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Euthanasia for Detainees in Belgium

The Case of Frank Van Den Bleeken

Published online by Cambridge University Press:  27 June 2016

KATRIEN DEVOLDER
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Abstract:

In 2011, Frank Van Den Bleeken became the first detainee to request euthanasia under Belgium’s Euthanasia Act of 2002. This article investigates whether it would be lawful and morally permissible for a doctor to accede to this request. Though Van Den Bleeken has not been held accountable for the crimes he committed, he has been detained in an ordinary prison, without appropriate psychiatric care, for more than 30 years. It is first established that Van Den Bleeken’s euthanasia request plausibly meets the relevant conditions of the Euthanasia Act and that, consequently, a doctor could lawfully fulfill it. Next, it is argued that autonomy-based reasons for euthanizing him outweigh complicity-based reasons against doing so, and that, therefore, it is also morally permissible for a doctor to carry out the euthanasia request.

Keywords

euthanasiadetaineepsychiatryautonomycomplicity
Type
Special Section: Bioethics Beyond Borders
Information
Cambridge Quarterly of Healthcare Ethics , Volume 25 , Issue 3 , July 2016 , pp. 384 - 394
Copyright
Copyright © Cambridge University Press 2016 

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References

Notes

1. Under Belgian law, mentally ill offenders can be interned as a safety measure, to protect society. Vandevelde, S, Soyez, V, Vander Beken, T, De Smet, S, Boers, A, Broekaert, E. Mentally ill offenders in prison: The Belgian case. International Journal of Law and Psychiatry 2011;34(1):71–8.CrossRefGoogle ScholarPubMed

2. The Belgian Act on Euthanasia of May 28, 2002; available (in Dutch and French) at http://www.ejustice.just.fgov.be and (in English) at www.kuleuven.ac.be/cbmer (last accessed 20 Jan 2015).

3. In section 2 of the act, euthanasia is defined as intentional termination of life by someone other than the person concerned, at the latter’s request. The doctor who carries out the euthanasia need not be the attending physician, though section 3 of the act stipulates that the doctor must have a number of conversations with the patient, spread over a reasonable period of time, to guarantee the durability of the euthanasia request.

4. Amnesty International. Belgium falls short of its obligations on torture and ill treatment [public statement]; available at http://www.amnesty.eu/en/news/press-releases/eu/torture/belgium-falls-short-of-its-obligations-on-torture-and-other-ill-treatment-0679/#.VEOSAr4kGS0 (last accessed 20 Jan 2015). The third European Court of Human Rights periodic report on Belgium is available at http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CAT%2FC%2FBEL%2FCO%2F3&Lang=en (last accessed 20 Jan 2015).

5. For example, the residents can do meaningful work, including repairing bikes, caring for animals, and gardening, and can have access to recreational facilities. Their rooms are more spacious than typical prison cells, and each resident has a (highly secured) balcony. More information (in Dutch) is available at http://www.pompestichting.nl/site/Home/ (last accessed 20 Jan 2015).

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9. A further concern is the possibility that acceding to VDB’s euthanasia request would set Belgium on a slippery slope toward the routine euthanasia of “ordinary” prisoners—some sort of death sentence on demand. It would be interesting to investigate this scenario. However, because it is agreed that sufficient empirical evidence is needed to support a slippery slope claim (Douglas T. Intertemporal disagreement and empirical slippery slope arguments. Utilitas 2010;22(2):184–97), and because at the moment we have little relevant data, I am not investigating this concern now.

10. See note 2, the Belgian Act on Euthanasia 2002, chap. 2. This provision was included to prevent doctors from imposing on the patient their own views as to what counts as a reasonable alternative.

