Euthanasia has been legal in Belgium since 2002. Catholic caregivers and the Church in that country are faced with ethical dilemmas when it comes to the suffering of certain patients who ask for their lives to be ended. Rather than opposing the current legislative framework head-on, the Catholic Church works to promote alternatives, notably by encouraging the development of palliative care.
More than two decades after its legalization, euthanasia is an increasingly common practice in Belgium. According to official data, the number of euthanasias performed there continues to rise: 3,423 in 2023, compared with 2,966 in 2022 and 2,699 in 2021.
The Pope didn’t mention the topic directly during his recent visit. However, he did praise the pro-life stance of the late King Baudouin with respect to abortion, and in that context mentioned new “criminal laws” in Belgium, possibly referring to euthanasia.
Euthanasia becoming legal in more Western countries
Pope Francis has often spoken out against the spread of euthanasia in Western countries. “Today, I am very sad, because in the country where the Virgin appeared, a law is being passed to kill, a further addition to the long list of countries with euthanasia,” declared Pope Francis on May 13, 2023. It was the day of the liturgical commemoration of the apparitions of the Virgin Mary to the shepherds of Fatima, the day after the vote on the law legalizing euthanasia in Portugal.
The country, which was preparing to host the World Youth Day in Lisbon, joined Belgium, Luxembourg, the Netherlands, Spain, and Canada among the countries that have legalized active assistance in dying.
In these countries, the gradual extension of the conditions under which euthanasia can be practiced is raising major ethical concerns, especially as well-known personalities have had recourse to it.
On February 5, 2024, former Dutch Prime Minister Dries Van Agt had himself and his wife euthanized. In Belgium, in 2013, the euthanasia of Christian de Duve, a renowned professor at the Catholic University of Leuven, Nobel Prize winner for medicine, and member of the Pontifical Academy of Sciences, sparked much debate.
While the Belgian Bishops' Conference has never called on Catholics to fight this law head-on, it is careful to maintain safeguards. Last April, the Belgian bishops, led by the new Archbishop of Malines-Brussels, Luc Terlinden, said they were “deeply dismayed” by a proposal put forward by Luc Van Gorp, President of the National Alliance of Dutch-speaking Christian Mutual Society, to drastically widen access to euthanasia, particularly for people suffering from dementia, or who feel tired of living or that their life is “over,” a particularly extensive notion that is difficult to define.
Relieving suffering to avoid euthanasia
I.MEDIA interviewed Professor Benoît Beuselinck, oncologist at Leuven University Hospital, regarding this issue which he faces regularly. He explains that half of all requests for euthanasia come from terminal cancer patients who feel “at the end of their tether.” But he points out that these requests are reversible.
“When symptoms are better controlled, or we decide to stop treatment and let them go naturally, euthanasia requests disappear: This has been the case for the last three euthanasia requests I've had in the last two weeks,” he explains.
Palliative care has developed and received public funding in Belgium, but the practice of euthanasia in the same hospital units raises ambiguity as to the nature of the care provided during these end-of-life periods.
“Contrary to the guidelines of the European Association for Palliative Care and the WHO, which state that euthanasia is not part of palliative care, or is even opposed to it, euthanasia has been promoted in Belgium as an integral part of palliative care,” says Dr. Beuselinck with concern.
“Very few teams have decided to continue working exclusively with traditional palliative care, but many have opened up the possibility of euthanasia, either out of conviction or under pressure from the press or patients,” he acknowledges.
However, “some palliative care units are fighting to reduce the number of cases of euthanasia as much as possible, as they feel that this is never a pleasant solution and not their main mission. They also fear becoming the 'euthanasia units' of the hospital,” explains the doctor.
Opening a dialogue with patients
“One advantage of the law, I admit, is the fact that patients talk more often and more spontaneously about their end of life and the fatal outcome that their illness can have,” explains the cancer specialist, who notes that “for some doctors, this remains a taboo or a difficult subject to approach.”
“Avoiding therapeutic obstinacy and therefore moving more quickly to providing comfort and palliative care is a very good development. As much as intentionally shortening life is a lack of respect for it, prolonging it in difficult circumstances and not letting life end naturally and peacefully is also a lack of respect for life and, to put it in Christian terms, a ‘sin,’” he says.
“We must therefore avoid therapeutic obstinacy at all costs and advanced discussions on the end of life can help us do this,” adds Dr. Beuselinck.
But serious ethical problems remain. The doctor notes that some patients are euthanized before they have received the treatments that could have given them good quality of life for several more months, or even years.
Pressure on the most vulnerable
Dr. Beuselinck also points out that 17% of euthanasias performed in Belgium concern people who are not terminally ill, suffering from neurodegenerative or psychiatric diseases, or subject to multiple pathologies, especially among the very elderly. He notes that "pressure" may be exerted to the detriment of the poorest people, who do not necessarily have the means to pay medical bills or accommodations in a retirement home.
Even among the left-wing parties, generally more in favor of euthanasia, some voices are raised to warn that "it would be especially the most vulnerable people, with fewer financial resources or less family support, or fewer cultural and philosophical resources to cope with the disease, who would request euthanasia more quickly." A new form of social segregation therefore appears in the final stage of life.
Promoting alternatives to euthanasia
So what can Catholics do about the expansion of assisted dying?
“Rather than expressing opposition to certain practices, it seems to me that the Pope and Christians must above all act in favor of a solution that seems better to them than euthanasia, because it corresponds better to human nature and respects the conscience of health care workers,” explains the doctor.
“It’s about helping [people] to rediscover the dignity of life, to find a new meaning to life even when we are sick, to rediscover the beauty of fragility that leads us to take care of each other, and treat nature with the greatest possible care. This also fits perfectly with the theology of ecology, dear to Pope Francis,” reflects the oncologist.
He points out, however, that the Pope's words are rarely reported in the media. Indeed, the secularization of Belgium has brought with it a certain indifference of public opinion towards papal speeches. "But sick people and caregivers who want to avoid euthanasia obviously feel very comforted by these messages from Francis and the Belgian Episcopal Conference," assures Dr. Beuselinck.
Any speeches by the Pope on this subject will in any case be closely scrutinized on the other side of the border, in France. The debate on the end of life, suspended since the dissolution of the National Assembly last June, could be relaunched there from the start of the parliamentary term.
