THOU SHALT KILL

Where Stopping Euthanasia Is Illegal

Since 2002, thousands of patients have been helped to die in Belgium, many of them in Catholic hospitals. But a battle is brewing.

AMSTERDAM — A Belgian civil court has fined a Catholic home for the elderly €6,000 ( $6,660) for interfering with a doctor trying to euthanize a patient.

The case, decided last week, stands out in a country where assisted dying has become almost commonplace. Last year, according to official statistics, 1,926 patients were helped to end their lives in Belgium, including some people who were suffering from depression.

“It is not unique for hospitals or nursing homes to try to prevent euthanasia,” says Dr. Patrik Vankrunkelsven, a former senator and physician involved in the case against the Sint Augustinus home in Diest, near Brussels. “Usually they do so for ideological reasons.” Or, as they would say, religious ones. But that is illegal in Belgium, whose laws since 2002, like those in the Netherlands, support the right to die.

The family of 74-year-old Mariette Buntjens started the suit against the care home in 2011, after they were forced to move their mother at the last minute to a different location in order to respect her final wish.

“Our mother was terminally ill, she had cancer,” one of her daughters told Belgian VRT television. Buntjens, diagnosed with final-stage lung cancer, had decided six months before where and when she wanted to die. “She was afraid to suffer, to have pain,” her daughter said.

On the set date, the home’s reluctance to cooperate with the euthanasia, which has been legalized in Belgium since 2002, came completely out of the blue.

“You prepare, for that day, for what’s going to happen,” said another daughter on the VRT broadcast. The whole family had said their goodbyes. It was hard enough to do that once, her daughter said. Then the director of the home said, “We will not go ahead; we don’t do that here.”

There are set procedures before a decision is made to help someone to die.

If a patient asks for euthanasia several times over an extended period, two doctors have to agree that the procedure can be performed. The first physician is usually the personal physician. (Family doctors are not so rare in Belgium and the Netherlands as they have become in some other countries.)

In this case Mariette Buntjens’ long-term doctor, Jozef Vankrunkelsven, agreed, and called in Patrik Vankrunkelsven, one of those second opinion doctors, who are called LEIF doctors in Belgium. A particularity of this case is that the long-term doctor and LEIF doctor are brothers.

“We look at the physical condition of the patient again and in this case we agreed that she had deteriorated to such an extent that the moment was indeed nearing,” Patrik Vankrunkelsven told The Daily Beast.

The nursing home had not previously said it objected, and had even prepared the drip for the procedure, then suddenly said no. The patient’s personal physician was refused entry. He called an ambulance and had her transported to another location.

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Given that most hospitals in Belgium to this day are Catholic, if they refuse to carry out euthanasia procedures that will complicate matters greatly for those who want assistance dying. “We just hope to prevent such situations for others,” said Buntjens’s daughter. “If your papers are in order and the moment is there, you should be able to get euthanasia.”

Archbishop Jozef De Kesel told the regional newspaper Het Belang van Limburg that when it comes to euthanasia or abortion, “I think that on an institutional level we have the right to decide that we won’t do that.” By institutions, he said, “I primarily mean hospitals.” But the law holds that conscientious objection is insufficient cause to refuse euthanasia, and at present many Catholic hospitals reportedly are allowing it.

The law says that euthanasia is an agreement between a physician and patient. It does not describe a position for a nursing home. So this court decision, which goes in favor of Belgium’s pro-euthanasia legislation, sets an important precedent.

The court case was set to determine if nursing homes were overstepping legal boundaries by intervening in the wishes of patients to end their lives. “It essentially marks the nursing home as an extension of the private living space of its patients,” explains Vankrunkelsven.

“One could take the position that if a nursing home takes a clear stand on euthanasia in its external communication, it would give a clear signal to its patients.” said Vankrunkelsven. “But in the case of St. Augustinus it told the family clearly, before they admitted Mrs. Buntjens, that euthanasia would not pose a problem.”

“I had a meeting with the head nurse and the resident doctor, who were on one page with us,” said Vankrunkelsven. All seemed set. But then things changed. “All of a sudden my brother received an email from management saying that the euthanasia we had ‘planned,’ that’s how it read, ‘can’t go ahead because we find the conditions have not been met.’ Apparently management changed its mind.”

“The judge decided the home did not stipulate which conditions were not met,” explains Vankrunkelsven, “so that leaves the option that the home resisted out of principle and that is not legal.”

For the Catholic homes there will be a chance to appeal, but so far there are no indications a case is in preparation.