In our facilities, we are dealing with the greatest caution in dealing with questions from patients to euthanasia in psychological conditions in a non-terminal situation. We take the unbearable and futile suffering and the request for euthanasia of patients seriously. On the other hand, we want to protect life and ensure that euthanasia is only performed if there is no more possibility of providing a reasonable treatment perspective to the patient.

To achieve that, we start a two-step guidance. On the one hand, we clarify the euthanasia question and we question the question of the terms of the euthanasia law. At the same time, we seek, together with the patient, possibilities for treatment, recovery, life support and sense of mind. Our caregivers can include these two pathways themselves, but they can also go for the path of the life perspective and appeal to a (physician) outside the facility for the euthanasia course.

The connection between the two trajectories enables us to work with precision requirements. These requirements specify and concretize the conditions of the euthanasia law (for example: Is the patient willing to apply for euthanasia? Is the medical condition hopeless? Is there no reasonably different solution?) In the future, an evaluation committee with people from inside and outside the Provide testing whether the doctor's decision meets these precautions.

In our facilities, we respect the freedom of doctors to carry out euthanasia or not, and the freedom of other healthcare providers to work with them or not. That freedom is also guaranteed by law. If consideration is given to implementing euthanasia in the provision, there is another additional focus on a residential context. In that case, all efforts must be made to prevent as much as possible a traumatizing effect on the patients.

In our facilities, we respect the freedom of doctors to carry out euthanasia or not, and the freedom of other healthcare providers to work with them or not.

In our facilities, we respect the freedom of doctors to carry out euthanasia or not, and the freedom of other healthcare providers to work with them or not.

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Although doctors in Belgium had been covertly performing euthanasia before it was legalized, the majority of them opposed the euthanasia law, according to a survey conducted at the time. The chairman of Belgium’s largest medical association cautioned against making “the exception the rule.” But the political composition of the Belgian government had recently shifted; for the first time since the Second World War, secular politicians (liberals, socialists, and the Green Party) had more power than Christian Democrats, who resisted legalization. Peter Backx, the former editor of Belgium’s largest medical journal, said that the law seemed like a “bit of political revenge.” At the Senate hearings on the law, the phrase “self-determination” was repeated ninety-seven times.

The right to a dignified death is viewed as an accomplishment of secular humanism, one of seven belief systems that are officially recognized by the government. Belgian humanism, which was deeply influenced by the nineteenth-century Freemasonry movement, offered an outlet for those who felt oppressed by the Church, but it has increasingly come to resemble the kind of institution that it once defined itself against. Since 1981, the Belgian government has paid for “humanist counsellors,” the secular equivalent of clergy, to provide moral guidance in hospitals, prisons, and the armed forces. Humanist values are also taught in state schools, in a course called non-confessional ethics, which is taken by secular children from first through twelfth grade, while religious students pursue theological studies. The course emphasizes autonomy, free inquiry, democracy, and an ethics based on reason and science, not on revelation. Jan Bernheim, an emeritus professor of medicine at the Free University of Brussels, who studies ethics and quality of life, told me that euthanasia is “part of a philosophy of taking control of one’s own existence and improving the objective conditions for happiness. There is an arrow of evolution that goes toward ever more reducing of suffering and maximizing of enjoyment.”

The Belgian Council of Ministers appointed Wim Distelmans to serve as the chairman of the Federal Control and Evaluation Commission, which reviews euthanasia deaths to insure that doctors have complied with the law. In terminal cases, two doctors need to confirm that the patient’s suffering stems from an incurable illness. For non-terminal cases, three doctors must agree. But doctors have adopted increasingly loose interpretations of disease. Distelmans told me, “We at the commission are confronted more and more with patients who are tired of dealing with a sum of small ailments—they are what we call ‘tired of life.’ ” Although their suffering derives from social concerns as well as from medical ones, Distelmans said that he still considers their pain to be incurable. “If you ask for euthanasia because you are alone, and you are alone because you don’t have family to take care of you, we cannot create family,” he said.

Last year, thirteen per cent of the Belgians who were euthanized did not have a terminal condition, and roughly three per cent suffered from psychiatric disorders. In Flanders, where the dominant language is Dutch, euthanasia accounts for nearly five per cent of all deaths. (The percentage is lower in the southern, French-speaking parts of Belgium.) The Flemish media have adopted a mostly uncritical approach to euthanasia, running numerous articles about the courage of people who have chosen to die. Last year, De Standaard, a prominent Flemish newspaper, published a long tribute to a depressed mother who was euthanized after being abandoned by her boyfriend and becoming disillusioned by her psychiatric care. “I am forever grateful to her that she handled this so well,” her twenty-four-year-old son told the paper. “I am so glad we were able to say goodbye in a beautiful way.”

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