Euthanasia In Belgium Research Articles

Explorer les formes contemporaines de l’aide à mourir : ethnographie de situations d’euthanasie en Belgique et de suicide assisté en Suisse

Explorer les formes contemporaines de l’aide à mourir : ethnographie de situations d’euthanasie en Belgique et de suicide assisté en Suisse

Whose Choice? A Qualitative Inquiry into Professionals' Moral Positions on Euthanasia in Belgium.

Death, which was once accepted as an incalculable otherworld journey initiated by the cessation of biological functions, became an object of socio-political regulation in late modernity. Euthanasia, a form of managing death and dying, has grown in popularity with accompanying controversy. What remains under-explored, however, are conceptions of selfhood animating different framings in moral and ethical debates around euthanasia from professional perspectives. Drawing on 20 interviews with physicians and other key professionals in the euthanasia field in Belgium, this study finds that moral division among participants lies in different attributes of selfhood related to euthanasia, which emphasize autonomous, social, or embodied aspects. This paper demonstrates that the diminishing role of religion in appeasing existential anxiety about death, combined with an increasing emphasis on choice as the basis of selfhood, facilitates the contemporary desire to control one's own demise.

Euthanasie bij dementie middels een voorafgaande wilsverklaring: een reflectie vanuit België en Nederland

Advance directives for euthanasia in dementia: a reflection from Belgium and the Netherlands Concerning the current law on euthanasia in Belgium, it is often suggested to enable euthanasia in patients suffering from (severe) dementia by means of an advance directive, largely triggered by the authority principle of the person who initially requested it. The current manuscript reflects on this proposed law extension: it mainly wants to stress the complexity of the issue. It is concluded that advance directives for euthanasia in dementia are not easy to implement in an optimized dementia care pathway.

Euthanasia of a person with a psychiatric disorder does not violate the European Convention on Human Rights (Mortier v. Belgium [no. 78017/17]).

For more than 20years, euthanasia in Belgium and The Netherlands is allowed for unbearable suffering caused by terminal or non-terminal illnesses, including psychiatric disorders. Although euthanasia numbers have been increasing over the years, the percentage of cases involving people with a primary psychiatric diagnosis has remained stable (between 1 and 2%). For these cases, the Belgian and Dutch Euthanasia Laws operate similar due care criteria: a well-considered, repeated, and voluntary request from a legally competent adult; a medical condition without prospect of improvement; constant and unbearable suffering that cannot be alleviated; consultation of two independent physicians, including a psychiatrist; and a posteriori evaluation and control [1-3].

Organ donation after euthanasia starting at home in a patient with multiple system atrophy

BackgroundA patient who fulfils the due diligence requirements for euthanasia, and is medically suitable, is able to donate his organs after euthanasia in Belgium, the Netherlands and Canada. Since 2012, more than 70 patients have undergone this combined procedure in the Netherlands. Even though all patients who undergo euthanasia are suffering hopelessly and unbearably, some of these patients are nevertheless willing to help others in need of an organ.Organ donation after euthanasia is a so-called donation after circulatory death (DCD), Maastricht category III procedure, which takes place following cardiac arrest, comparable to donation after withdrawal of life sustaining therapy in critically ill patients. To minimize the period of organ ischemia, the patient is transported to the operating room immediately after the legally mandated no-touch period of 5 min following circulatory arrest. This means that the organ donation procedure following euthanasia must take place in the hospital, which appears to be insurmountable to many patients who are willing to donate, since they already spent a lot of time in the hospital.Case presentationThis article describes the procedure of organ donation after euthanasia starting at home (ODAEH) following anesthesia in a former health care professional suffering from multiple system atrophy. This case is unique for at least two reasons. He spent his last conscious hours surrounded by his family at home, after which he underwent general anaesthesia and was intubated, before being transported to the hospital for euthanasia and organ donation. In addition, the patient explicitly requested the euthanasia to be performed in the preparation room, next to the operating room, in order to limit the period of organ ischemia due to transport time from the intensive care unit to the operating room. The medical, legal and ethical considerations related to this illustrative case are subsequently discussed.ConclusionsOrgan donation after euthanasia is a pure act of altruism. This combined procedure can also be performed after the patient has been anesthetized at home and during transportation to the hospital.

