End of life

Belgium - Euthanasia of minors in Belgium

On 28 February 2014 a law was enacted "amending the Act of 28 May 2002 on euthanasia in order to extend it to minors"1. Belgium thus became the first and only country to authorise euthanasia of minors without specifying that any conditions with respect to their age should be met.

Some people welcomed it, underlining the "pioneering" role Belgium played in establishing a legal framework for euthanasia, which was presented as the ultimate "humanitarian act" of which any patient, major or minor, should be able to take advantage. In contrast, others in Parliament and in civil society opposed the extension of the law. Among these were nearly two hundred paediatricians and paediatric palliative care specialists.

Clearly, the ethical, legal and medical questions that euthanasia raises are no less acute when it comes to approving a request from a minor. This article provides an overview and, after sketching the outline of the new legislation, makes several critical points.

 PDF file  Read more 

Are people in a persistent vegetative state "Vegetables" ?

Playing tennis in your head

The case which has clearly contributed the most to broadcasting the issue of people in a persistent vegetative state is the one of Terri Schiavo.  In medical history, persistent vegetative state (PVS) is relatively recent (start of the 70s). The technical developments in intensive care made during the 60s have in effect allowed patients, showing a serious deterioration of brain functioning, to survive.

Most recently, two teams - one directed by the neuropsychologist Adrian Owen (University of Cambridge), the other by Steven Laureys, neurologist (Centre de Recherches du  Cyclotron, University of Liege) - established that the brain activity of a patient in a permanent vegetative state (a 23 year old English female) indicated that she was conscious of herself and of her surroundings. The experiment consisted of giving oral commands to the young lady whilst a functional magnetic resonance imaging machine measured her brain activity.  The scientists asked he...

 PDF file  Read more 

Belgium - Does the Belgian model of integrated palliative care distort palliative care practice?

The purpose of this report is to describe the Belgian model of end of life care that, since 2002, has aimed at developing "palliative care for all", while nonetheless authorizing the practice of euthanasia under certain conditions.
The thirteen years since the passage of this decree have culminated in a clash between two opinions:
 * one affirms that the decriminalization of euthanasia has truly enabled the development of continuous, palliative care;

* the other, conversely, stresses that making euthanasia commonplace is cannibalizing, and, little by little, distorting the concept of palliative care, which, in principle, focuses on support until death, but without triggering it.

After we have explored the evolution of the philosophy of palliative care in Belgium, it will be useful to examine the consequences of this integrated approach, as much for the well-being of patients as for the proper practice of medicine and management of life's end in health care institutions.

 PDF file  Read more 

Netherlands - Euthanasia of newborns and the Groningen Protocol

Until now, only three countries in the world have decriminalised euthanasia: the Netherlands, Belgium and Luxembourg. This practice is available only to people who are mentally competent when they apply (if necessary, via a declaration in advance requesting euthanasia).
A notable exception to the voluntary nature of the request for euthanasia concerns newborns who face suffering that is deemed intolerable and who have no prospect of enjoying an acceptable "quality of life" at any point in the future. In a text written in 2004, entitled the Groningen Protocol, Professor Eduard Verhagen, Head of the Department of Paediatrics at the Medical Center of the University of Groningen in the Netherlands, provides criteria to enable doctors to deliberately end the life of severely ill newborns.
First we outline the content of the Groningen Protocol, specify its legal status in the Netherlands and present several statistics. Then we review the main criticisms of the Protocol. Finally, the issue...

 PDF file  Read more 

Euthanasia in Belgium : 10 years on

Belgium - Euthanasia in Belgium : 10 years on

May 28, 2012 marks the 10th anniversary of the legalisation of euthanasia in Belgium,  with the Netherlands following suit a year earlier and Luxembourg doing the same in 2009 6.

To date, these three Benelux countries are the only ones to have legalised the act of intentionally killing a person who makes such a request. At a time when legalisation of euthanasia is being debated in several European countries, notably in France, it would appear appropriate to take stock of the last 10 years of implementation of the law on euthanasia in Belgium.


 PDF file  Read more 

Ethical points in caring for people nearing end-of-life

Ethical points in caring for people nearing end-of-life

Issues linked to ageing and the end of life are complex and sometimes painful. The questions surrounding this topic are sensitive and cannot have a simple response. They challenge our sense of solidarity and our ingenuity in seeking ways and means to express true compassion and act appropriately.  

Several people have become household names as part of the debate on the end of life. Whether we like it or not, they have become part of our collective memory: Karen Ann Quinlan and Terri Schiavo from the United States, Ramón Sampedro and Immaculada Echevarría from Spain, Vincent Humbert and Chantal Sébire from France, Piergiorgio Welby and Eluana Englaro from Italy, Hugo Claus from Belgium, and many others.  

The media has focussed on extreme cases which have been brought to public attention because of their particularly dramatic nature. Thus, the discussion has largely been based around certain "unusual" situations with high emotional stakes. Because of this, the complex ...

 PDF file  Read more