Belgium gives terminally ill people the right to die
BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7320.1024/a (Published 03 November 2001) Cite this as: BMJ 2001;323:1024
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Response to:
Issues of loss versus growth
Leslie Piet, Nurse Educator , Johns Hopkins Healthcare
bmj.com, 3 Nov 2001 [Response]
In regard to Leslie Piet's comments, these comments would all be
relevant if the debate were about life being ended without the consent of
the person involved, but voluntary euthanasia allows all of what Mr Piet
wants to happen to be done should the person so wish.
Competing interests: No competing interests
Response to:
Look into your hearts, not to your neighbours
Sam Hjelmeland Ahmedzai, Professor of Palliative Medicine, University of
Sheffield
bmj.com, 2 Nov 2001 [Response]
Whilst I would strongly agree that the serious subjects of Voluntary
Euthanasia requires full and open discussion, I fear that publishing this
response from Sam Hjelmeland Ahmedzai does not contribute to this.
His personal Prejudies and unsubstantiated statements concerning
Dutch society and behaviour have nothing to do with this issue. Those who
wish to consider this important issue seriously may wish to consider how
two countries with very different cultures and religious beliefs have both
come to the same conclusions regarding this matter.
Competing interests: No competing interests
Issues of loss are certainly difficult, especially during the final season of living. What so many fail to recognize is the opportunity for growth and development in the end of life.
This time period is incredibly significant for the opportunity for self-actualization. It can be a time of great healing, love, finishing up business and saying goodbye. To end a life, prematurely, denies this opportunity.
Those who remain are often left with an uncomfortable case of the "what ifs" and "if I had only known". Some of the greatest "living" can and is done in the end of life.
Competing interests: No competing interests
Timothy James is right to criticise the question-begging use by
journalists of 'strict' to describe guidelines for euthanasia. Journalists
too often seem to think that 'strict guidelines' is one word, and to
overlook the fact that guidelines may in fact be lax. The Dutch guidelines
for euthanasia are demonstrably lax, both in theory and in practice (see
my EUTHANASIA EXAMINED (CUP, 1995)chapter 16). The proposed Belgian
guidelines, as reported in the BMJ, are certainly no stricter. Journalists
would indeed do well to exercise caution in their choice of adjective, and
to ensure that their description fits the reality.
Competing interests: No competing interests
Sir,
Rory Watson reports that Belgium is shortly expected to change its
law in order to decriminalise euthanasia. Two factors were quoted as
influencing the Belgian Senate. First, a view from their senior lawyers
that the current Western love for ‘self-determination’ means that the
‘right to life’ can somehow, as a non-sequitur, include the duty of
doctors to end it at the request of the public.
The second factor was even more specious: that was the recent
approval given by Belgium’s neighbour, the Netherlands, to change their
law. No doubt many in other nearby countries will wonder if they should
follow these free-thinking leaders of opinion. I would suggest, however,
that we should stop and consider the context of the cultures in which such
decisions are made. I cannot speak for Belgium, but I hold that a country
like the Netherlands, which tolerates huge consumption of unnecessary
‘recreational’ drugs, which allows open displays of pornography and the
public degradation of near-naked women (a bizarre reversal of the equally
hideous Talibans' covering up of females), should probably not be seen as
a moral guide to the rest of the world.
Dutch people, as I know personally, are fine and caring. Their
society, however, is in a cultural mess and only history will tell if its
current fascination with killing people who feel value-less (or whom some
doctors feel are value-less), will be seen as a major advancement of the
human race.
Competing interests: No competing interests
It is lazy journalism, and encourages lazy thinking among readers of
the BMJ, to write of "strict criteria" in this context.
I do not think I have yet read a report of a projected euthanasia
law, in any jurisdiction, which did not use this adjective, but the extent
to which the criteria proposed will actually restrict anything varies
greatly. It would be better to avoid what is simply a cliche.
The proponents of any liberalisation of the law invariably, in my
experience, reassure the nervous by asserting that strict rules will
govern its exercise. Politicians, with their love for the rhetorical,
pick up the phrase, which becomes progressively more meaningless.
A report should describe the proposed criteria, and leave the reader
to judge whether they are sufficiently strict. It would of course, assist
our judgement if it were to include an assessment of extent to which
similar criteria have in practice restricted undesirable practices.
Considerable data are available from the Netherlands, for example.
Comparison with the impact of regulation on other matters of ethical
concern (the obvious comparator in the UK is therapeutic abortion under
the 1967 Act) would also assist thoughtful readership.
Competing interests: No competing interests
Re: Issues of loss vs growth
The issue of euthanasia always brings forth lots of high-sounding,
and perfectly valid rhetoric, especially from those involved in palliative
care, on the one hand - as they tend to see it as an accusation that they
are somehow not delivering properly, - and on the other hand, from those
paranoid doubters in the community who have no faith in their fellow man
(doctor) to continue to do what we have always strived to do in good
faith, and that is to do what is best for our patients. I guess I might
once have also felt reservations about taking this last (logical) step in
delivering that care until my own mother died in 1994 of bowel cancer. I
remember clearly the feeling of grief and despair, that after having flown
3000 kms to be at her bedside, just in time for her last breath, she was
so wasted away I could not even recognise her, my own mother, and I kept
thinking about funny things like, if maybe I put her glasses back on her
face, it might somehow help her to look like I remembered her. I was
crying at the bedside of a stranger! My brother, driving his heart out to
be there in time, did not make it.
It came to me then - surely there is a basic 'rightness' about being
able to choose the time of out departure. We have no choice about our
birthday, or how, when, or where we enter this earth, but surely we should
be able to choose our 'deathday'. So that once we are in a state of
irretrievable decline, and before we lose the dignity of control of our
bladder and bowels, or ability to eat, - or more importantly, speak, - we
can summon our loved ones from wherever they are, to rally round so we can
say those last things we all want to say, - then hit the button, so to
speak, and off we go, with their good-byes the last thing we hear. The
funeral is then logically follows soon after, and all can be there, then
return to the many scattered places around the globe from whence they came
- a modern phenomenon, but one which will not change. Now why would
anyone want to deny someone a good death like that?
It is not a criticism of palliative care, it is just a fact, that
sometimes to maintain adequate comfort, one has to be obtunded enough
meaningful discourse is precluded, and so is attendance on ones bodily
functions. Loss of dignity, in a nutshell. Add to that the need for
relatives who live widely scattered but want to attend at the end, but are
unable to tarry for weeks away from home and work, and you have a pretty
powerful imperative for change, don't you think?
Competing interests: No competing interests