End of life (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.
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.
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.