Survival of Patients With Liver Transplants Donated After Euthanasia, Circulatory Death, or Brain Death at a Single Center in Belgium

Nicholas Gilbo, Ina Jochmans, Daniel Jacobs-Tulleneers-Thevissen, Albert Wolthuis, Mauricio Sainz-Barriga, Jacques Pirenne, Diethard Monbaliu

Abstract

Journal of the American Medical AssociationTransplantation of organs donated after euthanasia may help alleviate the critical organ shortage.1 However, aside from preliminary data on lung transplantation,2 data on graft and patient survival following transplantation of organs donated after euthanasia are unavailable. Because donation after euthanasia entails a period of detrimental warm ischemia that hampers graft survival, similar to donation after circulatory death,3 results after transplantation of this type of graft need to be carefully evaluated.


Gilbo N, Jochmans I, Jacobs-Tulleneers-Thevissen D, Wolthuis A, Sainz-Barriga M, Pirenne  J, Monbaliu D.  Survival of Patients With Liver Transplants Donated After Euthanasia, Circulatory Death, or Brain Death at a Single Center in Belgium. JAMA. 2019;322(1):78-80. doi:10.1001/jama.2019.6553

Belgium’s euthanasia commission under fire after shock letter by whistleblower

BioEdge

Xavier Symon

Evidence of gross negligence is mounting against Belgium’s peak euthanasia regulatory body, the Federal Commission for Euthanasia Control and Evaluation.

Dr. Ludo Van Opdenbosch, a neurologist who was a Commission member for several years, resigned in September 2017. Associated Press recently obtained the letter of resignation that Dr Van Opdenbosch sent to senior politicians, which details his dissatisfaction with the oversight processes of the Commission. “I do not want to be part of a committee that deliberately violates the law,” he wrote.

According to the letter, the Commission failed to refer to authorities a doctor who Van Opdenbosch says euthanised a demented patient without consent. The letter outlines the basic details of the case – the patient, whose identity was not disclosed, was euthanised at the family’s request, and there was no record of any prior request for euthanasia from the patient.

Furthermore, Van Opdenbosch states that when he expressed concerns about other potentially problematic cases, he was immediately “silenced” by other members of the Commission. He suggests that because many of the doctors on the commission are leading euthanasia practitioners, they can protect each other from scrutiny, and act with “impunity”.

“It’s not euthanasia because the patient didn’t ask, so it’s the voluntary taking of a life,” said Dr An Haekens, psychiatric director at the Alexianen Psychiatric Hospital in Tienen, Belgium. “I don’t know another word other than murder to describe this.”

However, the two co-chairs of the commission, Dr Wim Distelmans and Gilles Genicot, have strongly denied that there has been any negligence. “It can obviously occur that some debate emerges among members but our role is to make sure that the law is observed and certainly not to trespass it,” they said. They also denied that Van Opdenbosch had been muzzled.

Associated Press had already revealed details of a rift between the co-chair of the Commission, Dr. Willem Distelmans, and Lieve Thienpont, an advocate of euthanasia for the mentally ill. Distelmans suggested some of Thienpont’s patients might have been killed without meeting all the legal requirements.

More than 360 doctors, academics and others have since signed a petition calling for tighter controls on euthanasia for psychiatric patients.


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Euthanasia dispute in Belgium: When do doctors cross a line?

CBC News

Associated Press

A disputed case of euthanasia in Belgium, involving the death of a dementia patient who never formally asked to die, has again raised concerns about weak oversight in a country with some of the world’s most liberal euthanasia laws.

The case is described in a letter provided to The Associated Press, written by a doctor who resigned from Belgium’s euthanasia commission in protest over the group’s actions on this and other cases.

Some experts say the case as documented in the letter amounts to murder; the patient lacked the mental capacity to ask for euthanasia and the request for the bedridden patient to be killed came from family members. The co-chairs of the commission say the doctor mistakenly reported the death as euthanasia. . . [Full Text]

Palliative care nurses quit ‘houses of euthanasia’

Catholic Herald

Simon Caldwell

Belgian nurses and social workers who specialise in treating dying patients are quitting their jobs because palliative care units are being turned into “houses of euthanasia”, a senior doctor has alleged.

Increasing numbers of hospital staff employed in the palliative care sector are abandoning their posts because they did not wish to be reduced to preparing “patients and their families for lethal injections”, according to Professor Benoit Beuselinck, a consultant oncologist of the Catholic University Hospitals of Leuven.

He said that after more than 15 years of legal euthanasia in Belgium “palliative care units are … at risk of becoming ‘houses of euthanasia’, which is the opposite of what they were meant to be”. . . [Full Text]

How does assisting with suicide affect physicians?

The Conversation

Ronald W. Pies*

When my mother was in her final months, suffering from a heart failure and other problems, she called me to her bedside with a pained expression. She took my hand and asked plaintively, “How do I get out of this mess?”

As a physician, I dreaded the question that might follow: Would I help her end her life by prescribing a lethal drug? . . . [Full Text]

Involvement of palliative care in euthanasia practice in a context of legalized euthanasia: A population-based mortality follow-back study

Sigrid Dierickx, Luc Deliens, Joachim Cohen, Kenneth Chambaere

Abstract

Background: In the international debate about assisted dying, it is commonly stated that euthanasia is incompatible with palliative care. In Belgium, where euthanasia was legalized in 2002, the Federation for Palliative Care Flanders has endorsed the viewpoint that euthanasia can be embedded in palliative care.

