- The Washington Times - Monday, August 13, 2001

BRUSSELS — Sunlight slants across the fifth-floor ward of Les Deux Alice hospital, where Dr. Michel Stroobant makes his afternoon rounds. He jokes with the nurses, admires a patient's family photo and shows a visitor the unit's homey lounge, complete with a microwave and a chatty canary.
But the cheery touches cannot erase reality. The fifth floor at Deux Alice is reserved for the terminally ill.
For nine years, Dr. Stroobant has overseen palliative care at this Catholic hospital located in a pleasant, tree-lined Brussels neighborhood. His team of nurses and social workers has eased the pain and terror of dying. But they will not bring on death.
"Death always means suffering, regardless of the quality of care and of those who give it," said Dr. Stroobant, a gray-haired physician with a jovial touch who is firmly against euthanasia.
"One must also accept the suffering, because death is also part of the mystery of life."

Euthanasia vote likely
Many here do not agree with this assessment. Soon, perhaps, the rules for dying at Deux Alice may be under siege. This fall, Belgian senators are expected to vote on a draft of a euthanasia law.
The lower chamber also must examine the measure. If passed, the proposal will make Belgium only the second country in the world to legalize the procedure.
In April, the Dutch Senate passed legislation legalizing mercy killings. The law goes into effect by this year's end. If a similar law is passed in Belgium, opposition Christian Democrats vow to take the matter to the European Court of Human Rights.
Critics argue that the legislation violates the European human rights law on inhuman and degrading treatment — though Belgium's State Council, a juridical advisory body, ruled otherwise this month.
"Euthanasia gives people the illusion they are deciding about their lives," said Sen. Hugo Vandenberghe, an opponent of the bill and member of Belgium's Christian Democratic People's Party. "But the person who is deciding is not healthy; he is fragile. He needs to be protected by law."

'Death tourism' feared
Critics like Mr. Vandenberghe also fear that the Dutch legislation and its closely tailored Belgian counterpart may open new venues for abuse, including prospects of euthanasia-seeking "death tourists" flooding Europe's low countries.
Supporters counter that the regulations, which stipulate a long-term doctor-patient relationship, make such chances unlikely.
Belgium's euthanasia drive was powered by a leftist coalition that toppled long-ruling Christian Democrats from power in 1999.
The new government's secular agenda embraced sensitive ethical questions like legalizing embryo research and soft drugs. Right-to-die proposals, which previously went nowhere, suddenly took on new life.
By the end of 1999, a group of liberal senators introduced a bill to legalize euthanasia.

Practiced already
"We know euthanasia has been practiced in hospitals and old-age homes for at least five years before this discussion," said Sen. Marie Nagy, a member of Belgium's Ecologist Party, which supports the bill.
"What's allowed this legislation to come forward is the arrival of a political coalition that doesn't include Christian parties."
Unlike Oregon's assisted-suicide law, which allows physicians to prescribe but not to administer lethal medications, euthanasia assumes that doctors deliver the deadly dose.
China and Colombia have dabbled with euthanasia. Australia's Northern Territory briefly legalized the practice in 1996, but the law was repealed the following year. Across Europe, the jury is still out.

Issue rife in Europe
This spring's passage of the Netherlands' euthanasia bill drew condemnation from doctors in Sweden and from critics in Germany, still haunted by Nazi-sanctioned killings of the congenitally handicapped. But assisted suicide is tolerated in Sweden and parts of Switzerland.
In Britain and Italy, pro-euthanasia movements are powerful. In France, an April survey by the IFOP polling group found 38 percent of French people strongly supported euthanasia in cases of terminal illness and unbearable suffering. Half those surveyed said they believed doctors should be allowed to end lives under certain conditions.
In July, French Health Minister Bernard Kouchner said in an interview he had once practiced euthanasia as a doctor in Lebanon and Vietnam.
"Euthanasia is, by its essence, contrary to medical ethics," Mr. Kouchner said in an interview with the Dutch weekly Vrij Nederland.
"Doctors are there to protect life, and not to end it. But if someone indicates he wants to die, society must also take this into consideration. That's what makes this debate so difficult."

Holland sets example
Nowhere has the issue been more closely examined than in the Netherlands, where euthanasia has been tacitly accepted for the past decade.
"We have had this debate in Holland for 30 years, so I think it will take another generation elsewhere in Europe," said Jaap Visser, head of the Department of Medical Ethics at the Netherlands Ministry of Health.
"But you never know. Maybe after what happens in the Netherlands — if people are convinced we have done it so carefully, and we are no murderers — this kind of development may go very rapidly."
The new Dutch law essentially formalizes 1990 euthanasia guidelines.


Dutch guidelines cited
The patient requesting the procedure must be in a hopeless or unbearable situation and a second medical opinion must be sought, along with a ruling by a committee of medical and legal specialists.
Dutch doctors turn down about three-quarters of all euthanasia requests, according to statistics provided by the Netherlands government.
"The big difference for the Netherlands is that 90 percent of euthanasia cases which would have been going on anyway now have a legal basis," said Rob Jonquiere, managing director of the Dutch Voluntary Euthanasia Society in Amsterdam.
"And doctors know that if they follow the rules, they no longer have to put a stamp on their heads that they are criminals."
"I don't think there will be more euthanasia than before," said Dr. Aycke Smook, a Dutch oncologist at a hospital near Amsterdam who has performed euthanasia on several occasions.
"It's not an act doctors perform eagerly. Also for my patients, life is the only thing they have left. Giving it up is very difficult."
Living with euthanasia's aftermath also can be difficult. Three years ago, Nelleke Dumee watched her mother die at her home, near The Hague.
The family gathered around, toasting their last reunion with wine. Then the family doctor injected a lethal mix of narcotics.
"Our experience was very good," said Mrs. Dumee, 47, whose mother had suffered from terminal cancer. "But I have friends who still live with the guilt that somebody they loved was killed illegally."

Consent often lacking
The Dutch government hopes the euthanasia law will reduce abuse. A pair of studies in the 1990s found that between 11 percent and 12 percent of mercy killings in the Netherlands were performed without specific patient requests.
A more troubling trend appears in Belgium. A study published in the November issue of the Lancet medical journal found Belgian doctors four times more likely to perform such "nonvoluntary" euthanasia than their Dutch counterparts.
A study conducted last year found about 80 percent of Belgians support legalizing euthanasia. The medical community is split on the measure, and the Belgian medical society has come out against it.
"I think a law is a good solution," said Dr. Wim Distelmans, an oncologist at the Free University of Brussels who supports legalizing the procedure. Dr. Distelmans estimates he has performed euthanasia several dozen times over the past decade.
There are no formal rules in Belgium, he said, but he tries to follow the Dutch guidelines.
"I'm not naive," Dr. Distelmans added. "The abuses won't be directly influenced by a law. But I hope that with a law, doctors will think more carefully before terminating a life."

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