When Conscience Wavers. Some Reflections on the Normalization of Euthanasia in Belgium

In this chapter, I evaluate from a philosophical perspective the ongoing discussions in the Belgian civil society triggered by the euthanasia law and its implementation in end-of-life care since 2002. I challenge the idea that the so-called normalization of euthanasia is an established fact and I contend that the ongoing discussions on the possible abuses of the law and the practice of euthanasia are unavoidable. I see three reasons for this. First, in contrast with what some think, euthanasia can never become a “normal” therapeutic option, that could be integrated in standard medical practice. Euthanasia is, by its very nature, a transgression of a fundamental moral taboo and will thus always, however liberal the law might be, challenge the conscience of some physicians. Secondly, because of its transgressive meaning, every act of euthanasia can always be contested by family members or the larger society. This is the case when euthanasia is given to patients who are not terminally ill (such as psychiatric patients), but also when a physician performs euthanasia in an undignified and negligent way. Thirdly, the very existence of the law puts pressure not only on patients and physicians but also the larger society. By making euthanasia into a symbol of the good death, a whole society loses its sensitivity for the intrinsic transgressive nature of euthanasia and creates all sorts of strategies to mask the wavering of conscience that results from this collective negligence. There is no way, so I conclude, to avoid this. The wavering of conscience will continue to haunt the end-of-life care in Belgium as long as the law on euthanasia remains as it is.

People Facing the Question of Euthanasia: Patients, Family and Friends, Healthcare Workers

Since the Oregon Death with Dignity Act was adopted in 1997, an increasing number of people have requested euthanasia, showing that life has become unbearable for them. However, a person who expresses the wish to die by euthanasia is not saying that he/she prefers death to life, but rather that death seems preferable to life under the actual circumstances. In order to respond to a person’s suffering, we need to understand the nature of that suffering, as they experience it. Suffering may be physical, psychological, relational, spiritual, or existential; frequently these different aspects overlap or intermingle, particularly in a serious illness. Euthanasia does not improve life—it ends it by giving death. But when the response involves listening and accepting the person in his/her present situation, it becomes possible to work together with the person to see what can be done to help reduce suffering. We can look for means of relief for the person’s individual, unique suffering, in partnership with the patient and his/her family and friends, using the resources of both medical knowledge and our shared humanity. The willingness to walk on this shared path with the sick person is in itself an affirmation of his/her human dignity.

Correction to: When Conscience Wavers. Some Reflections on the Normalization of Euthanasia in Belgium

https://doi.org/10.1007/978-3-030-56795-8

Resisting

Trained in France, I have been practising in Belgium since 2015. As general practitioner, I also hold a diploma in palliative care, a degree requiring 2 years of training and placements. Before coming to Belgium, I practised in France in a mobile hospital and community palliative care team, and in a palliative care unit.Early significant dealings with practises in Belgium happened during my studies when a physician in a Belgian community palliative care team came to give a lecture in Lille, where he told us about his practise of euthanasia. We were confounded by this ‘medical capacity to take away a life’!

Surrendering to or Inducing Death: Artificial Feeding as Paradigm

The subject of tube feeding may seem highly specific and a selective study; it actually reveals itself as a paradigm of all “end-of-life” ethical questions: therapeutic obstinacy, (i.e. unreasonable and coercive therapies), euthanasia, assisted suicide, abandonment of the sick, informed consent, difficulties with the loss of autonomy, advanced directives, and/or designation of a legal proxy (living wills), quality of life concepts, chemical or physical restraining methods, the subtlety of the act leading to double effect, with unintended consequences.The very question at the core of this debate is: what is the cause of death? Did we want to induce it or did we surrender to it as ineluctable? How can we distinguish between “surrendering to death,” i.e., accepting it as part of our human condition with its limits, and “inducing the dying process.”

Euthanasia for Unbearable Psychological Suffering

In this chapter, we focus on the problem of euthanasia because of unbearable psychological suffering. We explain that there are fundamental problems with euthanasia for psychological suffering and that the criteria for euthanasia in the current Belgian legislation are open to much interpretation and (thus) not suitable for euthanasia for psychological suffering. In addition, there are many concerns about the functioning of the Belgian Committee for the evaluation and monitoring of euthanasias carried out.

Behind the Scenes of Euthanasia

Euthanasia is on everybody’s lips, the media, politicians, public services, and various organisations…. However, the debate is often biased or ill-informed, and it is my wish to contribute to this volume by describing the (harsh) reality surrounding the practise of euthanasia as accurately as possible.Life in our hospitals no longer runs smoothly and gently; it is exceedingly busy and often near breaking point. As a member of the healthcare staff, I notice how difficult it can be for us nurses, doctors, psychologists, and social workers, to keep our heads above water when it comes to ‘ethics’.

The Slippery Slope Syndrome

For more than 20 years I have practiced nursing, first in oncology services, then in palliative care. As a teacher and psychotherapist for the past 10 years, I have had the opportunity to continue working with nursing students in palliative care and psychiatric services, as well as to supervise nursing teams. An ethicist by training, I belong to an ethics committee in a neuropsychiatric hospital. Wearing these different hats gives me the great privilege of encountering patients at the end of life or who suffer from mental illnesses as well as nurses and students who face difficult situations, and to review in the ethics committee clinical situations involving great suffering.The question of euthanasia comes up very regularly and occasions numerous discussions that are both emotional and engaging.

The Doctor Turned into an Instrument

I have been working as a cancer specialist since 1984, and I have witnessed an explosion of therapeutic possibilities. In caring for my fellow human beings, I have learned to recognize the effectiveness and the extent of my treatments, but also their limits, which are closely connected to the reality of the human condition that is so rich but naturally limited. As he strives for the physical, psychological, social, and spiritual well-being of the sick person who seeks his help, the doctor stands at the patient’s side to combat pain and suffering with determination, perseverance, humility, and patience.

The Meaning of Suffering or the Meaning of Life Despite Suffering

Even in patients suffering from severe physical diseases such as cancer, the request for euthanasia is often motivated by mental reasons: they consider that their life no longer has meaning, are afraid of future suffering or to be a burden for their family and are discouraged because they have to abandon some activities. Therefore, the request for euthanasia more often emerges in isolated or depressed cancer patients. On the other hand, physical suffering can often be controlled with medication, and if refractory, with palliative sedation.Should a lethal injection be the solution that we offer to the emotional despair of cancer patients? What other solutions can be offered? Where can we find the necessary resources to respond to mental and existential suffering? The theories of Viktor Frankl seem to be a good starting point since this psychiatrist devoted his entire career to empirical research on the meaning of life. Frankl’s logotherapy was developed in part in peculiar circumstances of severe suffering: during his deportation to Auschwitz. Frankl’s theories as well as his personal experience show us in an empirical way how mankind can find the meaning of life despite, or sometimes as a consequence of situations of severe suffering.