Aim: To examine the involvement of palliative care services in euthanasia practice in a context of legalized euthanasia.

Design: Population-based mortality follow-back survey.

Setting/participants: Physicians attending a random sample of 6871 deaths in Flanders, Belgium, in 2013.

Results: People requesting euthanasia were more likely to have received palliative care (70.9%) than other people dying non-suddenly (45.2%) (odds ratio = 2.1 (95% confidence interval, 1.5–2.9)). The most frequently indicated reasons for non-referral to a palliative care service in those requesting euthanasia were that existing care already sufficiently addressed the patient’s palliative and supportive care needs (56.5%) and that the patient did not want to be referred (26.1%). The likelihood of a request being granted did not differ between cases with or without palliative care involvement. Palliative care professionals were involved in the decision-making process and/or performance of euthanasia in 59.8% of all euthanasia deaths; this involvement was higher in hospitals (76.0%) than at home (47.0%) or in nursing homes (49.5%).

Conclusion: In Flanders, in a context of legalized euthanasia, euthanasia and palliative care do not seem to be contradictory practices. A substantial proportion of people who make a euthanasia request are seen by palliative care services, and for a majority of these, the request is granted.


Dierickx S, Deliens L, Cohen J, Chambaere K. Involvement of palliative care in euthanasia practice in a context of legalized euthanasia: A population-based mortality follow-back study. Palliat Med. 2018 Jan;32(1):114-122. doi: 10.1177/0269216317727158. Epub 2017 Aug 29.

What could help me to die? Doctors clash over euthanasia

Associated Press

Maria Cheng

GHENT, Belgium (AP) — After struggling with mental illness for years, Cornelia Geerts was so desperate to die that she asked her psychiatrist to kill her.

Her sister worried that her judgment was compromised. The 59-year-old was taking more than 20 pills every day, including antidepressants, an opioid, a tranquilizer, and two medicines often used to treat bipolar disorder and schizophrenia.

About a year later, on October 7, 2014, her doctor administered a lethal dose of drugs. It was all legal procedure in Belgium, which has among the world’s most permissive euthanasia laws.

“I know it was Cornelia’s wish, but I said to the psychiatrist that it was a shame that someone in treatment for years could just be brought to the other side with a simple injection,” said her sister, Adriana Geerts. . . .[Full text]

 

Ensuring access to euthanasia by encouraging physician participation: it’s complicated

Sean Murphy*

In July, 2017, Canadian euthanasia/assisted suicide (EAS) practitioners and advocates alleged that patient access to euthanasia and assisted suicide was in danger because of “barriers” and “disincentives” to physician participation. Dr. Stefanie Green, president of their professional association, described the situation as “a crisis.”1 There was, in fact, no crisis — only a false perception of crisis fuelled by unrealistic expectations about levels of physician participation in euthanasia and assisted suicide.2

Nonetheless, it is reasonable for policy makers to respond to their concerns that physicians are discouraged from participating in euthanasia and assisted suicide. Indeed, objecting physicians are less likely to experience disadvantage and coercion if policy-makers seriously consider suggestions by EAS practitioners and advocates about how to encourage physician participation in euthanasia.

Removing barriers and disincentives to physician participation

Minimizing procedural and administrative requirements
Returning to the complaints and concerns of Canadian euthanasia practitioners (see Canada’s Summer of Discontent2), reducing or streamlining procedural requirements and minimizing burdensome paperwork might encourage more physicians to participate. However, this raises a question that may prove difficult to answer. Is a procedural requirement a “barrier” — or a necessary safeguard? A “disincentive” — or an essential ethical prerequisite? The difficulty is illustrated by developments in Belgium. . . .[Full text]

Vatican summons Belgian order to Rome over euthanasia policy

Catholic Herald

Simon Caldwell

Vatican officials want to hear in person why Brothers of Charity board members insist on allowing the euthanasia

The Vatican is planning to summon members of a Belgian nursing order to Rome to explain why they are refusing to ditch a policy which allows doctors to kill psychiatric patients in Church-run homes.

Senior Vatican officials want to hear in person why board members of the Organisation of the Brothers of Charity insist on allowing the euthanasia of non-terminally ill patients in the face of a top-level order to reverse the policy. . . [Full text]

 

‘Utterly outrageous’: Belgian Catholic care group denounced by Church over euthanasia plans

Christian Today

James MacIntyre

A furious row has broken out within the Catholic Church over the Belgian Brothers of Charity, who are refusing to comply with a Vatican order to stop providing euthanasia for the people it cares for.

The UK-based Catholic priest Alexander Lucie-Smith has described the behaviour of the Brothers as ‘utterly outrageous,’ and pointed out the crucial fact that the order is lay-run.

In a statement released in Flemish, French and English, the organisation said it ‘continues to stand by its vision statement on euthanasia for mental suffering in a non-terminal situation’ and goes on to make the incendiary claim that it ‘is still consistent with the doctrine of the Catholic Church. We emphatically believe so.’ . . . [Full text]