that the necessity of these consequential 'small laws' can be taken as a retrospective proof that the 'big law' was, itself, a guarantee of a freedom or duty that existed prior to the state and which the state should never have messed with.Difficult if not impossible to enforce, these new 'small laws' render the 'big law' increasingly impotent in its original principles of protecting citizens from harm. In The Netherlands, successive court judgements from the 1980s preceded the 2002 legislation and 'small laws' continue to follow on in one form or another.In Belgium, the public prosecutor's role in pursing homicides is deeply compromised in respect to euthanasia. That office has been largely neutered; the regulatory role having been passed to a commission who assesses reports on each euthanasia deaths properly notified. In more than a decade, no cases have been referred for possible prosecution. The growing list of publicised euthanasia cases suggest that there have been many where further scrutiny should have been applied. That some doctors don't report their cases at all is also well known. Even these flimsy guidelines are being deliberately flaunted without comment and without redress.Having trampled over the logical moral boundary against killing, more 'small laws' become inevitable. Again, Belgium springs easily to mind having extended its 2002 laws in 2013 to include euthanasia for minors and having also expanded the concept of the original law to now include euthanasia for psychiatric reasons.What began as a response, albeit a dubious one, to the question of suffering at the end-of-life, has become a right. The state, having created a right has a duty to provide the means. Initially this duty created no obligation on anyone except the state; the person would request euthanasia voluntarily and there was no obligation on any doctor to agree. Medical professionals were free to decline on grounds of conscience and/or on other grounds.That defence - the right to refuse or to dissent - is now also under serious threat in a number of places. Once the euthanasia monster is unshackled from the 'big laws' it feeds voraciously, gnawing away on the 'small laws' until it gains enough strength and momentum to tackle other 'big laws'.Conscientious objection is perhaps the last such domino to fall. Though not a 'big law' itself, in terms of formal statutes, it is a hitherto undisturbed 'big principle'. If euthanasia is a right, then there is logic in its imposition.This may come to a head soon in both Belgium and The Netherlands via a legal stouche following the suicide death in Holland of Milou de Moor after her approval for euthanasia was withdrawn. Her parents have said that they will sue her GP, who pressed for the euthanasia request to be stopped, and the Belgian hospital who agreed to reverse their earlier decision to proceed. In Canada, the recourse to conscience has fallen even before the breach of the 'big law' on homicide comes into force. The Quebec Government recently made it clear that they will expect the co-operation of all doctors in their coming euthanasia regime, even going so far as to threaten the loss of funding for agencies that refuse to comply.We break with the 'big laws' at our ultimate peril. 'Small laws' carry little force and are easily eroded of all potency overtime. This is one instance where 'big' is definitely 'better'.see also:Quebec tells doctors they will be made to practice euthanasiaFamily to sue over withdrawal of euthanasia  Continue reading

A complicated set of circumstances lead to the approval, over a three year period, of euthanasia for Dutch resident, Milou de Moor who suffered from Lupus; a debilitating autoimmune disease. Treated in Belgium at the University Hospital in Ghent, de Moor was to be euthanased by her neurologist of six years.However, her Dutch general practitioner, who had not been required to approve the euthanasia, intervened and, after discussing his or her reservations with the Ghent Hospital ethics committee, the approval for her euthanasia was formally withdrawn. On hearing the news, de Moor then took her own life.According to reports, the intervention at this point of de Moor's GP was entirely unexpected; especially considering that he or she had been virtually silent on the matter over the preceding three years and had seemed to support the process.The Dutch and Belgian laws presuppose the involvement of the persons GP, but they do not mandate it. De Moor's family are now said to be considering legal action against the GP and the Ghent hospital.There's much in this sad situation that we do not know. The GP concerned has not spoken publicly and is on leave.According to the media, de Moor's family wants to take action to prevent this kind of thing from happening again. One can understand their grief. But what, precisely, would a successful law suit prevent?This is a very serious question. On the face of it, perhaps the remedy being sought is to prevent any medical professional from intervening in a euthanasia process once initiated. If that is the case, any remaining sense of obligation of the state to protect its citizens will have been all but obliterated. Any vestige of process, be it genuine or otherwise, would become a rubber stamp; medical judgement and even any requirement of second or third opinions will become meaningless. The Low Countries will have reached euthanasia on demand.Over all of that, as I've pointed out before, the damage to the culture can be seen in this false dichotomy that only offers euthanasia or suicide as solutions. See also:SBS Dateline special report: Allow me to dieThe 'end of the therapeutic path': supporting suicide in disguise Continue reading

