The Right to Die: Belgium’s Liberal Euthanasia Law

By Frankie Salamida

Belgium legalized voluntary euthanasia in 2002 and currently has the most liberal euthanasia laws compared to any other country in the world.[1] Some have wondered if these laws have gone too far, but physicians in Belgium believe they have not.[2] With the number of safeguards in place and conditions that must be met, physicians assure that people who die via euthanasia are making an informed choice themselves. Thus, Belgium’s legalization gives these patients a right to die.[3]

Euthanasia is the practice of intentionally ending life to relieve pain and suffering, and a physician performs the actual act of euthanasia.[4] There are four types of euthanasia: voluntary, non-voluntary, involuntary, and passive and active.[5] Specifically, voluntary euthanasia is defined as “a clearly competent person mak[ing] a voluntary and enduring request to be helped to die.”[6] As of 2022, there are six countries where voluntary euthanasia is legal: Australia, Belgium, Canada, Colombia, Luxembourg, and the Netherlands.[7]

There are many moral and ethical issues regarding euthanasia and physician assisted suicide. First, supporters of euthanasia say that these laws give physicians a humane way to help patients end their long-term suffering.[8] In a study sent out to physicians in Belgium, ninety percent of physicians accepted euthanasia for terminal patients who had severe and uncontrollable pain.[9] Another study performed with psychiatrists in Belgium concluded that almost seventy-five percent of those psychiatrists agreed with the Belgian euthanasia laws in place for patients suffering from psychiatric conditions.[10] Even with this overwhelming support of the laws in place for patients with psychiatric conditions, further education is needed to ensure patients who suffer from psychiatric conditions have their euthanasia requests assessed properly.[11]

On the other side, different groups have argued various moral or ethical issues with euthanasia.[12] Most arguments against euthanasia are that it is against God’s will, that it weakens society’s respect for life, and that voluntary euthanasia is a slippery slope that could also legalize involuntary euthanasia.[13]

The first voluntary euthanasia request approved from a minor was two years after the amendment passed in 2016. Courtesy Prindle Institute.

Voluntary euthanasia is legal in Belgium patients who are unbearably suffering and will not recover.[14] Belgium was the second country in the world to legalize voluntary euthanasia.[15] Under the Belgium Act of Euthanasia of May 28, 2002 (the “Act”), euthanasia is defined as intentionally terminating life by someone other than the person concerned, at the latter’s request.[16] Under this Act, there are several conditions that a patient must meet and procedures that the physician must complete before the act of euthanasia is performed.[17] Under Section 3 §2, before carrying out the euthanasia, a physician must: (1) inform the patient about their health condition and life expectancy; (2) discuss other possible courses of action; (3) come to the belief with the patient that there is no reasonable alternative; (4) be certain of the patient’s constant physical or mental suffering; (5) consult another physician and discuss the requests with the patient’s nursing team; and (6) if the patient desires, discuss the decision with relatives appointed by the patient and be certain patient has had the opportunity to discuss the request with requested persons.[18] Under Section 3 §3, if the physician believes the patient is clearly not expected to die in the near future, then the physician must consult a second specialist physician, and allow one month between the patient’s written request and euthanasia.[19] Under Section 3, §4, the patient’s request must be in writing, drawn up, dated, and signed by the patient themselves.[20] The patient may revoke request at any time.[21]

In 2014, Belgium amended the Act to remove any age requirement.[22] This effectively extended the option of voluntary euthanasia to children.[23] Belgium is the only country where there are no age restrictions on voluntary euthanasia.[24] When the amendment was first proposed, there was a lot of opposition from various groups, including physician and religious groups that claimed that children do not possess the mental capacity to make this decision.[25] Despite much opposition, the amendment passed in Parliament by a wide margin.[26] For someone under the age of eighteen to be euthanized, they must meet several additional criteria.[27] There must be voluntary and repeated requests and the child must have a medical condition that leaves them in “constant and unbearable physical suffering that cannot be alleviated and that will result in death in the short term.”[28] These conditions most likely occur when a child is in the final stages of a terminal illness.[29] The child must also display a capacity of discernment and be conscious when making the requests.[30] An additional safeguard in place before a minor proceeds with euthanasia is that the parents or legal guardians of the child have a right to veto.[31] The first voluntary euthanasia request approved from a minor was two years after the amendment passed in 2016.[32] The child was a seventeen-year-old who suffered from a terminal illness.[33] The most recent data states that since 2018 there have only been three minors granted voluntary euthanasia in Belgium.[34]

Euthanasia continues to be a hot topic, and the Act in Belgium is currently the most liberal voluntary euthanasia law in the world.[35] Supporters of the Act believe in giving a peaceful end to patients who are suffering from painful and terminal conditions.[36] Opponents to these laws worry that it is a slippery slope that will lead to other types of euthanasia to become legal.[37] In the end, supporters of voluntary euthanasia laws in Belgium win out, and Belgium continues to support a patient’s right to die.[38]

[1] Euthanasia & Physician-Assisted Suicide (PAS) Around the World, Britannica ProCon.org (July 7, 2022), https://euthanasia.procon.org/euthanasia-physician-assisted-suicide-pas-around-the-world/#belgium [hereinafter Euthanasia].

[2] Tinne Smets et al., Attitudes and Experiences of Belgian Physicians Regarding Euthanasia Practice and the Euthanasia Law, 41 J. of Pain and Symptom Mgmt., 580 (2011).

[3] Id.

[4] Id.

[5] Euthanasia, supra note 1.

[6] Voluntary Euthanasia, Stanford Encyc. Of Phil., https://plato.stanford.edu/entries/euthanasia-voluntary/ (last updated May 24, 2022).

[7] Euthanasia, supra note 1.

[8] The Right to Die in Belgium: An Inside Look at the World’s Most Liberal Euthanasia Law, PBS NewsHour (Jan. 15, 2015), https://www.pbs.org/newshour/show/right-die-belgium-inside-worlds-liberal-euthanasia-laws.

[9] Smets et al., supra note 2.

[10] Monica Verhofstadt et al., Belgian Psychiatrists’ Attitudes Towards, and Readiness to Engage in, Euthanasia Assessment Procedures with Adults with Psychiatric Conditions: a Survey, 20 BMC Psychiatry 374 (2020).

[11] Id.

[12] Anti-Euthanasia Arguments, BBC (2014), https://www.bbc.co.uk/ethics/euthanasia/against/against_1.shtml.

[13] Id.

[14] Euthanasia, supra note 1.

[15] Id.

[16] The Belgium Act on Euthanasia May, 28th 2002, 10(3) European J. of Health L. 329 (2003) [hereinafter The Act].

[17] Id.

[18] Id.

[19] Id.

[20] Id.

[21] Id.

[22] Jo Samanta, Children and Euthanasia: Belgium's Controversial New Law, 12 Diversity & Equal. in Health & Care 4 (2015).