Select Committee on Assisted Dying for the Terminally Ill Bill Minutes of Evidence

Examination of Witnesses (Questions 1860 - 1879)



  Q1860  Lord Turnberg: Out of the total number of physicians that are likely to be involved, is it half of them that are involved or less than that?

  Professor van den Eynden: No, much less than a half. I cannot give you the percentage but it is a very small amount.

  Q1861  Lord Turnberg: Patients are referred to them, are they?

  Professor van den Eynden: In the law it is built in that as a doctor you are not obliged to act, but in the case, of course, it is not punishment built in but you are obliged to send, if you are not doing it yourself and you are not accountable, you have to send the patient to another doctor whom you suppose or you know is able to and will do it. That is built in, it is Article, whatever, in the law.

  Q1862  Lord Turnberg: You know that group of doctors, do you?

  Professor van den Eynden: There are lists and there is a group of about 200 doctors in what is called LEF, I cannot translate it. It is the F doctors who are saying publicly and one can say promoting that you can contact them for the act of euthanasia.

  Q1863  Lord Turnberg: I take it that you have not referred any patients to them?

  Professor van den Eynden: I did.

  Q1864  Lord Patel: The view you have expressed, is it held by the majority of doctors in Belgium, two years after the law has been enacted?

  Professor van den Eynden: No. There has been, at least at that moment, and we are trying to see after two years if there is some evolution or maybe through the implementation of the law, there was a strong opposition of physicians against the law.

  Q1865  Lord Patel: At the beginning, or now?

  Professor van den Eynden: I believe still now, but again people, and doctors are also people, are more and more used to it.

  Q1866  Lord Patel: My supplementary question was whether any law is being broken by the doctors? We hear evidence in other countries that the documentation is not completed or reporting is not complete. Is that the case?

  Professor van den Eynden: As I said, 350 reported cases. There are assumptions that it is the same quantity as it is in The Netherlands. It means that at least 50 per cent is not reported and maybe it is more, but because it is not reported you do not know.

  Q1867  Lord Joffe: Professor, I assume you are aware of the recent report by the Federal Inspection and Evaluation Committee on Euthanasia of Belgium?

  Professor van den Eynden: Yes. I have it somewhere in my luggage.

  Q1868  Lord Joffe: I have to rely on the translation, which I hope is correct. What it appeared to be saying is, and this was set up by the Government in conjunction with medical practitioners and lawyers, my understanding is that the Committee consists of 16 individuals, of whom eight are physicians, four are palliative care consultants and four are lawyers. In their first report, which covers the period from, I think, the inception of the legislation in September 2002 to 31 December 2003, it appears that the whole system is working well and they say they see no reason at all to suggest any new initiatives. Overall, it would seem to be an endorsement of what is happening with the implementation of euthanasia in Belgium. Would you agree with that?

  Professor van den Eynden: I agree with the second thing you said, this was also in my, let us say, lecture, that new initiative, and they are making allusion to legalising it also for dementia patients and for children. On the other hand, this is also a conclusion of the Committee. I am a member of them. There are 16 and then 16 people who are taking the place when someone is ill and I am one of those.

  Q1869  Lord Joffe: You are a deputy?

  Professor van den Eynden: I follow the whole discussion and of course it is a consensus document. Mainly from the palliative care corner, there has been a lot of discussion about it, and, for example, Professor van Nistal, he is one of the most excellent members of the whole Committee, he had also formulated a lot of criticism on the way the whole law is implemented now. On the other hand, it is only the first two years and the Committee decided not to be too critical and to give at least two more years. We have to report every two years.

  Q1870  Chairman: Do I take it from what you have just said that you agree with the findings of the report from which Lord Joffe is quoting?

  Professor van den Eynden: The report is just giving figures and some statistical analysis, it is not going in-depth because the time was too short.

  Q1871  Chairman: I follow that. Anyway, you agree with the report from which Lord Joffe is quoting?

  Professor van den Eynden: Not that, otherwise I would not have said what I have said here, not that the situation is perfect. When the document was floated, of course it is then the group of 16 which has to agree with the document.

  Q1872  Chairman: Do I understand that the report recommended that no further changes should be made in the law at the present time, but that you understood, am I right, that there were two extensions of the law which were being proposed which this group has said should not be considered, at least at the moment, and that is an extension to those with dementia and to children?

  Professor van den Eynden: We would call it two Bills which are now in our Parliament to be voted on or not to be voted on by politicians.

  Chairman: Thank you. I just wanted to be sure that I followed that.

  Q1873  Lord Joffe: My Lord Chairman, basically the point has been made that this report states specifically that they are not recommending any new initiatives, and that is clear. They are debating two Bills in Parliament. What is that?

  Professor van den Eynden: There are now two Bills which will be discussed by our politicians in Parliament, one about broadening it to patients with dementia and allowing it for patients with dementia, and one for children.

  Q1874  Lord Joffe: This Committee does not support that?

  Professor van den Eynden: That is right.

  Q1875  Lord Joffe: In your helpful evidence, you spoke about controlled sedation, which you thought could be appropriate for some patients. Is that the same as terminal sedation?

  Professor van den Eynden: No. That is a whole discussion about definition but let us say it is the same. I think that one of our philosophers has written six months ago an article just about terminology. Let us not go in that trap but let us say it is the same. It is about patients with refractory symptoms, so it is a tool for symptom control, who are normal and then you can discuss what is a normal tool, a normal method to try to control that symptom has failed and controlled sedation is then the ultimate means to get control and to give the patient rest.

  Q1876  Lord Joffe: They can die peacefully?

  Professor van den Eynden: No. Just that is the difference between euthanasia, in the case of euthanasia, okay, then we will also reach symptom control by, excuse me, but it is so, killing the patient, which is another case in controlled sedation where you are giving just rest, you are letting the patient sleep and a sleeping patient is not suffering, is not getting any symptom problems.

  Q1877  Lord Joffe: Would that sedation carry on until the patient eventually died of the underlying causes?

  Professor van den Eynden: Yes, the natural disease, the natural process of dying is continuing, of course, because it is only applicable, as far as I can agree, in terminal situations. When for a patient in that situation you are not able to reach good symptom control, okay, then you are asking, because that is for me another very important thing which has been discussed with the patient.

  Q1878  Lord Joffe: The patient remains unconscious until they die?

  Professor van den Eynden: Yes.

  Q1879  Lord Joffe: In order to use that means of dealing with a patient's suffering, are there any safeguards within the law, not like the euthanasia safeguards?

  Professor van den Eynden: That is what I mean, that was my first point. The whole palliative world in Belgium would have liked and would have agreed that if they had tried to make some kind of regulation, whatever, some parts, doctors who were asking "Let's do it ourselves," it did not happen, but there is no regulation for palliative sedation, for assisted suicide, for stopping or not starting active treatment, or augmenting pain control when the patient does not agree. For all these end-of-life issues there is no global regulation, there is only for euthanasia.

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