Exploring contemporary forms of aid in dying: An ethnography of euthanasia in Belgium and assisted suicide in Switzerland

Drawing on two case studies from large-scale fieldwork carried out on euthanasia in Belgium and assisted suicide in Switzerland, this article focuses on the processes of normalization that structure aid in dying. Normalization takes place through a set of apparatuses only partially derived from current legislation, which underlie the relationships that develop between those requesting aid in dying, healthcare staff, volunteers, and loved ones. The resulting arrangements are specific to each national context, but the empirical data also point to broadly common traits, highlighting new paradigmatic forms of aid in dying in the contemporary era.

Eutanazja w Belgii – 16 lat po legalizacji

WstępEutanazja to pojęcie ogólnie definiowane jako czyn bądź zaniedbanie powodujące śmierć, a w konsekwencji przerwanie dotychczasowego cierpienia osoby nieuleczalnie chorej.Materiał i metodyAnalizę przeprowadzono na podstawie danych Europejskiego Instytutu Bioetyki. Główne źródło informacji stanowiły Raporty Belgijskiego Federalnego Komitetu ds. Kontroli i Oceny Eutanazji nr 1–8.WynikiJuż rok po zalegalizowaniu eutanazji w Belgii 235 osób zostało poddanych „wspomaganej śmierci”. W roku 2017 liczba eutanazji przekroczyła 2300. W latach 2002–2017 wykonano łącznie 17 063 eutanazje. Na przełomie ostatnich lat zmieniała się struktura wieku osób poddających się eutanazji. Zwiększa się liczba osób od 80 roku życia wzwyż, a zmniejsza w wieku 40–59 lat. Głównym miejscem śmierci pacjentów pozostaje dom i szpital.Wnioski1. Od momentu legalizacji eutanazji w Belgii liczba osób poddających się temu działaniu stale wzrasta. 2. W ostatnich latach częściej obserwuje się przeprowadzanie eutanazji w domu pacjenta oraz w domach opieki. 3. Spośród najczęstszych przyczyn eutanazji wymienia się choroby nowotworowe.

Euthanasia in Belgium: Shortcomings of the Law and Its Application and of the Monitoring of Practice.

In 2002 with the passing of the Euthanasia Law, Belgium became one of the few countries worldwide to legalize euthanasia. In the 18 years since the passing of the law, much has changed. We argue that in Belgium a widening of the use of euthanasia is occurring and that this can be ethically and legally problematic. This is in part related to the fact that several legal requirements intended to operate as safeguards and procedural guarantees in reality often fail to operate as such. We focus on three kinds of safeguards or procedural guarantees: (1) the legally defined due care criteria for eligibility for euthanasia; (2) the consultation of a second (and sometimes third) physician; and (3) the reporting of euthanasia cases to the Federal Control and Evaluation Commission for Euthanasia. We will show how each of these three safeguards can exhibit shortcomings in theory and practice.

The Importance of Clear and Careful Thinking in Clinical Ethics

AbstractClear and careful thinking is an indispensable aid in the pursuit of answers to the difficult ethical question faced by clinicians, patients, and families. In this issue of The Journal of Medicine and Philosophy devoted to issues in clinical ethics, the authors engage in this enterprise by reflecting on morally good medical decision making, conscientious objection, presumed consent in organ donation, the permissibility of surrogate decision making, and the failure of legislative limits on the scope of euthanasia in Belgium.

Flemish healthcare providers’ attitude towards tiredness of life and euthanasia: a survey study

Objectives To explore the legal understanding and attitudes of nurses and physicians in both acute and chronic geriatric care (Flanders, Belgium) regarding euthanasia in the context of tiredness of life in older people. Method Healthcare providers employed in acute care (59 geriatricians and 75 nurses of acute geriatric wards), as well as chronic care (135 general practitioners (GPs) and 76 nurses employed in nursing homes and home care services) were sent a survey with four case vignettes. For each case vignette, respondents were asked the following questions: (1) ‘Does this case fit the due-care criteria of the euthanasia law?’, (2) ‘Do you consider this person to be tired of life?’, (3) ‘Can you comprehend this person’s euthanasia request?’. Results In cases of severe and life-limiting physical suffering, where the patient meets the legal criteria for euthanasia in Belgium, only 50% of physicians and nurses are aware of this legal basis. In case of tiredness of life without underlying pathology, nurses showed more comprehension for the euthanasia request compared to physicians (43.0% vs. 10.8%, p < 0.001). Physicians tend to assess the legal base of an euthanasia-request depending on the severity of physical morbidity, whereas nurses show a greater comprehension towards euthanasia-requests even in absence of severe illness. Geriatricians are more reserved regarding performing euthanasia themselves as compared to GPs, regardless of underlying pathology or reason for the euthanasia-request (p < 0.001). Conclusion The legal understanding and attitude of Flemish physicians and nurses towards tiredness of life and euthanasia in older patients differed to a great extent. This study showed (1) a lack of awareness of the legal basis for euthanasia in the context of ToL among all HCPs, (2) differences in the extent of comprehension between nurses and physicians and (3) differences in willingness to actually perform euthanasia between geriatricians and GPs. So even with the formulation of strict due-care criteria there is still room for interpretation. This creates a gray area and a discussion point between healthcare providers.

