The difficulty of controlling euthanasia practices once they are made legal, based on problems experienced in Belgium.
This is the testimony of Carine Brochier
European Institute for Bioethics, Brussels to New Zealand
Dear Members of the Health Comittee,
Can I assume that you are aware of the documents available on the European Institute of Bioethics’ website in English?
· Euthanasia in Belgium: 10 years on
· Does the Belgian model of integrated palliative care distort palliative care practice?
· Euthanasia for minors
In the submission I sent you, I insisted on the fact that euthanasia law application is difficult to control mainly because of the subjective concept it holds: “unbearable physical pain”. Belgium has very good palliative care which allows 96% of physical pain to be alleviated. Control over euthanasia law is therefore not possible because of the subjective concept of “unbearable physical pain”. Priority is given to the patient’s autonomy allowing him to demand: “Do as I say! Do what I want!” whatever the existing alternatives.
The question is:
Should we bother trying to control a law which is inherently incontrollable?
Should we try to identify the foreseeable consequences of the euthanasia practice in Belgium namely its negative collateral effects?
This is the purpose of my contribution, to show that not only doctors, nurses and hospitals but also family members may suffer from the death decision of one and only person. The same way suicide has negative collateral effects on society, euthanasia also holds these consequences and probably in even worse proportions.
First, let us talk about the negative collateral effects of euthanasia on family members. At the European Institute of Bioethics, we receive quite a few witness statements from family members, daughters and sons, nephews and nieces, etc., expressing the fact they are fighting against one another. In some cases, disputes occur between brothers and sisters, in other cases between children and one of their parents. Conflict may appear when one family member wants to take care of his dying kindred while another would agree on euthanasia of his relative. This kind of disagreement has already lead to the unbearable situation in which an ill mother at the end of her life is indecisive and cannot express her will nor make a firm decision on her own fate. In this specific case, tensions between family members were very hard to manage. The fact that this could happen at the very last moment of the mother’s life is an awful shame. I do not mention here cases where the mother did not ask for euthanasia but whose death was hassled upon request of the family and in total contradiction with the terms of the euthanasia law. You can easily imagine that when a family mourns their dead relative, it is very unlikely anyone shall be in the mood for bringing this case to court.
Now, let us tackle negative collateral effects of euthanasia on doctors as individuals. More and more often, the European Institute of Bioethics gets testimonies from psychologists, nurses and doctors who confide in us about how the participating in the euthanasia process is hurting them and has psychological effects on them. A growing number of practitioners refuse to perform euthanasia because they do not feel well after the procedure in which they deliberately put an end to somebody’s life.
A hospital director who used to practice euthanasia up to 10 years ago shared with us the fact that he was still waking up during the night with the faces of euthanized patients in mind. He also added that even if it does not happen to him every night, these nightmares are strong enough for him to say that he does not sleep well anymore. Another doctor said right after practicing a euthanasia: “My quota is full, I can only perform two euthanasia’s per year, no more! Otherwise, I will break down!”
You may want to know that after a euthanasia is performed in a hospital, the medical team has a meeting with a psychologist to evacuate the negative feelings and the stress due to this deadly act. A doctor once reported us that a psychologist taking part in this type of counselling told him that a doctor who performs euthanasia should take some distance from the situation, that one shall dehumanize himself and put aside some of his human reactions. Is this what we expect from a medical team? That medical staff should dehumanize themselves, change their human nature to hold on? The euthanasia topic is of major importance for the mental health of the medical team and (the negative effects of euthanasia) for the therapeutic alliance between the patient and the medical team. Do we really want dehumanized people around us when we are sick and about to die? Dehumanizing oneself is a means for the practitioner to protect himself and has no contribution to the patient’s well-being. A doctor who performs euthanasia will not be the same for the next patient he deals with. How could a doctor be totally himself when the previous patient imposed him to let a part of himself die?
What we just explained is based on different witness statements, it is a reality. This reality is not visible in the first place, it is very often hidden because euthanasia has become a right. Moreover, doctors who would not perform euthanasia are truly under pressure on behalf of their peers.
