Belgium: mandatory referral for euthanasia
Project Letter to the Belgian Association of General
6 October, 2004
Secretariaat, Nancy Denyn
Wetenschappelijke Vereniging van Vlaamse Huisartsen
Thank you for your reply to our letter of 23 July, 2004, concerning your
Standpunt over medische beslissingen rond het levenseinde en euthanasie.
I am pleased to see that you do not mean to compel conscientious objectors to
participate in euthanasia. This common point of departure promises a fruitful
discussion of related issues.
The text of the statement from the Federatie Palliatieve Zorg Vlaanderen does
clarify your understanding of the relationship between euthanasia and palliative
care, but some points remain obscure.
On the one hand, the statement describes euthanasia as a legitimate part of
the continuum of palliative care, so much so that a member of a palliative team
might act as the second physician in processing a euthanasia request. On the
other, the statement insists that a palliative care team member must not be
expected to perform euthanasia. The rationale for this division of
responsibilities is unclear. If euthanasia is a natural and morally legitimate
extension of palliative care, upon what grounds do you insist that palliative
care physicians must not directly participate in it?
Similarly, the Standpunt seems to emphasize the importance of
multidisciplinary teamwork and the involvement of general practitioners, yet you
state that you do not intend to make euthanasia part of the provision of
normal health care. How can this separation be maintained if euthanasia is to be
performed by medical personnel as part of a continuum of care, but not by
specialists or euthanasia teams or clinics?
The formal statement appears to go further than your letter in its
expectations of objecting physicians. The Standpunt asserts that an objecting
physician must refer a patient to a physician willing to perform euthanasia,
while your letter suggests that it would be sufficient to inform a patient of
the existence of the helpline. I would like to be certain which of these
assertions expresses the position of the signatories to the Standpunt.
The Standpunt includes, in English, references to
consent" and "shared decision making." ["Communicatie en overleg vormen de kern
van het 'informed consent', de 'shared decision making' . . ."] The Project has
found that these terms are now being used to override conscientious objections
of physicians in order to serve the autonomy of the patient. Please advise what
English language source was drawn upon in drafting this section of the document.
Finally, I would appreciate it if you would provide a copy of that part of
your Patients' Rights Act that refers to a physician's obligations to
provide a patient with information about "all possible therapeutic options". You
indicate that this obligation is accompanied by the right to fully express one's
moral objections to a procedure, and I would like to see how the statute is
phrased to strike this balance. The provision may suggest a means to resolve
conflicts about the provision of information to patients.