by Paul RussellThe relationship between suicide and the double sided spectre of euthanasia and assisted suicide is complex. Though complex, it is paradoxically easily understood at first glance given that all three relate to a wish to die and given that some of the most prominent advocates for the latter also involve themselves in the former.Though advocates for both euthanasia and assisted suicide have tried to soften and obscure this reality by the use of slogans such as 'assisted dying' and 'dignity in dying', I expect that most people understand the correct terminology. At the very least, people understand that both euthanasia and assisted suicide include an active decision by a third party or parties to take part in an action that has as its goal making someone dead.There is little substantive difference between the hopelessness experienced by the 'person on the ledge' who acts alone and the person who either asks for a lethal substance to take themselves or asks for a medical professional to deliver the dose. All three are about hopelessness.Few suicide prevention organisations have actively engaged with this relationship. The promotion of personal autonomy as the highest ideal added to a difficult prognosis colours both euthanasia and assisted suicide drawing the false conclusion that prevention is applicable to some and not to others. That some seeking an early demise should have their desire accepted. Accepted under the cloak of medicine that somehow sanitizes the grizzly behaviour.But in Belgium, that medical cloak has been extended in recent years to the suicidal but otherwise not dying. Between 50 and 60 cases of euthanasia were recorded in 2013 and 2014 where the overwhelming reason for the euthanasia request was recorded as psychological.The Belgian act of 2002 states that: The patient is in a medically futile condition of constant and unbearable physical or mental suffering that can not be alleviated, resulting from a serious and incurable disorder caused by illness of accident.Mental suffering, or what we would call psychological suffering is clearly included here. The phrase: The patient is in a medically futile condition of constant and unbearable physical or mental suffering is entirely subjective. It is somewhat modified by the criteria: that can not be alleviated; a caveat that, one would have thought, would have excluded those for whom treatment had not been yet exhausted.That seems to be the opinion of 38 Belgian psychiatrists and medical staff who recently gathered to pen an open letter to the Belgian people questioning the rise in euthanasia for psychiatric reasons. (De Standard) Prompted by the widely publicised euthanasia death of the 24 year old "Laura" who did not want to continue living these medical professionals insist that those involved in the euthanasia request should provide proof that the constant and unbearable physical or mental suffering cannot be alleviated. Otherwise, as they say, the act of euthanasia would be illegal.They cite Co-Chair of the Belgian Euthanasia Evaluation Commission, Dr Wim Distelmans and his observations that two criteria must be satisfied: that the patient has suffered for a long time and is 'at the end of the therapeutic path'. They observe that often, given the opportunity, such people go on to 'develop a satisfying life' and observe that it is the nature of mental suffering of 'not seeing prospects' noting that, 'the impression of lack of outlook teaches nothing about the prognosis of mental suffering'. An unambiguous reference to the pathology of mental illness and suicide.Distelmans' assertion that the criteria that the person be 'at the end of the therapeutic path' appears disingenuous. In the case of Tom Mortier's mother, Godelieve De Troyer, she has been suffering clinical depression for years, was under good care but was suffering following a relationship break up. Distelmans could have insisted that she talk to Tom and his sister; a clear therapeutic option. He did not. Dr Marc van Hoey could have likewise withheld the euthanasia of Simona de Moor who was grieving at her favourite daughter's untimely death until such time as she reconciled with her other daughter or until her grieving had passed. He did not."Laura" was clearly in the grip of suicidal ideation following the death of a friend. Though she appears to have had a history of mental illness, her request for euthanasia was triggered by her loss.The 38 medical professionals also observe that Distelmans' supposed twofold criteria will also have a perverse effect upon the work of psychiatric clinicians. They suggest that such clinicians may begin to question just how far they might be prepared to go in treating a patient who is asking to die.Distelmans is exposed further in the letter by the attribution of a quote wherein he observes that euthanasia for psychological distress is a necessary option 'as long as there are people who go throw herself (sic) under a train or from the top of an apartment building' adding that, 'euthanasia is still too taboo'.And there you have it: my opening point reinforced in a chilling fashion. Rather than actually helping the person 'on the ledge', Distelmans would rather simply change the method. And we've heard this many times before; the false reasoning that because desperate people choose to suicide we need to change the law. Where is due care in that equation?The Belgians are reinforcing any sense of hopelessness and adding into the mix nihilistic abandonment.A link to the Statement by the 38 Belgian specialists (in French) can be found HERE. Continue reading

Last night saw the screening of a documentary filmed by the Australian Special Broadcasting Service (SBS) and made by their highly regarded European Correspondent, Brett Mason. It looked at the Belgian euthanasia regime through the lens of personal stories.As the documentary unfolds we hear clearly from Mason, a voice of concern. To his credit, both in the documentary and in his blog story, he doesn't put his own views nor conclusions. Clearly, however, the reality of euthanasia is very different from his initial conceptual thoughts as evidenced in these comments from the blog: "I was taken aback - not for the first time in recent weeks - by just how mundane and unremarkable euthanasia is to those who perform it.""I'm unable to bury a burning sense of anguish in the pit of my stomach. While I fully accept and respect that this decision was the patient's and the patient's alone, over these last nine months I've been filming in Belgium questions have repeatedly been asked about how this nation's euthanasia laws are safeguarded." Continue reading