Examination of Witnesses (Questions 1860
THURSDAY 13 JANUARY 2005
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
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
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
Q1865 Lord Patel: At the beginning,
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
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
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.