Dr. David Amies: Learning lessons from Belgium

As Canada continues to anticipate the implementation of the Supreme Court's decision in Carter v. Canada, Dr. David Amies looks into the curious case of Simona De Moor and other lessons from Belgium's 13-year experience with assisted death.

Simona De Moor, a fit, 85-year-old woman, living in a Belgian seniors’ home, lost her daughter this year and was very saddened by the loss. Accordingly, she decided to avail herself of Belgium’s assisted dying laws. Dr. Marc van Hoey agreed to help her and provided her with a glass of lethal syrup to drink. 

Assisted dying legislation has been in place in Belgium for 13 years. During that time, over 10,000 people have availed themselves of its provisions. Eligibility for assisted dying requires that the patient must suffer from a serious accidental or pathological condition, be in a hopeless medical condition and be suffering from constant physical or mental pain that cannot be relieved. A second medical opinion is required and a specialist or psychiatric opinion is also required where relevant.

Dr. Marc van Hoey is the president of the Belgian Dying with Dignity Association and conducts between 15 and 20 such cases each year.

Belgium has established a 16-member Federal Commission of Control and Evaluation to oversee the practice of assisted dying. The commission eventually reviews all cases, after the fact. To date, it has reviewed over 10,000 instances and that of Susan De Moor and Dr. Marc van Hoey is the first that it has referred to the legal authorities as being suspicious. A review is presently ongoing and the doctor could be charged with murder.

Cases of this sort will provide ammunition for those in Canada who are unhappy about the prospect of assisted dying legislation being introduced into this country during the next few weeks, consequent on the Carter v. Canada ruling handed down by the Supreme Court in February 2014. 

Several points are worth noting. There have been 770 cases of legal assisted dying in Belgium on average each year since their laws were introduced 13 years ago. Canada’s population is three times great than that of Belgium. Could Belgium’s practices be directly extrapolated to Canada such that there would be 2,300 annual cases here? It seems that will be most unlikely. Palliative care provisions will expand greatly to ensure that as few people as possible seek to end their lives through assisted dying.

The requirements in place in Belgium for assisted dying look very similar to those likely to be established in Canada: suffering from serious, irremediable disease and from serious physical and psychological torment. Canada is also looking at a minimum of two medical opinions backed up by specialist reviews where relevant. 

The press reports of Simona De Moor’s case do suggest that her doctor behaved rather cavalierly. Patently, the Belgian Federal Commission of Review thinks so or else why would they refer the matter to the legal authorities? Could such cases occur in this country when our new laws are introduced? The honest answer to that question must be yes. Doctors are human, patients’ relatives are human. Humans are venal and will act in their own best interests from time to time without regard for third parties. I have a sneaking suspicion that Canadian health regulatory bodies and Canadian health professionals will somehow conspire to make the kind of behaviour that has taken place in Mme. De Moor’s case harder to engineer.

No amount of legal drafting and regulation will produce the perfect system. Doubtless, the way in which assisted dying is managed will evolve over the years. Should doubtful cases occur, they are likely to be detected and rules tightened accordingly. However, we ought not to expect flawlessness in anything. Shakespeare’s Duke of Albany remarks in King Lear, “Were it not sinful then, striving to mend, to mar the subject that before was well?” Voltaire chimes in with, “Le mieux est l’ennemi du bien.” In short, let’s do our best and seek excellence but not perfection!

Dr. David Amies is a retired doctor in Lethbridge, Alta., and a member of DWD Canada's Physicians Advisory Council.

*Photo by Alex Proimos, some rights reserved.

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