Examination of Witnesses (Questions 1880
THURSDAY 13 JANUARY 2005
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
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
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
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
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
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
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
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.