Oyster Care: An Innovative Palliative Approach towards SPMI Patients.

Oyster Care is the result of the search by caregivers in Flanders, Belgium, to develop quality care for patients with a Severe and Persistent Mental Illness (SPMI). This article offers a conceptual analysis of the Oyster Care model, based on experiences, analysis, and reflection of the authors, and on several examples. The starting point of the development of this new care model is the complex and difficult context of the care for SPMI patients. Their needs and suffering are very challenging on account of a wide variety of causes. At the same time they are in danger of being neglected by the care system. Paradoxically, the development and implementation of psychosocial rehabilitation in Belgian mental health care puts the care for these patients under pressure. In practice, they are often exposed to over- or under-treatment. Another aspect that has influenced the search for more qualitative care in cases of severe psychological suffering in general and palliative approaches in particular is the background of the legal regulation of euthanasia in Belgium. Oyster Care is an innovative form of the palliative approach and philosophy, tailored to the specific target group of SPMI patients. The caregivers create an “exoskeleton” or “shell” in which SPMI patients can “come to life”: they are mainly dependent on the “external structure” they receive in order to function, rather than on the “internal structure” of their abilities. It is a dynamic approach that responds to the needs, possibilities and pace of each patient: within this safety, people can fold back or take new steps. Oyster Care is also a holistic care approach, based on four pillars: physical care adequately responding to the somatic impairments of these patients; psychological care changing the scope of therapy by focusing on mental comfort and wellbeing; social care providing a structure of daily activities and contacts; existential care enhancing the experience of life as valuable and meaningful. The wellbeing of patients is paramount and requires a range of interventions, such as a highly personal approach, a flexible dealing with rules, a great dose of creativity in everyday life, extensive expertise in somatic care, and specific attention to existential needs and the search for meaning. The development of this care model in a number of care units in Flanders increases the wellbeing of the patients and creates a significant positive dynamic among caregivers. However, more research and resources are needed to further develop and integrate this model.

What influences intentions to request physician-assisted euthanasia or continuous deep sedation?

ABSTRACTThe increasing prevalence of euthanasia in Belgium has been linked to changing attitudes. Using National health survey data (N = 9651), we investigated Belgian adults’ intention to ask a physician for euthanasia or continuous deep sedation in the hypothetical scenario of a terminal illness and examined its connection to sociodemographic and health characteristics. Respectively, 38.3 and 25.8% could envisage asking for euthanasia and continuous deep sedation. Those with very bad to fair subjective health and with depression more likely had an intention to ask for euthanasia, which suggests need for attention in the evaluation of requests from specific patient groups.

Potential Number of Organ Donors After Euthanasia in Belgium

Organ donation after euthanasia involves patients whose request to undergo euthanasia has been granted and who voluntarily want to donate their organs after death. It requires patients to undergo euthanasia in the hospital, and organ donation is performed after circulatory death. The practice is controversial and currently only allowed in Belgium and the Netherlands. Even in these countries, it is rarely performed; as of August 2016, 43 patients undergoing euthanasia had donated organs.1 Organ donation after euthanasia has been described in a practical manual, which addresses the medical, ethical, and legal aspects of performing euthanasia and donation after circulatory death.2

Euthanasia in Belgium: trends in reported cases between 2003 and 2013.

