Page 2 of 5 METAFORUM POSITION PAPERS The interdisciplinary think-tank Metaforum aims to strengthen the KU Leuven's involvement in societal debate by supporting multidisciplinary working groups in which researchers from different disciplines combine their scientific expertise and discuss relevant social issues from different angles. 1. Increased Use of Psychiatric Medication (2010) 2. Biodiversity: Basic Commodity or Luxury Item? (2010) 3. Socio-economic Differences in Overweight (2010) 4. Traffic Mobility in Flanders (2011) 5. Conservation and Management of Forests for Sustainable Development: Where Science Meets Policy (2011) 6. Full Sequencing of the Human Genome (2011) 7. Secondary Education Reforms in Flanders (2012) 8. Towards a New Communality for Brussels (2012) 9. Studium Generale: Proposal for an Interdisciplinary Bachelor Course (2013) 10. Public Funding of the Art Sector: The Importance of Investing in Art Production (2013) METAFORUM CONTRIBUTIONS TO INTERNAL DEBATE A university intent on contributing to societal debate must also accept its own responsibilities. For this reason, Metaforum also supports working groups that reflect on the KU Leuven’s own identity and potential for action. 1. University, Church and Society (2010) Metaforum KU Leuven, interdisciplinary think-tank for societal debate Holland College, Damiaanplein 9 bus 5009, 3000 Leuven [email protected], www.kuleuven.be/metaforum Page 3 of 5 INHOUDSOPGAVE Metaforum .............................................................................................................Fout! Bladwijzer niet gedefinieerd. Executive Summary ............................................................................................................................................................... 4 Page 4 of 5 EXECUTIVE SUMMARY Belgium is one of the few countries in the world in which euthanasia is permitted by law under certain conditions. The competent Senate Committee discussed a number of legal proposals in the spring of 2013 that would establish the possibility of euthanasia for minors on the one hand, and for people in an advanced phase of dementia who are unable to give informed consent on the other, provided they have made a prior living will. A Metaforum working group within the KU Leuven consisting of representatives from a variety of academic disciplines has explored this issue in depth. The Metaforum position paper also addresses the question of the extent to which persons with serious psychiatric problems can make a valid request for euthanasia under the present law. A severe ethical prohibition exists against taking a person’s life, which is also supported by a punitive prohibition. Belgium is no exception in this regard. The members of the Metaforum working group are of the opinion that a careful and fundamental reflection is necessary concerning the conditions that would permit a potential deviation from the said prohibition. Instances of euthanasia relate to individuals in an extremely vulnerable situation. The authors of the position paper have been influenced and driven by this human vulnerability. It is clear throughout the position paper that requests for euthanasia should always be heard and listened to. Care providers and institutions alike must create openness in their policies in order to deal with such requests in an individualised manner. The position paper begins by outlining a transparent conceptual framework for discussion, which are deployed in the following chapters. It is also clearly stated here that palliative sedation is not a ‘slow’ form of euthanasia and that there is no grey zone between adequate symptom control and active termination of life. As a radical form of symptom control, palliative sedation can facilitate a dignified death in extremely difficult and exceptional circumstances. From the juridical perspective, euthanasia is the deliberate termination of a life by someone else than the person him or herself at the latter’s request. It is therefore of the greatest importance that requests for euthanasia are formulated in a voluntary manner and after due consideration. This is one of the most important points of departure of the existing law on euthanasia. Meeting these conditions for minors, persons in a less advanced phase of dementia, and persons with serious psychiatric problems, is far from evident. The text therefore contains a fundamental reflection on the concept of ‘informed consent’. The literature insists that the capacity to give consent and make decisions should best be understood as a task-specific concept and not as a characteristic an individual does or does not possess. What has to be judged is the capacity to make clearly defined decisions, in the present instance to make a request for euthanasia. Such judgements presuppose highly nuanced individual assessments. The capacity to give one’s informed consent cannot be objectively measured. It is for this reason that criteria for establishing this capacity cannot be established by law. The position paper is critical with respect to an overly narrow understanding of the concept of autonomy. The authors presuppose that the autonomous individual able to grant informed consent lives in connection with people in his or her immediate environment as well as the team of care providers. Listening to requests for euthanasia, therefore, is not only a ‘colloque singulier’ between a patient and a doctor, but also a process in which a family and a care-giving team are involved. Page 5 of 5 This position paper does not dedicate an explicit contribution to the concept ‘intolerable suffering’. Each contribution makes it clear, however, that suffering is the result of a complex interaction of factors. Three matters are of importance in this regard: − − − First, every care provider is aware that the position of the patient him or herself on what they consider the absence of dignity to mean usually evolves in the course of the illness. Second, we must be on our guard against an exclusively experience-oriented interpretation of the concept of dignity. Philosophers such as Immanuel Kant have rightly insisted that there is a more fundamental form of human dignity that one can never lose, even in circumstances of extreme physical and mental decline. Third, the social context co-determines the way in which individuals experience their situation in an almost untraceable manner. Statements and questions such as “I don’t want to be a burden to anyone” and “does my life still have any purpose?” are in part determined by a society in which everyone has an overfull schedule, in which time should never be wasted, in which care has to take place in a cost-efficient way, and in which the option ‘to quit’ is offered as a possibility and even as desirable. In this sense it is important not to lose sight of the fact that facilitating access to euthanasia has the inevitable if unintentional side-effect of relativizing – to a degree – the urgent need to take care of very vulnerable people. With specific reference to the issue of euthanasia for adolescent minors, the authors underline the fact that the numbers in question are extremely limited. Psychologists and neurologists point out that the social-emotional, cognitive and moral development of individuals varies considerably from person to person. Some observe that the human brain only reaches full development as a rule from the age of 20 years. Others point to the inconsistency of locating the criminal liability of young people at a much later age than is done in relation to making life or death decisions. With respect to the question of euthanasia for patients with serious psychiatric conditions, psychiatrists should assess whether the formulated euthanasia request is not itself a symptom of a condition, such as a treatable depression. The question whether the situation of a patient with a serious psychiatric condition can be assessed as medically incurable and lacking future perspective is even more delicate and difficult to predict. Research has demonstrated that patients, after years of serious suffering, often achieve a relatively satisfying life in which their suffering is more bearable. The implementation of euthanasia based on a prior declaration of will in a later phase of dementia in which patients are no longer capable of giving informed consent implies that they are no longer active participants in the decision to proceed with euthanasia at the moment of implementation, that they barely understand the intentions of the doctor when he or she enters the room, and at that moment do not offer conscious consent. We consider euthanasia for patients without the ability to give informed consent in conflict with a number of important ethical principles, including the principle of respect for the autonomy of the patient. For these reasons we reject the potential expansion of the present law on euthanasia.