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The right to die in Belgium: An inside look at the world’s most liberal euthanasia law

January 17, 2015 at 11:30 AM EST
Belgium has the world’s most liberal law on physician-assisted suicide, which is not just for the terminally ill. Patients with psychiatric conditions – and now, even children – can request euthanasia. Surveys in Belgium show overwhelming public support, and many doctors say it gives patients with constant and unbearable suffering a practical and humane way to die peacefully. But even in a country with a far-reaching acceptance, controversy still exists. NewsHour's Megan Thompson reports.
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Editor’s note: This broadcast segment contains footage that may be disturbing to some viewers. Viewer discretion is advised.

MEGAN THOMPSON: As she opens the door to her home…this 34-year old Belgian woman known as “Eva” seems at ease. But actually she’s chronically depressed. More than once she’s tried to commit suicide. And now she’s asking doctors to help her. Help her die by euthanasia…all of it captured in a Belgian documentary.

EVA (voiceover): It may seem strange but I am looking forward to the rest. The choice has been made. The decision has been made. I am looking forward to the rest I have longed for, for so long.

MEGAN THOMPSON: It may sound shocking, but in Belgium euthanasia is quite accepted. And it’s not just for the terminally ill. Chronically depressed patients like Eva can request it, too. And so on a day and time she’s chosen… Eva says goodbye to her family.

MARC VAN HOEY: Eva, are you ready?

EVA: Yes, I am ready, doctor.

MEGAN THOMPSON: And then she lays down on her couch.

MARC VAN HOEY (voiced over): Would you like to say something to your brother and sister-in-law?’

EVA (voiced over): Bye.

BROTHER: Sleep Well.

EVA (English): Thank you.

MEGAN THOMPSON: The man kneeling by her side, about to give her the lethal injection, is her doctor for the past two years. Dr. Marc Van Hoey.

MEGAN THOMPSON: Doctor, how many euthanasias have you performed yourself?

MARC VAN HOEY: More than 100. In 12 years time, I think.

MEGAN THOMPSON: Dr. Van Hoey is a general practitioner and president of one of the leading right to die organizations in Belgium. He’s helped shaped the country’s policy toward euthanasia which can be requested by patients who meet two basic conditions: They are experiencing “constant and unbearable” suffering – either mental or physical – and their condition is ‘incurable.” And then patients must put their request in writing.

MARC VAN HOEY: Only thing you have to write down is the name, the date and ‘I want Euthanasia,’ and signature.

MEGAN THOMPSON: In the few American states with laws on the books allowing this, patients must take the life-ending drugs themselves.

Brittany Maynard: I’ll die upstairs …

MEGAN THOMPSON: Like terminal cancer patient Brittany Maynard who recently went to Oregon to end her life. But in Belgium it’s the doctor who must administer the lethal dose – usually an injection.

MARC VAN HOEY: I start with a narcotic drug, in a higher dose, to create a deep sleep.
And later on we give barbiturate in a shot. If you use an intravenous injection and do it good, the patient is dead in one or two minutes.

MEGAN THOMPSON: One or 2 minutes?

MARC VAN HOEY: Yes

MEGAN THOMPSON: So it happens very quickly.

MARC VAN HOEY: Yes. You have a life-line. You say are you ready? Do you want to go with it? Till the very end we ask do you want to go, because there’s no way back. Then we give the injection and (whistles) it’s gone.

MEGAN THOMPSON: You talk about it very matter-of-factly.

MARC VAN HOEY: I’m quite used to talking about assisted dying and so on. It’s part of my job.

MEGAN THOMPSON: That’s right. In Belgium, it can be part of a doctor’s job to end a patient’s life. It’s been the law since 2002.

MEGAN THOMPSON: Belgium has the most liberal euthanasia law in the world. And even though this country is predominantly Roman Catholic, surveys show overwhelming support here for the right to die by euthanasia.

MEGAN THOMPSON: Since the law passed, the number of Belgians choosing euthanasia has steadily risen each year, with more than 1,800 dying this way in 2013 – that’s an average of about 5 people a day. In 2014, Belgium made headlines when it became the first country in the world to extend euthanasia to terminally ill children of any age, although no cases have occurred so far.

MEGAN THOMPSON: So in Belgium it’s not just the terminally ill who can request euthanasia. Psychiatric patients. Now children. Is Belgium pushing the boundaries when it comes to euthanasia?

GILLES GENICOT: I don’t think so. I don’t think so.

MEGAN THOMPSON: Gilles Genicot is a lawyer and co-Chairman of the Euthanasia Control and Evaluation Commission, which oversees the practice in Belgium.

GILLES GENICOT: The law humanizes– the deaths of terminally ill patients, on the one hand, and on the other hand, for patients who are not terminally ill but who are completely hopeless, there is a respect to the individual autonomy. I think it’s a major advance in the way society, law and– philosophy see this very important issue.

MEGAN THOMPSON: The 16-person euthanasia commission – half doctors, half lawyers, meets every month in Brussels. By law, after performing euthanasia, doctors must file a report with the Commission detailing what they did and why. The Commission reviews the reports to be sure conditions set by the law were met. If not, Genicot says in the worst case, a doctor could face homicide charges.

