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

Examination of Witnesses (Questions 1880 - 1899)



  Q1880  Lord Joffe: There are safeguards for patients with euthanasia only?

  Professor van den Eynden: Yes.

  Q1881  Lord Joffe: You were asked something about statistics and about the extent of support among doctors and society. The information that I have from Belgium is that at the time the legislation was introduced there was about 50 per cent of physicians in favour and about 80 per cent of society. Would those figures sound more or less correct to you?

  Professor van den Eynden: As far as I was informed at that moment, I have not got the figures now, it was much less, and there has been some integration evaluated. I can look for you. Of course, a study is a study and even statistical studies do not always confirm each other.

  Q1882  Lord Joffe: I see. Perhaps we can make some inquiries. You might be able to find out and let us know?

  Professor van den Eynden: Yes.

  Q1883  Bishop of St Albans: I wonder, Professor, if you could enlighten me about the history of palliative care in Belgium and for how long it has been a very significant part of the health provision in that country?

  Professor van den Eynden: The history is not as long as it is here in Great Britain; that is one. I think it started, let us say, in the middle of the 1980s. We have the symbol of palliative care, like you have Cecily Saunders, we have Sister Leontine, it is a nun who is a medical doctor, a social worker and nurse at the same time and she was the director of the first in-hospital palliative care unit in Brussels. Then quickly it has been followed by two others, and I think in Antwerp we were the third one in 1994, so our unit is now almost 11 years old, we have just celebrated 10 years of our LEF care unit.

  Q1884  Bishop of St Albans: Are there hospices for children involved in that?

  Professor van den Eynden: There are no specific hospices for children. Most children, and mostly it is for children with oncological situations, are cared for in the University Hospital and you can call that a unit but it is not a hospice. There is a unit in the University Hospital in Leuven and one in Gent, and since they were created they are offering them the most high quality care, especially because the relative curative and palliative care for children is still more difficult than it is already for others.

  Q1885  Chairman: Are there different legislative provisions or laws in the different parts of Belgium or is it a uniform law over the whole of Belgium?

  Professor van den Eynden: The law we are speaking about here is the same, it is federal law.

  Q1886  Chairman: It is about two years old, is that right?

  Professor van den Eynden: Yes. September or October 2002.

  Q1887  Chairman: Up to now anyway it has not been changed?

  Professor van den Eynden: No, not yet.

  Q1888  Baroness Finlay of Llandaff: Can I thank you for having made the effort to come today and you got up very early to be here. In your opening remarks, you described a situation that you see now of some patients who express fear that they will be given euthanasia even when they have not asked for it. I wonder if you could tell us, in your own experience, how often you see that in your own clinical work and also in your own hospital, the University Hospital, whether there have been cases where euthanasia has been performed in the context of care?

  Professor van den Eynden: To the first part of your question, there is no registration about that but it happens at least once a week within the whole Hospital as well as in the unit, and mostly nurses are reporting to me that all the patients, 70, 80 years old, really fear that when a nurse comes into the room with a syringe for whatever, of course not to do with euthanasia, or to give a pill, they are asking "Is this to end my life?" It happens at least once a week. Before, let us say three years ago, it was never reported. Of course it is just a factual comparison but at least I think really it is true. To be honest, it is a world of things most hospitals had to organise. Clearly we have a law and, as I said, we are trying to go on with loyalty, so there has to be prosecutors and ways to go on with that. I said, it is a complicated and rigid way which makes that, it does not happen once but often that patients one day are really suffering and requesting it, you have no time and no possibility to offer it any more. To explain that, I should go into detail and I will do that if there is time, but there are a lot often, it is okay, it is what you call the requirements, they are to protect patients against unwanted euthanasia, of course. In the hospital, it happened three times in this two and a half years.

  Q1889  Baroness Finlay of Llandaff: Three patients have gone through the procedure?

  Professor van den Eynden: Yes.

  Q1890  Baroness Finlay of Llandaff: You know that in the Bill that we are considering there is a requirement that patients are told about palliative care at the time that they request euthanasia. I wonder if you have any comments from your own experience about the way in which patients would view being told about palliative care then as opposed to patients who have been in receipt of palliative care previously and their reactions to it?

