Dr. L?opold Vanbellingen:

I am a doctor of law at the University of Leuven and I work as research fellow at the European Institute of Bioethics. Our institute is an independent research centre based in Brussels. Over the past 20 years, the European Institute of Bioethics has developed expertise on the impact of assisted death laws on the protection of vulnerable people in society, particularly in the Belgian and Dutch contexts. Our major observation is that despite their alleged safeguards, each of these national laws rapidly tends to pose a threat to the lives of vulnerable people.

We can identify at least three categories of victims of this threat, elderly people who are dependent, people suffering from mental illness and healthcare practitioners. The first illustration of this trend is the elderly and the concept of polypathologies.

This category now accounts for almost one fifth of officially reported euthanasia in Belgium, for example. Among these pathologies, the Belgian federal control committee mentions impaired eyesight, hearing problems, walking disorders, and incontinence. Although none of these conditions is a serious or terminal disease, patients are nevertheless considered eligible for assisted death because of their suffering, which is related to the “loss of autonomy”or “social exclusion”. From the very beginning, the euthanasia control committees in Belgium, the Netherlands and Canada considered that the criterion of suffering should be assessed subjectively, that what the patient says about his or her suffering should be considered as binding on the doctor, regardless of whether the patient’s pain could actually be relieved, for example, by palliative care.

A second illustration of this trend is assisted death for mental illness. In Belgium, in particular, there has been a constant increase in euthanasia of patients suffering from depression or other psychiatric conditions such as autism. I will mention one such person: Shanti De Corte. Shanti was a young Belgian woman suffering from depression. She was also one of the victims of the March 2016 terrorist attacks at Brussels airport. Shanti was already suffering from depression before that attack but obviously things did not improve after it. Two doctors eventually agreed to end her life. In May 2022, Shanti died by euthanasia at the age of 23. The problem here, once again, is the subjective approach followed by every country that has permitted assisted death. This makes it virtually impossible to reconcile suicide prevention with the practice of euthanasia.

The third and last example of the threat to vulnerable people is the impact of euthanasia laws on healthcare professionals. In theory, each of these laws protects healthcare professionals who conscientiously object to participating in euthanasia but what we see in practice is that the individualistic and subjective nature of assisted dying leads to implicit or explicit forms of pressure on doctors and nurses to agree to be involved in the practice of euthanasia. One example is the latest amendment to the Belgian euthanasia law which aims to force every hospital or nursing home to accept the practice of euthanasia within their walls. This trend is rapidly leading to healthcare practitioners becoming increasingly vulnerable as they are forced to work in an environment where they are asked to do two completely contradictory tasks, namely caring for some patients on the one hand and taking the lives of others on the other hand.

In conclusion, what we see is that in every western country that has decriminalized euthanasia, the combination of a subjective and individualistic approach leads to a gradual extension of the law to situations that were not considered eligible initially. This particularly affects vulnerable groups including the elderly who are tired of living, young people who suffer from mental illness, and ultimately, any person in a vulnerable situation who, at some point,considers that his or her life may not be worth living.