Nightingale Alliance® Euthanasia Opposition - Resources, End of Life Alternatives

Summary

Euthanasia in Belgium is defined as “the act, performed by a third party, which intentionally ends the life of a person at his or her request. Before killing a patient, the physician must ascertain (1) whether the patient is an adult or emancipated minor, capable and conscious at the time of the request; (2) whether the request is made voluntarily, is well-thought out and reiterated, and not the result of outside pressure; and (3) whether the patient is in a hopeless medical condition and complains of constant and unbearable physical or mental pain.

In all cases the physician must: (1) inform the patient of his/her diagnosis, prognosis, and life expectancy; (2) ascertain the persistent nature of the patient’s physical or mental pain and reiterated request for euthanasia; (3) hold a consultation with an independent physician, who is competent concerning the pathological condition of the patient, and who shall study the medical record, examine the patient, and write a report of his/her findings (the report will be discussed with the patient by the treating physician); (4) if a treatment team is involved, discuss the patient’s request with the team; (5) if the patient continues to pursue euthanasia, discuss the patient’s request with those persons close to him/her that s/he designates; and (6) ascertain whether the patient has had the opportunity to discuss his/her request with those persons.

If the physician is of the opinion that death is not expected within a short period of time, he/she must also (1) obtain a consultation with a second physician, either a specialist or psychiatrist, who must study the medical record, examine the patient, ascertain the constant, unbearable and unrelievable nature of the physical or mental suffering, and the well-thought-out and persistent character of the request, write a report of his findings; and (2) allow one month between the patient’s written request and the euthanasia. The request may be cancelled at any time. All requests for euthanasia, and all steps taken by the physician, including the reports of the consulting physicians, must be entered into the medical record.

Belgium law also provides for a declaration for euthanasia called “anticipated declaration” which a person may provide in anticipation of the eventuality that s/he would no longer be able to express his/her wish for euthanasia. The declaration may request euthanasia if (1) s/he is the victim of a serious and incurable accidental or pathological condition; (2) s/he is unconscious; and (3) that this constitutes an irreversible situation. The declaration may be made at any time, in writing, with two witnesses, and dated and signed by the declarant and by the witnesses. A patient representative may be appointed to discuss the matter with the physician. A medical certificate confirming the permanent physical incapacity must be attached to the declaration. The declaration may be withdrawn or modified at any time. The declaration will be invalidated if it is executed more than five years from the onset of the incapacity. There is a special provision for those persons physically incapable of writing.

Before proceeding with euthanasia based upon a declaration, the physician must confirm that (1) the patient is suffering from a serious and incurable accidental or pathological condition; (2) the patient is unconscious; (3) the condition is irreversible; and (4) that the physician has complied with the conditions and procedures prescribed by law. Specifically, the physician must: (1) consult with an independent physician regarding the issue of irreversibility, who must review the medical record, examine the patient, and write a report (the report will be discussed with the patient representative by the treating physician); (2) if there is a treatment team, discuss the declaration with the team; (3) if a patient representative has been designated, discuss with the patient representative the declaration; and (4) discuss the declaration with those persons close to the patient and designated by the patient representative. The declaration and all steps taken by the physician, including the consulting physician’s report, must be made part of the medical record.

Posted on June 26, 2004.