A high proportion of deaths classed as euthanasia in Belgium have involved patients who have not requested that a doctor ends their lives, a new study has found.
Researchers have discovered that seriously ill or elderly patients taken to hospitals are often given lethal doses of drugs to end their lives even though they have not asked to be killed.
The practice, known as “involuntary euthanasia”, is against the law in Belgium. Critics say it is barely distinguishable from murder.
But “voluntary euthanasia”, where patients request that a doctor ends their lives, has been permitted in the country for the last eight years.
The extent of the medical malpractice was revealed in a study called The Role of Nurses in Physician-Assisted Deaths in Belgium.
It found that a fifth of nurses interviewed by researchers admitted that they had been involved in the euthanasia of a patient. But it also found that nearly half of these – 120 of 248 – also admitted they had taken part in “terminations [of patients' lives] without request or consent”.
Belgium became the second country in the world after the Netherlands to legalise euthanasia since the fall of Nazi Germany but politicians insisted that patients had to consent and stipulated that doctors were the only people allowed to administer lethal drugs. Euthanasia now accounts for two per cent of all deaths.
The new study, published in the Canadian Medical Association Journal, shows that safeguards introduced with the legislation are routinely flouted to allow involuntary euthanasia and the administration of fatal drugs by nurses. “By administering the life-ending drugs in some of the cases of euthanasia, and in almost half of the cases without an explicit request from the patient, the nurses in our study operated beyond the legal margins of their profession,” wrote authors Freddy Mortimer, Luc Deliens, Johan Bilsen and Els Inghelbrecht.
Furthermore, the researchers said they believed that the number of nurses involved in involuntary euthanasia was in fact higher than their study found.
They said it was likely that many nurses under-reported their involvement because they did not wish to admit to taking part in an illegal activity.
In the study the authors sought to give nurses the benefit of the doubt for their actions, assuming that the patients were too incapacitated to give their consent to their deaths.
It asserted, without evidence, that “although about half of the nurses’ reports indicated that there was no explicit request from the patient, it should be stated that the physicians and nurses probably acted according to the patient’s wishes”.
The study will nevertheless encourage anti-euthanasia activists in Britain who argue that euthanasia and assisted suicide can never be properly regulated and that even the most stringent laws are open to abuse.
Dr Peter Saunders, director of the Care Not Killing alliance, an umbrella group of more than 50 British medical, disabled and religious charities opposed to euthanasia, said: “Once you legalise any form of euthanasia you inevitably get people pushing the boundaries.
“We should take warning from this that wherever you draw the line people will go up to it and beyond it. We are seeing here what we have already seen in the Netherlands which is once you have legalised voluntary euthanasia involuntary euthanasia will inevitably follow.”
He added: “This is further strong evidence that any law allowing euthanasia with so-called safeguards does not work. The only workable approach is that which we have in the UK, which is to have a blanket prohibition on all acts of assisted suicide and euthanasia with the discretion of prosecutors and judges to temper justice with mercy in hard cases.”
Baroness Finlay of Llandaff, a professor of palliative medicine at Cardiff University School of Medicine, said the study represented “clear evidence that around half of euthanasias are occuring outside Belgium law without the request of the patient”.
She said: “It shows that safeguards are far from watertight. The study describes euthanasia as having become a routine process in clinical care-such a shift in the nurses attitudes to ending life is deeply worrying because they have traditionally been viewed as the patient’s advocate and expected to ensure nothing is done to a patient without explicit consent.”
John Smeaton, the director of the Society for the Protection of Unborn Children, said: “The results of this study are not surprising. There’s no fundamental moral difference between voluntary and non-voluntary euthanasia.
“The study also shows, beyond reasonable doubt, that once you legalise voluntary euthanasia, you get widespread non-voluntary euthanasia too.”
The study has also caused an outcry among anti-euthanasia activists overseas.
Wesley Smith, a senior fellow in human rights and bioethics of the Discovery Institute in Washington DC, said the results of the survey proved that “once the euthanasia monster is let out of its cage, the ‘guidelines’ and ‘safeguards’ become less protective than wet tissue paper”.
He said that countries where euthanasia or assisted suicide were legal showed evidence of the “slippery slope” to worsening situations.
He said: “Euthanasia consciousness rests on two intellectual pillars: that killing is an acceptable answer to human suffering, and radical individualism in which we all own our bodies and have the absolute right to do what we wish with it, including make it dead. But interestingly, the latter idea – often reduced to that most effective of all soundbites, ‘choice’ – turns out to be far less robust than the acceptance of active killing as a proper method of ending suffering. In other words, once a society accepts killing as the answer to suffering, the request element becomes increasingly less important as doctors assume they are doing what is best for the patient by extinguishing their lives.”
But Dignity in Dying, the British campaign group formerly known as the Voluntary Euthanasia Society, insisted that safeguards for assisted suicide, where the patient takes his or her own life instead of a doctor administering the drugs, could still work in practice.
Davina Hehir, head of the group’s legal strategy and policy, said: “Research shows that non-voluntary euthanasia occurs both in countries that have legalised euthanasia, and those that have not, including the UK.
“This is one of the reasons that Dignity in Dying does not advocate euthanasia, but only assisted dying for terminally ill, mentally competent adults. An important difference between the two is that the terminally ill adult, having met all the safeguards set down in the law, and having made an informed decision administers the life-ending medication themselves.
“Such a law, as exists in the US states of Oregon and Washington, ensures that people do not have to suffer against their wishes at the end of life and offers much greater scrutiny of end-of-life decision making.”
Campaigners for assisted suicide have failed to persuade Parliament and the courts to change Britain’s law.
Last July Debbie Purdy, a multiple sclerosis sufferer from Bradford, West Yorkshire, forced the House of Lords to order a clarification the 1961 Suicide Act because she wanted to know if her husband would be prosecuted if he helped her to travel to the Dignitas euthanasia clinic in Switzerland to commit suicide.
In February Keir Starmer, Director of Public Prosecutions, issued guidance in which he insisted that it remained a crime. He set out six factors that would make prosecution unlikely, however, including when the suspect was “wholly motivated by compassion” and when the patient had a clear and determined wish to commit suicide.
In spite of the setbacks the campaign to decriminalise assisted suicide is continuing with pressure on MPs to support an future attempt to change the law in Parliament.