MEGAN THOMPSON: The reports also must affirm the patient’s request for euthanasia was voluntary, and that two doctors had approved it. Three doctors in the case of psychiatric patients.

MEGAN THOMPSON: These are all euthanasia cases from the last few years?

GILLES GENICOT: Yes.

MEGAN THOMPSON: Genicot’s office is filled with reports of past and future cases…

GILLES GENICOT: It’s the current box.

MEGAN THOMPSON: And he says the system works well. Giving doctors a practical and humane way to help suffering patients die peacefully. Genicot says some doctors choose to describe that in an optional section of the report.

GILLES GENICOT: Very often it is to express how serene, peaceful and quick the procedure was. That the patient was grateful. Said ‘thank you’ to the doctor. And was surrounded by family and friends.

MEGAN THOMPSON: But it isn’t always that way. Tom Mortier’s mother Liefe had a passion for traveling the world but suffered from a lifetime of severe depression. Despite 40 years of therapy with several psychiatrists, and treatment with anti-depressants, she continued to struggle with suicidal thoughts and hopelessness.

MEGAN THOMPSON: Deemed “incurable,” she was euthanized in a hospital in Brussels on April 19, 2012. The date marked in her own calendar. Mother and son were estranged at the time and Mortier didn’t find out about it until the next day when the hospital called his home with the news.

TOM MORTIER: Yeah, it was a complete shock. Of course, I knew that my mother was suffering mentally. But she would never have done it herself. She never would have committed suicide. I went to talk to the physician who killed my mother and he told me he was absolutely certain my mother didn’t want to live anymore. And I said how can you be certain?

MEGAN THOMPSON: When you said, ‘Why wasn’t I consulted. Why wasn’t I involved?’ What was his response to that?

TOM MORTIER: He said my mother didn’t want the children to be contacted and he had to fulfill the wish of the patient.

TOM MORTIER (reading letter): “The psychic suffering has been too much… and I can’t go on.”

MEGAN THOMPSON: Letters Mortier’s mother left behind did little to help him make sense of how she died.

But wasn’t it his mother’s choice, and hers alone, to make? Mortier says his mother’s depression came partly from being estranged from her children, so her doctors should have reached out to him. And, he’s convinced his mother – severely depressed and on medication – was not in the right state of mind to make such a decision.

ROBERT CLARKE: The option being offered to her rather than treatment is death.

MEGAN THOMPSON: Attorney Robert Clarke with the Christian group Alliance Defending Freedom is now using Tom Mortier’s case to challenge Belgium’s euthanasia law in the European Court of Human Rights …arguing it violates the basic obligation of the state to protect the “right to life.” If the court takes the case – and if it rules in Mortier’s favor, a big if, Belgium could be forced to re-write its law.

ROBERT CLARKE: What we see in Belgium is a slippery slope. We see the number of euthanasia deaths rising year in, year out since the legalization in 2002. And what we see is completely inadequate oversight. The committee that monitors them has received just over 8000 notifications of euthanasia deaths since the legalization. In its history of those 8,000 cases the committee has submitted not a single one to the public prosecutor.

MEGAN THOMPSON: That’s not an indication of a flawless system, Clarke says…but instead, it suggests that the euthanasia commission’s reliance on doctors’ reporting alone is not enough to catch possible abuses. We asked euthanasia commission co-chair Gilles Genicot about that number.

GILLES GENICOT: I can understand it might sound surprising, but the way our law works is– based on– trust we give to doctors. Because they know their patients far better than anyone else.

MEGAN THOMPSON: Genicot says he thinks doctors acted appropriately in the case of Tom Mortier’s mother, and that Mortier’s complaint to the European Court has no legal standing. But there have been other controversial cases that have raised eyebrows, including: A transgender patient who was euthanized because of depression following an unsuccessful sex change operation…. And twins who were chronically ill, deaf and going blind who were euthanized together.

GILLES GENICOT: Those cases are really extremely rare, so we can mention them, it’s okay to discuss them, but we should not bring them to the front to say– to put the law into question, because the law is not primarily made for these cases.

MEGAN THOMPSON: In fact, Dr. Marc Van Hoey says only about 5 percent of his cases were psychiatric patients. But he doesn’t shy away from discussing them. As he sees it, euthanasia can be a less traumatic option for a patient and their family than some other form of suicide.

MEGAN THOMPSON: Can it be emotional for you? Are some cases harder than others?

MARC VAN HOEY: It’s always emotional. And what I always say to my colleagues and also to the family I say this, try to bear in mind you follow the law and it’s the question of the patient. I didn’t say you have to die.

MEGAN THOMPSON: Which brings us back to Eva, the young woman convinced the only way to end her mental suffering was to end her life. Eva agreed to be filmed because she believed that people with chronic, incurable psychiatric illness can be helped to die with dignity. About two minutes after receiving the lethal injection from Dr. Van Hoey Eva died. The last thing for Dr. Van Hoey to do was fill out the paperwork required for the Commission.

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