In 2002, the Belgian Act on Euthanasia came into effect, regulating the intentional ending of life by a physician at the patient's explicit request. We undertook this study to describe trends in officially reported euthanasia cases in Belgium with regard to patients' sociodemographic and clinical profiles, as well as decision-making and performance characteristics. We used the database of all euthanasia cases reported to the Federal Control and Evaluation Committee on Euthanasia in Belgium between Jan. 1, 2003, and Dec. 31, 2013 (n = 8752). The committee collected these data with a standardized registration form. We analyzed trends in patient, decision-making and performance characteristics using a χ2 technique. We also compared and analyzed trends for cases reported in Dutch and in French. The number of reported euthanasia cases increased every year, from 235 (0.2% of all deaths) in 2003 to 1807 (1.7% of all deaths) in 2013. The rate of euthanasia increased significantly among those aged 80 years or older, those who died in a nursing home, those with a disease other than cancer and those not expected to die in the near future (p < 0.001 for all increases). Reported cases in 2013 most often concerned those with cancer (68.7%) and those under 80 years (65.0%). Palliative care teams were increasingly often consulted about euthanasia requests, beyond the legal requirements to do so (p < 0.001). Among cases reported in Dutch, the proportion in which the person was expected to die in the foreseeable future decreased from 93.9% in 2003 to 84.1% in 2013, and palliative care teams were increasingly consulted about the euthanasia request (from 34.0% in 2003 to 42.6% in 2013). These trends were not significant for cases reported in French. Since legalization of euthanasia in Belgium, the number of reported cases has increased each year. Most of those receiving euthanasia were younger than 80 years and were dying of cancer. Given the increases observed among non-terminally ill and older patients, this analysis shows the importance of detailed monitoring of developments in euthanasia practice.

Legal and ethical aspects of organ donation after euthanasia in Belgium and the Netherlands

Organ donation after euthanasia has been performed more than 40 times in Belgium and the Netherlands together. Preliminary results of procedures that have been performed until now demonstrate that this...

First Do No Harm: Euthanasia of Patients with Dementia in Belgium.

In Memory of Ed Pellegrino. Euthanasia in Belgium is not limited to terminally ill patients. It may be applied to patients with chronic degenerative diseases. Currently, people in Belgium wish to make it possible to euthanize incompetent patients who suffer from dementia. This article explains the Belgian law and then explores arguments for and against euthanasia of patients with dementia. It probes the dementia paradox by elucidating Dworkin's distinction between critical and experiential interests, arguing that at the end-of-life this distinction is not clearcut. It argues against euthanasia for patients with dementia, for respecting patients' humanity and for providing them with more care, compassion, and good doctoring.

Euthanasia in Belgium and the Netherlands: On a Slippery Slope?

20. Kuiken A. Was haar leven nog leefbaar? Trouw. January 11, 2014. http://www.trouw.nl/tr/nl/4516 /Gezondheid/article/detail/3575826/2014/01/11 /Was-haar-leven-nog-leefbaar.dhtml. Accessed July 6, 2015. 21. Bolt EE, SnijdewindMC,Willems DL, van der Heide A, Onwuteaka-Philipsen BD. Can physicians conceive of performing euthanasia in case of psychiatric disease, dementia or being tired of living [published online February 18, 2015]? J Med Ethics. doi:10.1136/medethics-2014-102150. 22. van Tol D, Rietjens J, van der Heide A. Judgment of unbearable suffering and willingness to grant a euthanasia request by Dutch general practitioners.Health Policy. 2010;97(2-3):166-172. 23. Muller MT, Onwuteaka-Philipsen BD, van derWal G, van Eijk J, RibbeMW. The role of the social network in active euthanasia and physician-assisted suicide. Public Health. 1996;110 (5):271-275.

Transgender Persons Applying for Euthanasia in Belgium: A Case Report and Implications for Assessment and Treatment

Gender confirming treatment has proven to relief gender dysphoria as a symptom and to improve psychological functioning in transgender persons. Nevertheless, small percentage shows regret after their surgical treatment. Risk factors for regret are the presence of psychiatric problems, dissatisfaction with the results of surgery and poor socializing. In Belgium, euthanasia can be applied for in a situation of constant and unbearable mental or physical suffering. In recent years, three patients applied for euthanasia in the Gender clinic of the University Hospital Ghent, Belgium. We report on one case of a trans-woman applying for euthanasia and discuss on implications for assessment and treatment.

PC-FACS

PC-FACS

Pediatric euthanasia in Belgium: some ethical considerations

On February 2014, the Belgian Parliament approved the first law on children euthanasia stating that also young children can make the autonomous choice to have their lives terminated. This article reviews the ethical objections to the law. These include the impossibility to gauge the competence of children and their vulnerability, and the fact that euthanasia itself implies that some lives are not worthy of living. The denial of life as a “bonum onticum” reneges the very principles on which civil laws and medical ethics are founded.