This leads us to our third point: the negative collateral effects of euthanasia on hospitals and nursing homes. In such institutions, as the IEB sees it in Belgium, there are doctors, on the one hand, who accept performing euthanasia and, on the other hand, those who do not. Within a same ward, it is well known who is in favour of euthanasia and who is not. Doctors must take position, they are under pressure and what the IEB hears more and more often is that the doctors who do not perform euthanasia have the reputation of being the “bad guys” who lack compassion. What we just said for doctors is true for nurses and the conflicts between doctors and the ones between nurses are greatly damaging a qualitative medical team work. We can easily understand that such an atmosphere does not ensure the best care possible for all other patients in the institution year after year. We also hear that to be truly part of the team and not to have problems with their hierarchy, some nurses and doctors perform euthanasia to avoid trouble and career obstacles. Is euthanasia positive for effective team work? Does euthanasia provide these teams with good working conditions in these circumstances?
No later than yesterday, a university hospital oncologist expressed himself regarding the level of stress increase at each euthanasia request. When an end-of-life patient is admitted to the hospital and requests euthanasia it is a tremendous stress factor for the doctor who knows that his team is not ready to perform euthanasia. On top of that, there is a real pressure from the Government on certain institutions, forcing them to have euthanasia as the “ultimate medical care”. The political pressure and blackmail are now part of the reality as euthanasia has become a right. Therefore, hospitals are not entitled to refuse any kind of medical act, even if this means denying conscience clauses. The institution’s freedom, its independence in making its own decisions is at stake. There is a debate in Belgium regarding the freedom of institutions not to accept euthanasia within their walls. As those institutions are financed by the state, you can easily imagine how power of persuasion is used: “You must practice euthanasia, otherwise, some of your services will not be subsidised anymore.” – true blackmail.
Now, let us address the negative collateral effects of euthanasia on fragile people, patients who are close to dying. After ten years of practice in Belgium, euthanasia has become the best way of dying, avoiding any form of suffering. The European Institute of Bioethics, which is in contact with doctors and patients, notices that it has become an automatism for patients to ask for euthanasia when a doctor announces them with a serious diagnosis: “Doctor: I want to have euthanasia, you have to write it down in my medical file!”. Only last week we received another testimony from somebody who was in a hospital waiting room and overheard a conversation between a husband his wife. This lady, who had recently been diagnosed with cancer, told her husband: “We have to ask him how I can get euthanasia.”. Here again, the practitioner is put under pressure. Not only from the patient himself but also from his relatives.
Practitioners must take the necessary amount of time with their patients to expose to them the entire range of possibilities in terms of palliative care. Dying patients and their relatives must know how it is made possible for everyone to get a good end of life in a palliative care structure in Belgium.
Unfortunately, pressure upon sick and old people to choose euthanasia instead of palliative care is common due to the euthanasia mentality often conveyed by media. When these ill people understand that they might become a burden for their families, when relatives understand that euthanasia only costs €100 while palliative care is more expensive for the society, euthanasia becomes the most altruistic solution for all.
The consequences of patient’s autonomy dictatorship and the possibility for an individual to ask another human being to kill him is now showing its effects in Belgium, 15 years after euthanasia depenalization. In the name of the patient’s autonomy, the person who asks for euthanasia is only considering oneself and not what one leaves behind. Blinded by its suffering from the loss of autonomy and by one’s will not to be a weight on others. One thinks euthanasia is the best way to leave the world – this is a total lie. One does not see the negative collateral effects on doctors, family members nor relatives.
If the state allows doctors to kill their patients the whole health system is in danger. Not only the entire health system is jeopardized but the living together and solidarity of a nation is under a threat. Life is not an individual choice because it concerns the whole society. Euthanasia is not only killing upon request. Euthanasia is killing our health system. Euthanasia is killing our relations within a human society.
To conclude, our first statement was about the impossibility to control a law that would allow euthanasia. Even in “very strict terms”, with the best political will to have the best law possible, control over it is impossible. Even if they were controllable, negative collateral effects of euthanasia should still be a priority issue to deal with. Our living together, our solidarity, our taking care of the most fragile people is at risk if we give the choice of death to individual people. Our solidarity is at risk if the so-called patient’s autonomy becomes a priority, if patient’s autonomy becomes a dictatorship. For these two aspects, I would encourage people of New Zealand not to open the door in any case to any form of intentional death, euthanasia nor assisted suicide.
Sincerely from Belgium,
European Institute for Bioethics, Brussels