After one year of enforcement, it is possible to say that this legislation didn’t cause any earthquake. The law is gradually infiltrating the area of patients’ rights and of respect for personal autonomy. The Commission whose task is to examine the declarations of euthanasia and who must report its findings to Parliament one year from now is gradually creating a jurisprudence as a result of its study of those declarations. Any other statement about the work of the Commission would be premature. Like the Netherlands, Belgium has passed without a period of transition from the reign of “clandestinity” where everything was possible, both good and bad, to a system of regulation and openness.
Although the debate persists, it is now calmer with some exceptions. There was the case of a Flemish physician who was working in a Catholic hospital. After he performed a euthanasia in the hospital and made the declaration to the Commission, the hospital notified him that he was in breach of contract. There was also the story of two GPs who, after having promised to follow the request of their patient, did not show up at the appointed time. After repeated calls from the wife of the patient, they finally told the patient they were breaking their promise. As the widow later said, it was the only visit for which they didn’t charge fees.
Where does the freedom of conscience start? What are the limits of this freedom and the duties bound to this right? Who has the right to refuse to practise euthanasia: physician or the hospital? For sure, we are going to pursue these discussions in the future. But at least we have regulation, and it is now possible to think about the way to improve the practice. A great deal of work has to be done in the areas of training and of dissemination of information. In Flanders a Forum of physicians – Leif artsen – exists to provide a space for discussion and advice in all matters regarding the end of life. Soon we shall create the same structure for French speaking physicians.
Some regrets have been expressed already that the law has not addressed the problem of patients under the age of 18.
Conclusion
The Belgian legislator does not pretend to propose “the” solution to this very sensitive issue. But at least Belgium succeeded in breaking the taboo and also in avoiding the false dilemma between palliative care and euthanasia. At the same time, a legislation on palliative care was discussed and adopted. Belgium also benefits from a system of health care which guarantees universal access to high quality medicine.
As emphasized by the State Council, “the appreciation of the legitimacy or illegitimacy of a law proposal aiming at de-criminalizing euthanasia requires […] that the starting point should be the principle that it is the legislator’s task to reconcile opposite ethical concepts.”