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Test Santé vient de publier les résultats d'une enquête sur les actes de fin de vie et l'euthanasie. Elle est le prolongement de l’enquête récente sur les soins palliatifs. Pour cela, Test Santé a donné la parole aux personnes concernées : proches, médecins et infirmiers. Il en ressort que les soins palliatifs, aussi efficaces soient-ils, n'empêchent pas certains de souhaiter mourir. L’enquête souligne le fait que la demande vient le plus souvent exclusivement du patient lui-même (47% des cas contre 38% de la famille), et c’est encore plus vrai pour les patients en soins palliatifs (61%). Par ailleurs, Test Achats constate que l’euthanasie joue un rôle dans le débat sur la qualité de la fin de vie et que celle-ci est meilleure lorsque l’euthanasie est appliquée «à un moment plus naturel de la mort » (ou même avant dans certains cas) plutôt qu’après un acharnement thérapeutique.
Some background information about the context of euthanasia in Belgium is presented, and Belgian law on euthanasia and concerns about the law are discussed. Suggestions as to how to improve the Belgian law and practice of euthanasia are made, and Belgian legislators and medical establishment are urged to reflect and ponder so as to prevent potential abuse. This study is based on a critical review of the literature supplemented by interviews I conducted in Belgium with leading scholars and practitioners in February 2003 and February 2005 about the practice of euthanasia. I first provide background information about euthanasia in Belgium and then discuss its law on euthanasia and voice some concerns, suggesting some constructive ideas to improve the practice of euthanasia.
In the linked study (doi:10.1136/bmj.b2772), Van den Block and colleagues report a national mortality follow-back study of end of life care in Belgium conducted during 2005 and 2006. The findings are a valuable contribution to understanding the context of dying in Belgium. They detail the frequency of team based palliative care; involvement of generalists; use of intensive alleviation of symptoms, which can extend to palliative sedation (termed continuous deep sedation); and the incidence of euthanasia and physician assisted suicide. However, the authors’ interpretation of the data and the conclusions they reach raise questions. Their conclusion that life shortening decisions, including euthanasia and physician assisted suicide, are not related to a lower use of palliative care in Belgium and often occur within the context of multidisciplinary care, misrepresents the frequencies they report and is tangential to the main findings.
End of life decisions that shorten life, including euthanasia or physician assisted suicide, are not related to a lower use of palliative care in Belgium and often occur within the context of multidisciplinary care.
The editorial by Ira Byock (1) commenting on the report from van den Block et al (2) correctly says that only 22 cases of euthanasia or physician-assisted suicide (PAS) occurred (1.3% of all 1690 non-sudden deaths), suggesting that this means these actions ‘occur relatively infrequently’. However, there were a further 26 cases of 'life ending drugs without patient request'. Readers should know that this latter category consists of doctors who answered the same question in the same way as the doctors who are counted as having provided euthanasia or PAS, except that in a subsequent question the doctors indicated that the patient had not asked for euthanasia at the time.
Van den Block and colleagues’ paper about end of life decision making and end of life care provides important data to support the debate about physicians’ role in death and dying. Their finding that end-of-life decision making seems to be associated with a high use of palliative care is not surprising, because a protracted dying process with much suffering may be expected to result in both a high use of palliative care and a high frequency of end-of-life decisions, especially for assertive patients with clear preferences concerning the end stage of their lives. More importantly, the study’s results suggest that palliative care is not able to prevent physicians and patients from making medical decisions that hasten death. This may be due to insufficient quality, that should be further improved, but it may also be indicative of principal limitations of palliative care, that apparently cannot address all suffering at the end of life.
Proponents of assisted suicide believe support for legalisation is growing among lawmakers and the public around the world. In the past year three names have been added to the list of places which permit it. The BBC's Vincent Dowd investigates whether assisted suicide is set to become even more common.
A Belgian man who doctors thought was in a coma for 23 years was conscious all along, it has been revealed. Medical staff believed Rom Houben had sunk irretrievably into a coma after he was injured in a car crash in 1983. The University of Liege doctor who discovered in 2006 that, although Mr Houben was paralysed, his brain was working, said the case was not unique.
Scientists have been able to reach into the mind of a brain-damaged man and communicate with his thoughts. The research, carried out in the UK and Belgium, involved a new brain scanning method. Awareness was detected in three other patients previously diagnosed as being in a vegetative state. The study in the New England Journal of Medicine shows that scans can detect signs of awareness in patients thought to be closed off from the world. Patients in a vegetative state are awake, not in a coma, but have no awareness because of severe brain damage. The scientists used functional magnetic resonance imaging (fMRI) which shows brain activity in real time.
