The Brussels, Flemish and Walloon palliative care federations favour all initiatives that allow patients to end their lives with greater humanity. They have noted with interest the draft royal decree dealing with the remuneration of physicians consulted in the context of a euthanasia procedure (“second/third opinion”). They wish by mutual agreement to draw the attention of the political powers and organisers to the necessity of making several modifications to it.
Over the past few decades, the development of palliative care has led to a heightened sensitivity to the support of those near the end of life. Furthermore, the practice of euthanasia has expanded in response to the request of a growing number of patients. Far from being contradictory or divergent, these two practices respond to the suffering of incurable patients in a concern for humanising the end of their life and with the desire to fulfil their expectations. Our country is distinguished on the international scale by its efforts to make treatment of patients at the end of life as complete as possible, including both access to palliative care for all patients and the possibility of euthanasia.
The federations wish to respect the right of patients to autonomy and self-determination. Some will let death come to them, having been supported to the end of their lives. Others, exhausted by suffering that has become intolerable, will request euthanasia despite the palliative support initiated. Still others, anxious to save themselves from the physical or psychological decline that they foresee, will decide to advance their deaths and will request euthanasia at once.
It is important that the federations respect the choice of patients who want euthanasia and put them at the centre of the procedure. They must be able to freely and autonomously call upon the practitioner(s) of their choice. For one, this will be the family physician or specialist physician who has treated the incurable illness. A second will also call on the palliative care team with whom he has made his way since the news that his illness was incurable. A third will prefer to address himself to a physician who is a member of an association such as LEIF or EOL.
These practitioners, whoever they may be, must be able to support the patients in their request and to practice euthanasia in complete independence. They must be able to freely choose the physician(s) consulted and the organisation that will train them in the issue and the practice of euthanasia.
The federations support the idea of allocating to a single, neutral coordination body, in the form of an organisation internal to Social Security (INAMI), possibly including experts on the subject, the task of gathering all the practitioners who wish to appear on the list of physicians who could be consulted in a euthanasia procedure and compensating them. This organisation would also have the task of recognising and possibly subsidising the associations that inform the public and train and oversee healthcare professionals on the issue of euthanasia.
This model will allow patients and the medical profession to preserve total freedom of choice. It will also preserve the possibility of continuity of care from the news of the severity of the illness to death, without interruption.
Commission Fédérale de contrôle et d'évaluation de l'euthanasie [Federal Commission on Control and Evaluation on Euthanasia]. Septième rapport aux Chambres législatives
L. Radbruch, C. Leget, P. Bahr, C. Müller-Busch, J. Ellershaw, F. de Conno & P. Vanden Berghe. Euthanasia and physician-assisted suicide. EAPC white paper, 2015.
Commission Fédérale de contrôle et d'évaluation de l'euthanasie [Federal Commission on Control and Evaluation on Euthanasia]. Sixième rapport aux Chambres législatives
P. Vanden Berghe, A. Mullie, M. Desmet & G. Huysmans. Assisted dying - the current situation in Flanders: euthanasia embedded in palliative care. Eur. J. Palliat. Care 2013; 20(6).
K. Chambaere, R. Vander Stichele, F. Mortier, J. Cohen & L. Deliens. Recent Trends in Euthanasia and Other End-of-Life Practices in Belgium. N Engl J Med 2015; 372; 1179-1180.
Forum End of Live [EOL]
LevensEinde InformatieForum [LEIF]