"Dying-with-dignity laws can hit a slippery slope" by Charlie Fidelman

"Dying-with-dignity laws can hit a slippery slope" was published by Charlie Fidelman, Gazette Health Reporter, in the Montreal Gazette on September 17, 2013.

Tom Mortier got a shocking email last year that his mother, Godelieva De Troyer, who had been suffering with depression, had died a day earlier by lethal injection. This photo was taken on April 11, 2010, almost two years before her euthanasia.

MONTREAL — Belgian professor Tom Mortier got a shocking message at work last year informing him that his 64-year-old mother, who had been struggling with depression, received a lethal injection a day earlier.

Since his mother’s death, Mortier, who lectures on chemistry at the University College Leuven, has questioned and criticized Belgian law allowing euthanasia.

“These kind of legislations are taking the ethics out of the medical practice,” Mortier said in a telephone interview from his home Tuesday as Quebec launched parliamentary hearings on Bill 52, the controversial right-to-die legislation aimed at allowing doctors to help some terminally ill patients end their lives.

While several medical groups told parliament on Tuesday they support legislation to legalize euthanasia, Mortier warned Quebec that dying-with-dignity laws represent a slippery slope.

“It will only create new problems. They don’t see how it’s going to evolve,” Mortier said.

When Belgium adopted euthanasia in 2002, a year after Holland, the practice was aimed at patients with incurrable diseases and unbearable suffering.

“It was meant for very restrictive situations and rare circumstances, but the numbers have been rising,” Mortier said, and the practice has now gained wide acceptance.

Dr. Sarah Van Laer, who has euthanized 28 patients, has criticized the growing practice as “turbo-euthanasia.”

In June, the case of identical, deaf, 43-year-old Belgian twins Marc and Eddy Verbessem reverberated worldwide when the pair chose to die after discovering they had a genetic anomaly that would lead to their blindness. The case was striking because they were young and not terminally ill.

Mortier, who paid the issue little attention until confronted by his own mother’s death, said that nothing was written about euthanasia in her medical report.

Godelieva De Troyer died on April 19, 2012. She was suffering from chronic depression after a long-term relationship with her boyfriend ended. The death was carried out on the recommendation of a single psychiatrist.

“I spoke to the doctor who euthanized my mother and he said he was absolutely certain she didn’t want to live anymore,” Mortier said. “How could he be so sure?”

Mortier warned that Quebec’s proposed legislation would create a new class of physician — one who will have the power to determine the criteria for death. Paraphrasing the declaration from the World Medical Association, which opposes euthanasia, Mortier said: “Doctors should be taking care of people, not killing them.”

Quebec is not Belgium, said Dr. Yves Robert of the Quebec College of Physicians.

“This case would not have been allowed in Quebec under Bill 52,” Robert said of Mortier’s mother. “No stakeholders want this.”

The proposed law specifies three conditions: there must be an incurable disease, imminent death and unbearable suffering — which rules out depression, Robert said.

“Under these medical criteria, this woman would not have had access to medical help to die in Quebec,” he added.

Quebec did look to countries like Holland and Belgium to learn from their weaknesses; the problem in Europe is the scope of the law, Robert said, referring to cases where patients got life-ending drugs without their consent.

Quebec’s legislation excludes patients who are declared “inapt”, for example, those with dementia, and who cannot consent for themselves, Robert said, and the government will have to address that in the future because the bill does not cover all cases.

When Quebec first began debating the issue four years ago, more than 80 per cent of the province’s medical specialists surveyed said they had already seen euthanasia practised, and 48 per cent said that palliative sedation “can be likened to a form of euthanasia.”

But a law would provide tools — a framework and controls for end-of-life care, Robert said: “Without one, we’re exposed to clandestine activities with the complicity of everyone — and no way to intervene against that. That’s the benefit of such a law and why the College was in favour of this bill.”

However, opponents call attention to a 2011 study published in Current Oncology by University of Ottawa palliative care physician José Pereira, who says that safeguards protecting patients from abuse are an illusion.

A key highlight of Quebec’s proposed law, Robert said, is a vigilante-type government committee that would be responsible for verifying and overseeing all issues surrounding end-of-life care under Bill 52.

