It has been twenty years since euthanasia was introduced in Belgium. In 2002, the Belgian Parliament decriminalised euthanasia for adults, two months after the Netherlands. They were the first countries in the world to do so.
Recently, during the presidential campaign, President Emmanuel Macron said he wanted to find inspiration in the “Belgian model.” What assessment can be made of twenty years of institutionalised practice of “aid in dying?”
When the law was passed in 2002, the stated aim was twofold: “to offer an exceptional solution to patients suffering from a ‘serious and incurable’ condition causing them ‘constant, unbearable suffering,'” and “to put an end to the clandestine euthanasia practised at the time.” Euthanasia remains an exception to the ban on killing, since no “right to euthanasia” has been established.
As soon as the law was passed, euthanasia was authorised for mental suffering, whether or not it was associated with physical suffering.
The 2002 law was only a first step. The practice of euthanasia has increased in Belgium since then, proving that this type of choice is rarely a stopgap to control harmful practices, despite the stated intentions, but rather an encouragement to go further. In 2014, minors were in turn allowed to resort to euthanasia, as long as they are “endowed with the capacity of discernment.” And in 2020, the law obliged health institutions to accept euthanasia in their facilities.
The figures show that euthanasia, far from being controlled to remain an “exception,” has multiplied. The website Généthique reveals that the number of euthanasias has increased more than tenfold since 2003, the first year the law was fully applied. Last year, 1 in 40 deaths in Belgium was the result of euthanasia. The conditions for authorising euthanasia have also been largely liberalised: while euthanasia was supposed to be for “patients with a ‘serious and incurable’ condition,” death was not expected in the “short term” for 16% of those euthanised in 2021—so there was no ‘emergency’ for these people.
But perhaps the most alarming indicator lies in the growth of non-consensual and undeclared euthanasia. For example, according to the figures available to us, 26% of the euthanasias carried out in 2013 in Flanders were non-consensual, and 35.5% of the euthanasias carried out in 2013 in the same region were not declared to the federal commission. The European Institute of Bioethics is alarmed by these developments, as they are on the rise. The commission’s monitoring of compliance with legal requirements is “deficient,” and the steady numbers of clandestine euthanasias remains “worrying.” “The arguments provided in 2002 to justify the decriminalisation of euthanasia are therefore now obsolete,” the Institute summarises.
Predictably, the pressure exerted by the legal option of euthanasia has led to a drastic decline in palliative care in Belgium. The reason for this is mainly financial: treating a patient who is suffering is much more expensive than ending a patient’s life with a lethal injection. According to a survey conducted by L’Incorrect in the spring of 2021, euthanasia costs around €100 in Belgium or the Netherlands—although elsewhere it can cost much more: in Switzerland, some associations do not hesitate to charge €9,000 for assisted suicide.
Within the context of health budget restrictions, against the backdrop of the COVID-19 pandemic, the financial trade-off is likely to weigh more and more heavily in respect to health care treatment. The existence of a Belgian “model” is therefore a vision that needs to be carefully scrutinised for what it means to health care.