Background The differential diagnosis of disorders of consciousness is challenging. The rate of misdiagnosis is approximately 40%, and new methods are required to complement bedside testing, particularly if the patient's capacity to show behavioral signs of awareness is diminished. Conclusions These results show that a small proportion of patients in a vegetative or minimally conscious state have brain activation reflecting some awareness and cognition. Careful clinical examination will result in reclassification of the state of consciousness in some of these patients. This technique may be useful in establishing basic communication with patients who appear to be unresponsive.
Continuous deep sedation (CDS) is sometimes used to treat refractory symptoms in terminally ill patients. The aim of this paper was to estimate the frequency and characteristics of CDS in six European countries: Belgium, Denmark, Italy, The Netherlands, Sweden, and Switzerland. Of all deaths, CDS was applied in 2.5% in Denmark and up to 8.5% in Italy. Of all patients receiving CDS, 35% (Italy) and up to 64% (Denmark and The Netherlands) did not receive artificial nutrition or hydration. Patients who received CDS were more often male, younger than 80 years old, more likely to have had cancer, and died more often in a hospital compared to nonsudden deaths without CDS. The high variability of frequency and characteristics of CDS in the studied European countries points out the importance of medical education and scientific debate on this issue.
In Belgium, where euthanasia was legalized in 2002, we conducted a follow-up study in 2007 to two largescale nationwide surveys on medical end-of-life practices that had been conducted in 1998 and 2001. This follow-up study enabled us to investigate differences in the frequency and characteristics of these practices before and after the enactment of the law.
Lieve Van den Block, Reginald Deschepper, Johan Bilsen, Nathalie Bossuyt, Viviane Van Casteren and Luc Deliens BMC Public Health 2009, 9:79 doi:10.1186/1471-2458-9-79
A majority of surveyed Flemish physicians appear to accept physician-assisted dying in children under certain circumstances and favour an amendment to the euthanasia law to include minors. The approach favoured is one of assessing decision-making capacity rather than setting arbitrary age limits. These stances, and their connection with actual end-of-life practices, may encourage policy-makers to develop guidelines for medical end-of-life practices in minors that address specific challenges arising in this patient group.
Medical end-of-life decisions are frequent in minors in Flanders, Belgium. Whereas parents were involved in most end-of-life decisions, the patients themselves were involved much less frequently, even when the ending of their lives was intended. At the time of decision making, patients were often comatose or the physicians deemed them incompetent or too young to be involved.
Marlisa Tiedemann Dominique Valiquet Law and Government Division Revised 17 July 2008 PRB 07-03E PARLIAMENTARY INFORMATION AND RESEARCH SERVICE SERVICE D’INFORMATION ET DE RECHERCHEPARLEMENTAIRES
A public policy think tank, which aims to promote “rational, evidence-based and measured debate” on the subject of assisted dying, has been launched by two members of the House of Lords. Lord Alex Carlile and Baroness Ilora Finlay, co-chairs of Living and Dying Well, have both fervently opposed any change in the law on this issue. Their new organisation is neither “neutral” nor “a campaigning pressure group,” instead, they want to present “hard evidence” to parliament and the public in an objective and informative manner.
To investigate attitudes towards physician-assisted death in minors among all physicians involved in the treatment of children dying in Flanders, Belgium over an 18-month period, and how these are related to actual medical end-of-life practices.
Surveys in different countries (e.g. the UK, Belgium and The Netherlands) show a marked recent increase in the incidence of continuous deep sedation at the end of life (CDS). Several hypotheses can be formulated to explain the increasing performance of this practice. In this paper we focus on what we call the ‘natural death’ hypothesis, i.e. the hypothesis that acceptance of CDS has spread rapidly because death after CDS can be perceived as a ‘natural’ death by medical practitioners, patients' relatives and patients. We attempt to show that the label ‘natural’ cannot be unproblematically applied to the nature of this end-of-life practice. We argue that the labeling of death following CDS as ‘natural’ death is related to a complex set of mechanisms which facilitate the use of this practice. However, our criticism does not preclude the view that CDS may be clinically and ethically justified in many cases.
One out of two euthanasia cases is reported to the Federal Control and Evaluation Committee. Most non-reporting physicians do not perceive their act as euthanasia. Countries debating legalisation of euthanasia should simultaneously consider developing a policy facilitating the due care and reporting obligations of physicians.
