Session 10: Euthanasia – Harm and Taboo
Chair: Barbara Dane
Jacqueline Herremans – The Belgian Law: From the Taboo to the De-criminalisation of Euthanasia
L aw Office, “Lallemand & Legros”, avenue E.De Mot 19, 1000 Brussels
End-of-life decisions are taken every day by physicians in hospitals (70 % of deaths occur in Belgium in medical institutions) or even by generals practitioners. It is generally accepted that physicians do decide to withhold or to withdraw treatment and to alleviate pain with opioids, even with the perspective of shortening life. The practice of administration of drugs with the explicit intention of shortening patient life is also extant; but for years, the rule of silence prevailed.
There was this common belief, that, while humans may invoke a right to live, they have no right over their own lives. No matter how this concept is presented – whether one asserts that life belongs to God or to Society – it is perfectly honourable and those who hold it are consistent with themselves in their refusal to shorten life. However, another concept focuses on the autonomy of the person.
The role of the law is not to impose one moral concept over another.
Belgium is the second country in the world (after the Netherlands) to pass a law on euthanasia. This law of 28 May 2002 placed the patient at the centre of the debate. Without a voluntary, well thought-out and repeated request of an adult patient, euthanasia cannot be a consideration. Furthermore, the living will or “anticipated declaration” is finally given a legal statute. The criminal law will no longer view the physician as a murderer if he/she respects the pre-conditions and the procedure. Finally, this law respects everyone’s freedom: on no one is euthanasia to be imposed, and no physician can be made to perform euthanasia against his/her will.
Roger Magnusson – Politics, Harm Minimisation and the ‘Euthanasia Underground’; An Australian Perspective
Faculty of Law, University of Sydney, Australia
There is a substantial body of literature quantifying levels of involvement in the practice of covert, physician-assisted suicide and euthanasia in the United States,1-2 Britain,3 Australia4-5 and other countries.
Despite this, very little is known about the social context of these illicit practices. Qualitative, interview-based research into illegal assisted death is in its infancy.
This paper draws on interview-based research into the practice of euthanasia by 49 health care workers specialising in HIV/AIDS health care in Sydney, Melbourne and San Francisco.6
Drawing on detailed, first-person accounts of involvement, the paper will illustrate how the ideals of “medical professionalism” frequently become corrupted in the “euthanasia underground”. Perhaps the most striking feature of covert euthanasia is the complete absence of norms, guidelines or stable criteria for deciding when it is appropriate to become involved. Accountability is absent. Participation is shrouded in secrecy, triggered by highly idiosyncratic factors, with evidence of casual and precipitative involvements. Participants lack the training required to achieve a gentle death, and “botched attempts” are common. In place of a tradition of disinterested service to patients, there is evidence of conflicts of interest and examples of euthanasia without consent.
“Underground euthanasia” presents difficult policy challenges. The criminal law neither effectively inhibits the practice of euthanasia nor adequately protects the vulnerable patients who most desire it. In this paper, I argue that the “euthanasia underground” is a public health and safety issue which should be addressed in pragmatic terms. At the same time, for all the debate about ethics and professionalism, euthanasia is also a political issue that must be resolved in political terms.7
This paper will assess a number of options for minimising the social costs and harms of “underground euthanasia”, including in circumstances where, for political reasons, the legalisation of euthanasia remains unlikely.