  Professor van den Eynden: Politicians so the law-makers in my country decided, there has been much discussion, not to put the palliative filter in the law, so it should be mentioned but that is not what we call a palliative filter. A palliative filter is that you can really offer palliative care to a patient, who of course can refuse it, that is another thing, but not just to speak about, not just mention that there is something called palliative care, that is not what we call a filter. In my hospital and in the whole confessional group of hospitals, we made a procedure where palliative care is offered to the patients, the maximum is invested in offering palliative care, and most of the patients, especially these patients, are suffering from pain, from fear, from all these kinds of symptoms, 98, 99 per cent accept this kind of care and the offer which is given to them. Then, of course, I said not for 100 per cent but at least for 97, 98 and it is also in the literature, so the symptoms are relieved and the request is melting away.

  Q1891  Baroness Finlay of Llandaff: Do you have any idea of the numbers of patients whom your own service has seen who have been asking for euthanasia who then have received full, intensive, palliative care intervention and that request has, as you put it, melted away? You have told us that three of them obviously went on but I wonder if we can get a feel of the size of the other group?

  Professor van den Eynden: No, I cannot. We are registering that it is going on. I cannot give even a preliminary figure.

  Q1892  Baroness Jay of Paddington: Just to follow up on this issue about palliative care, obviously we have not had the opportunity to visit Belgium so much of what we are asking you is on the basis of written submissions.

  Professor van den Eynden: You are welcome.

  Q1893  Baroness Jay of Paddington: Thank you. I may be mispronouncing his name but Professor Luc Deliens, the Chairman of the End-of-Life Care Research Group at the University in Brussels, did submit written evidence in which he said, and I wondered if you could help us with what exactly happened, the introduction of euthanasia legislation at the same time as palliative care legislation has resulted in all end-of-life care being placed central to Belgium's healthcare and has resulted in many new discussions on how to improve end-of-life care, suggesting that, in a sense, this has opened up this whole topic for discussion between patients and their medical advisers, and so on. What exactly do you see as having happened? I am just interested in this research document.

  Professor van den Eynden: I know Deliens and his group very well who are co-operating. Only this fact makes me angry. You were not really saying it but the real fact is that when you see the written law on euthanasia it is seven, eight, nine pages, or something like that, the law about euthanasia, which I agree is voted, and going in regulation at the same time is just one page and it is an empty box, there is nothing in it. Until now in my country you have the law and then there is some kind of regulations which make the law work, so there is nothing until now, while euthanasia law, a solution and it works because it is written down in the legislation.

  Q1894  Baroness Jay of Paddington: I am sorry, I think I am not following, I am so sorry. You are saying the palliative care provisions do not have teeth, or are very empty, to use your expression?

  Professor van den Eynden: No, no. It is about the whole regulation, so the palliative care movement. They are working, as I said, it started up in 1985, something like that, and has built up. There are facilities for patients, that is okay, I agree, but this has not taken in the regulation and the law which has been created and which should stimulate and build up palliative care in a regular and official way. This is still an empty box saying that our King will enforce palliative care and make it possible, and that is all, and he is still trying to do it, I believe.

  Q1895  Chairman: Am I right in understanding that the euthanasia law is quite detailed?

  Professor van den Eynden: Yes.

  Q1896  Chairman: There are seven to nine pages of legislative text. We are accustomed to long laws in this country also. That basically palliative care is a voluntary provision which has been built up over the years, and at least so far has not had any detailed legislative recognition?

  Professor van den Eynden: No. As I said, there are practical provisions, for example, which existed before, like, just an example, the money for palliative care beds is coming out of our hospital funds, you would call it the National Health Service, but this was there already before and we did not need it. I still do not see why we needed this palliative care law till now.

  Q1897  Baroness Jay of Paddington: I am just quoting from this research document, as I say, and obviously it is not something I have been able to explore myself. The Professor, with whom you are obviously familiar, says: "Further, palliative care and euthanasia legislation were passed at the same time and as a result there has been much more discussion and focus on how to improve end-of-life care in Belgium." This is something which has brought this whole matter to a much more open discussion between the physicians and the patients?

  Professor van den Eynden: Yes. Maybe I did not say that but that is one of the advantages of the whole discussion which resulted, I agree with that, because of the whole public debate.

  Q1898  Baroness Jay of Paddington: It has stimulated better care. Thank you very much.

  Professor van den Eynden: Yes, that is true.

  Q1899  Lord Joffe: Just to clear up one point. You mentioned these 200 doctors and the LEF. Are they not similar to the scheme doctors in The Netherlands, and they are there for second consultations and there must be more doctors, I suggest, who actually are helping with the administration of euthanasia, these are the consultants?

  Professor van den Eynden: Yes. Some of them also deliver the act of euthanasia.

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