11. Adams, M, Nys, H. Comparative reflections on the Belgian euthanasia act 2002. Medical Law Review 2003;11(3):353–76.CrossRefGoogle ScholarPubMed

12. See note 11, Adams, Nys 2003, at 369.

13. See note 2, the Belgian Act on Euthanasia 2002, chap. 2, S. 3, §1.

14. See, for example, the first principle of the Nuremberg Code (1947); the Convention of Human Rights and Biomedicine, articles 5 and 6; and Beauchamp, TL, Childress, JF. Principles of Biomedical Ethics. 5th ed.Oxford: Oxford University Press; 2001, at 183.Google ScholarPubMed

15. See, for example, the first principle of the Nuremburg Code (1947).

16. Farah, MJ. Emerging ethical issues in neuroscience. Nature Neuroscience 2002;5:1123–9, at 1126.CrossRefGoogle ScholarPubMed

17. See, for example, note 14, Beauchamp, Childress 2001, at 132–3; and Wertheimer, A, Miller, FG. Payment for research participation: A coercive offer? Journal of Medical Ethics 2008;34(5):389–92.CrossRefGoogle ScholarPubMed

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19. See note 18, Zimmerman 1981, at 133.

20. Taylor, JS. Autonomy, duress, and coercion. Social Philosophy and Policy 2003;20(2):127–55.CrossRefGoogle Scholar

21. Another argument in support of euthanasia refers to the interest of the patient. If the patient’s quality of life is negative, then on a whole-life approach to best interests, euthanasia is in the patient’s best interests because it increases lifetime well-being.

22. Childress, JF. The place of autonomy in bioethics. Hastings Center Report 1990;20(1):12–17.CrossRefGoogle ScholarPubMed

23. This is also reflected in the law. Section 14 of the Euthanasia Act stipulates that a physician is not legally required to fulfil a patient’s euthanasia request when it meets the conditions of the act. She may refuse to do so on grounds of conscience or medical reasons. Thus, in Belgium there is no such thing as a right to euthanasia (though there is a right to request euthanasia).

24. Van Mol F. De Gezondheidszorg in de Belgische Gevangenissen; Dienst Gezondheidszorg Gevangenissen, FOD Justitie 2013.

25. Some would see this as an instance of hypocrisy. Crisp and Cowton, for example, have argued that what runs through paradigm cases of the various kinds of hypocrisy, and what makes hypocrisy problematic, is a failure to take morality seriously. Crisp R, Cowton C. Hypocrisy and moral seriousness. American Philosophical Quarterly 1994;31(4):343–9. My argument is also related to G. A. Cohen’s claim that an argument’s persuasive value may depend on who appeals to the argument: Cohen GA. Incentives, inequality and community [Tanner Lectures]; 1991; available at http://tannerlectures.utah.edu/lectures/documents/cohen92.pdf. (last accessed 20 Jan 2015). In an unpublished paper, Johann Frick has termed this “speaker relativity of justification.” Frick J. What we owe to the hypocrites: Contractualism and the speaker-relativity of justification [unpublished paper].

26. Gardner, J. Complicity and causality. Criminal Law and Philosophy 2006;1(2):127–41;CrossRefGoogle ScholarLepora, C, Goodin, RE. On Complicity and Compromise. Oxford: Oxford University Press; 2013.CrossRefGoogle ScholarPubMed

27. See, for example, Kutz, C. Causeless complicity. Criminal Law and Philosophy 2007;1(3):289–305.CrossRefGoogle Scholar

28. It may be wrong on deontological grounds, because complicity is wrong in itself, or on consequentialist grounds, as contributing to others’ wrongdoing has bad consequences.

29. See note 26, Lepora, Goodin 2013.

30. In fact, as the case enfolded, it became clear that there was some external pressure to not carry out the euthanasia: hospitals refused to provide the required facilities for carrying out the procedure.

31. Yuill K. Belgium’s insane right-to-die law; available at http://www.spiked-online.com/newsite/article/belgiums-insane-right-to-die-laws/15899#.VC6JYb4kGfQ (last accessed 22 Jan 2015).