Death is the last enemy for Christians as much as anyone else. Despite poignant poetic allusions to death coming kindly, this is in fact comparatively rare. A very close Christian friend of mine did die peacefully in her sleep just over a week ago. However more often dying is a difficult, draining and all too often dreadful business. No matter how great our confidence that to be with Christ is far better, the process of getting there is rarely one we relish if we are honest.
If we have witnessed a terrible, protracted death of a loved one in pain, it is easy to understand why so many Christians privately if not openly, might be in sympathy with the idea of legalising assisted suicide or euthanasia just in case we should face the same plight when our time comes. Some Christians, of whom the most notable is the former Archbishop of Canterbury, George Carey, have even become open advocates in the media for doctor-assisted or doctor-administered death.
However legalising doctors to assist us to kill ourselves or to kill us – which is what we are actually talking about – does not affect us or our loved ones simply as individuals without affecting society as a whole. We are all affected when laws are changed in such a profound way. The best way in which to see how such a change in the law could affect us in the UK is to examine how it has affected other countries and Belgium is ideally placed in this regard. Having legalised euthanasia in 2002, trends there are causing great concern even for those who campaigned for the change.
A new book Euthanasia and Assisted Suicide: Lessons from Belgium* explores such concerns and though its authors take different views of the permissibility of euthanasia, all of us are concerned about its adverse consequences on Belgian society.
It is very clear that the numbers of reported cases have risen dramatically year on year. There were 235 cases in 2003, the first whole year following legalization but this had risen to 2021 cases in 2015. Dr Wim Distelmans a leading advocate of legalisation and now chair of the commission for monitoring cases commented on the 2015 figures by stating: 'Remember, there could be some euthanasia cases carried out but which are not declared so we cannot say for certain what the position is.' In essence, he has confirmed that there are probably many more cases of euthanasia in Belgium which are going unreported and there can be little doubt the monitoring of cases there is inadequate when the chair of the monitoring commission himself makes such an admission. Independent research shows that only around a half of cases of euthanasia are actually reported,
This dramatic rise in numbers would be cause for concern even if they were all of patients in their final weeks of life from incurable terminal illness. However many cases do not involve the terminally and an increasing number have no physical illness at all but have psychiatric or psychological health problems. Euthanasia is also being advocated for and given to those who are simply 'tired of life'. Even more worryingly the book demonstrates that the increase in number has been accompanied by 'an increase in life ending without request' thus mirroring what has already been well-documented in the Netherlands.
Legalising assisted suicide and euthanasia has impacted other elements of end of life care also. Hospices and other facilities providing terminal care in Belgium must now offer euthanasia as part of their services of fact threat of closure. The prescribing of sedation in palliative care in the UK is rarely used with the deliberate intention of shortening life but in Belgium, continuous sedation up to death was initiated without patient or relative's consent or request in over a quarter cases where is was used. The book also provides evidence that continuous sedation is also being overtly used as a mechanism for euthanasia which would not have to be reported.
Another cause for concern, not just because of its potential to put pressure on those considering euthanasia but also to bring the whole enterprise of organ transplantation into disrepute, is the increasing practice of organ removal after euthanasia. If those requesting euthanasia are physically well, the timing of the removal of their organs can be optimised to coincide with their death so such organs will be often of very high suitability for transplantation. Around a quarter of lung transplants in Belgium come from euthanasia cases. As one prominent researcher into Belgian euthanasia comments: 'The concern is that patients might be motivated to consider euthanasia for the purpose of organ procurement and that the planning of the death procedure might be against the wishes of the patient, against her best interests, premature and possibly for profit. Adequate checks need to be squarely in place to ascertain that such abuse does not happen.'
The Belgian experience clearly shows that once euthanasia and assisted suicide are legalised they take on a dynamic of their own. I totally endorse the editors' conclusion that 'the only secure way to avoid these consequences is to resist calls to legalise euthanasia or assisted suicide and instead invest in palliative care as well as research into end-of-life practices while re-emphasising the preciousness of human life.' It is now far too late for Belgium but not for the UK.
* Euthanasia and Assisted Suicide: Lessons from Belgium 2018 Cambridge University Press
Trevor Stammers is Reader in Bioethics, St Mary's University, Twickenham