The total number of deaths studied was 11,704 of which 1517 involved continuous deep sedation. In Dutch hospitals, CDS was significantly less often provided (11%) compared with hospitals in Flanders (20%) and U.K. (17%). In U.K. home settings, CDS was more common (19%) than in Flanders (10%) or NL (8%). In NL in both settings, CDS more often involved benzodiazepines and lasted less than 24 hours. Physicians in Flanders combined CDS with a decision to provide physician-assisted death more often. Overall, men, younger patients, and patients with malignancies were more likely to receive CDS, although this was not always significant within each country. Conclusion Differences in the prevalence of continuous deep sedation appear to reflect complex legal, cultural, and organizational factors more than differences in patients’ characteristics or clinical profiles. Further
A large number of films and documentaries on euthanasia available to watch online. Quite a few in English including documentaries by Terry Pratchett and John Zaritsky on Dignitas. Also a documentary on Philip Nitschke and the law in the Northern Territory of Australia.
May 28, 2012 marks the 10th anniversary of the legalisation of euthanasia in Belgium, with the Netherlands following suit a year earlier¹ and Luxembourg doing the same in 2009². To date, these three Benelux countries are the only ones to have legalised the act of intentionally killing a person who makes such a request. At a time when legalisation of euthanasia is being debated in several European countries, notably in France, it would appear appropriate to take stock of the last 10 years of implementation of the law on euthanasia in Belgium.
AFP - Belgium is considering a significant change to its decade-old euthanasia law that would allow minors and Alzheimer's sufferers to seek permission to die. The proposed changes to the law were submitted to parliament Tuesday by the Socialist party and are likely to be approved by other parties, although no date has yet been put forward for a parliamentary debate. "The idea is to update the law to take better account of dramatic situations and extremely harrowing cases we must find a response to," party leader Thierry Giet said. The draft legislation calls for "the law to be extended to minors if they are capable of discernment or affected by an incurable illness or suffering that we cannot alleviate." Belgium was the second country in the world after the Netherlands to legalise euthanasia in 2002 but it applies only to people over the age of 18.
In de eerste drie maanden van dit jaar werden in België 445 aangiften gedaan van euthanasie. ‘Een opvallend cijfer’, zegt professor Wim Distelmans (VUB), voorzitter van de Federale Commissie Euthanasie.
BRUSSELS—Tom Mortier received a message at work last year saying his 64-year-old mother had died the day before, and he quickly found out she'd been euthanized. Mr. Mortier, who teaches college chemistry, was shocked. Though estranged from his mother, he knew she was depressed and had spoken of euthanasia. But he had no idea this could happen, he said, especially since she wasn't physically ill, and her children weren't informed. "This is irreversible," he said. "One day my mother is dead." In the past 10 years since the country legalized the practice, more than 5,530 Belgians have signed up for ... FULL TEXT AVAILABLE VIA PROQUEST NEWSPAPERS DATABASE (FROM IALS/SAS)
PUTTE, Belgium—In this small village amid an array of Flemish farms, they were an unusual but seemingly happy pair, two 43-year-olds who were identical, deaf twins. Townspeople recalled seeing Marc and Eddy Verbessem around town frequently, talking animatedly in sign language together, tooling around in a small blue car, and regularly buying two copies of a popular gossip magazine. No one expected them to decide to die on purpose.
No country has a blanket policy of mandatory psychiatric review but the specialty contributes in circumstances of exclusive mental disorder or when there is doubt regarding capacity and sound judgement. The absence of a mandatory role for psychiatrists means that reversible psychopathology may be missed. As a result, the patient's decision to end his/her life may be more informed by treatable mental disorder than by his/her lifelong preferences.
This article is concerned with the practice of euthanasia in Belgium. Background information is provided; then major developments that have taken place since the enactment of the Belgian Act on Euthanasia are analysed. Concerns are raised about (1) the changing role of physicians and imposition on nurses to perform euthanasia; (2) the physicians' confusion and lack of understanding of the Act on Euthanasia; (3) inadequate consultation with an independent expert; (4) lack of notification of euthanasia cases, and (5) organ transplantations of euthanized patients. Some suggestions designed to improve the situation and prevent abuse are offered.
The right-to-die debate has gone a step futher in Belgium. Charlotte McDonald-Gibson speaks to a mother who wants others to avoid her baby’s slow, painful death.
This week, lobbyists for euthanasia appeared to be winning people over to their way of thinking. The 71-year-old physicist Stephen Hawking gave an interview to the BBC in which he was asked whether he supported assisted suicide. “Those who have a terminal illness and are in great pain should have the right to choose to end their lives, and those that help them should be free from prosecution ...” he replied. “But there must be safeguards that the persons concerned genuinely want to end their life and are not being pressurised into it, or having it done without their knowledge and consent.”
A Belgian man has chosen to die by euthanasia, after his sex change operation turned him into “a monster”. Nathan Verhelst, 44, was administered legal euthanasia on Monday afternoon, on the grounds of “unbearable psychological suffering”