“Nothing is sure 100 per cent,” Robert said. “But I think there are enough safeguards to protect the public.”

Also, Quebec will have to invest in palliative support as part of the spectrum of end-of-life care, which in some cases will include the possibility of medical help to die.

“We said that to the MPs this morning, ‘Yes, there will be a need for investment,’ ” to improve services all across the province for a population that is aging, Robert said.

Claims that euthanasia will replace palliative care is “misinformation,” Robert said.

According to a survey this week conducted for the Quebec Medical Association, two-thirds of the province’s physicians say they agree that medical aid represents appropriate end-of-life care.

But not everyone agrees. Paul Saba, of the Coalition of Physicians for Social Justice, said that informed consent is not always respected in countries where euthanasia is legal.

Only 20 per cent of Quebec patients have access to palliative care in hospital. “Can they make a clear and informed consent when facing inadequate health care and risk suffering because they’re lacking homecare and medical services?”

Quebec is promoting euthanasia as a cheap alternative to palliative care, Saba said. The cost of dying is about $13 for an injection with a lethal cocktail of drugs, while the Canadian Hospice Palliative Care Association pegged the cost of a patient dying in a hospice at $439 a day and $800 to $1,000 a day in hospital.

On average, it costs $36,000 to die in a chronic care facility, the association said.

The hearings continue this week in Quebec City.

cfidelman@montrealgazette.com

"Disclosure Rules Leave Some Relatives in the Dark" by Naftali Bendavid

"Disclosure Rules Leave Some Relatives in the Dark" was published by Naftali Bendavid in The Wall Street Journal on June 14, 2013.

BRUSSELS — Tom Mortier received a message at work last year saying his 64-year-old mother had died the day before, and he quickly found out she'd been euthanized.

Mr. Mortier, who teaches college chemistry, was shocked. Though estranged from his mother, he knew she was depressed and had spoken of euthanasia. But he had no idea this could happen, he said, especially since she wasn't physically ill, and her children weren't informed. "This is irreversible," he said. "One day my mother is dead."

In the past 10 years since the country legalized the practice, more than 5,530 Belgians have signed up for euthanasia, according to government records. By most accounts, those who carry it out are surrounded by supportive family and friends. But however they occur, most cases have a searing effect on more than just the patient.

Five years ago, in a more typical case, a well-known Belgian writer Hugo Claus decided to be euthanized at age 78 while suffering from Alzheimer's. "He wanted to remain master of his life and also of his death," said his wife, Veerle Claus.

As the time approached, Mr. Claus's best friend came to stay with the couple to spend some final days visiting restaurants, talking, and laughing. Then on March 19, 2008, they took a cab to the hospital. "You leave in the morning with your husband and you talk normally," she recalled. "You know it's a one-way drive."

The Clauses drank champagne in the hospital room and shared a last forbidden cigarette. "Now it's time," Mr. Claus said. As he lay down, Ms. Claus sang a sentimental song, "Un Jour Tu Verras," about lovers who will reunite one day. Mr. Claus joined in until the injection took effect. "He died singing," Ms. Claus said. "You can't dream of a better death."

But Mr. Mortier remains angry about the fate of his mother, Godelieva De Troyer. She was depressed and emotionally difficult her whole life, he said, and in January last year, told him by email she'd asked for euthanasia. Mr. Mortier was used to his mother's emotionalism, and said doctors he knew insisted she wasn't a candidate for euthanasia.

They were wrong. Belgian law reserves euthanasia for patients with unbearable suffering and incurable conditions. But the suffering need not be physical, and the condition need not be fatal. The law also doesn't require the patient to notify the family.

In the end, in April that year, Mr. Mortier received an email from his wife saying to call a hospital because his mother was dead. Still stunned, he learned at the mortuary he was responsible for moving her body to an anatomy lab, since his mother had donated her body to science. He later received a final letter from his mother, confirming she was being euthanized and explaining how to retrieve her house key.

The doctors, including her primary physician who declined to comment, told Mr. Mortier his mother's desire to die was unequivocal and that she refused entreaties to contact him. Mr. Mortier says the law just gives doctors too much power determining the criteria for death. "What the doctor does is like a god," he said. "He decides if the life is worth living or not."

Write to Naftali.Bendavid at naftali.bendavid@wsj.com