Legalised Euthanasia for Children Regardless of Age in Belgium: The Actual Law in English

The past few days we have heard the reports of the change made to the Belgian (permissive, but also restrictive) euthanasia law that makes it include children of all ages among those who may lawfully receive medical help to end their lives. For instance here, here, here and here. None, however, have had access to or quoted any actual English translation of the new law. Thanks to my colleague Kristof Van Assche at the Vrije Universiteit Brussel's Faculty of Law and Criminology, I'm now happy to be able provide one for interested readers, with the following disclaimer: This is Kristof's own provisional translation, based on this English version of the original law and his own added translations of the made changes. Kristof posted it in the closed Facebook group for bioethics scholars, Bioethics International, and gave me permission to share it with a wider audience in this way. Here comes screenshots from the original post just referred to:

And here, to make quotation easier, is the text in plain text:
 

Law of 28 May 2002 on Euthanasia, amended by the Law of 13 February 2014 – Consolidated version [changes in brackets]

Chapter II: Conditions and procedure

Section 3

§1. The physician who performs euthanasia commits no criminal offence when he/she has verified that:
- the patient is a legally competent adult, a legally competent emancipated minor, [or a minor with the capacity of discernment] and is conscious at the moment of making the request;
- the request is voluntary, well-considered and repeated, and is not the result of any external pressure;
- the adult or emancipated minor patient is in a medically futile condition of constant and unbearable physical or mental suffering that cannot be alleviated, and that results from a serious and incurable disorder caused by illness or accident;
- [the minor with the capacity of discernment is in a medically futile condition of constant and unbearable physical suffering that cannot be alleviated and that will result in death in the short term, and that results from a serious and incurable disorder caused by illness or accident;]
and when he/she has respected the conditions and procedure as provided in this Act.

§2. Without prejudice to any additional conditions that the physician may wish to attach to his/her intervention, he/she must in advance and in each case:
1) inform the patient about his/her health condition and life expectancy, discuss with the patient his/her request for euthanasia and the possible therapeutic and palliative courses of action and their consequences. Together with the patient, the physician must come the belief that there is no reasonable alternative to the patient’s situation and that the patient’s request is completely voluntary;
2) be certain of the constant physical or mental suffering of the patient and of the durable nature of his/her request. To this end, the physician has several conversations with the patient spread out over a reasonable period of time, taking into account the progress of the condition of the patient;
3) consult another physician about the serious and incurable nature of the disorder and inform him/her about the reasons for this consultation. The consulted physician reviews the medical record, examines the patient and must be certain of the patient’s constant and unbearable physical or mental suffering that cannot be alleviated. He/she drafts a report on his/her findings.
The consulted physician must be independent of the patient as well as of the treating physician and must be competent to give an opinion about the disorder in question. The treating physician informs the patient about the results of this consultation;
4) if there is a nursing team that has regular contact with the patient, discuss the request of the patient with the team or its members;
5) if the patient so desires, discuss the request of the patient with his/her relatives appointed by him/her;
6) ensures that the patient has had the opportunity to discuss his/her request with the persons that he/she wanted to meet;
7) [when the patient is an unemancipated minor, consult, in addition, a child psychiatrist or a psychologist, and inform him about the reasons for this consultation.
The consulted specialist takes note of the medical record, examines the patient, verifies the capacity of discernment of the minor and certifies this in writing.
The treating physician informs the patient and his or her legal representatives of the outcome of this consultation.
At a meeting with the legal representatives of the minor, the treating physician provides them with all the information specified in §2, 1° in and verifies that they agree with the request of the minor patient.]

§3. […]

§4. The request of the patient [and, if the patient is a minor, also the agreement of the legal representatives] have to be put in writing. The document is drawn up, dated and signed by the patient himself/herself. If the patient is not capable of doing this, the document is drawn up by an adult person who is designated by the patient and must not have any material interest in the death of the patient.
This person indicates that the patient is incapable of putting his/her request in writing and indicates the reasons why. In such case the request is drawn up in the presence of the physician and the said person mentions the name of the physician on the document. This document must be annexed to the medical record.
The patient may revoke his/her request at any time, in which case the document is removed from the medical record and returned to the patient.

[§4/1. After the physician has treated the request of the patient, the persons concerned are offered the possibility of psychological assistance.]

My most sincere thanks to Kristof for allowing me to share.

Court Acquits Swedish Neonatal Doc Charged with Murdering Newborn Baby in Controversial Case

Today, the verdict was announced in a very controversial case in my country regarding a neonatal intensive care doctor, who has been charged with murdering a newborn baby by administrating high doses of sedatives (here, here, here, here, here, here, here, here). The doctor is acquitted of the charges of manslaughter. It remains to be seen if the prosecutor decides to take the case further to appellate court.

The case has sparked heated discussions and not so little confusion in the medical, political and ethics expert community. Leading voices of medicine have somewhat lost their marbles and made megalomaniac claims about doctors being immune from prosecution whatever they do to their patients in the name of best practice. There has also been rather peculiar criticism about the prosecutor taking a long time bringing the case to court, where the unspoken message seems to be that medical doctors should somehow be treated differently than other people in criminal proceedings - reminding a bit about how Julian Assange or Mr. Strauss-Kahn have been reasoning around their own persons in relation to the rape charges they are or have been facing.

All of this has, to my mind, been sheer nonsense. Of course, it is immensely burdensome for anyone to face serious criminal charges. Even more so if your own view is that you have made nothing wrong, but rather the best you can. It is also completely understandable and justifiable that the legal defense and friends of those charged do their best to have the person charged described as innocent in media. However, the principle of equality before the law stands far above any such individual consideration. Take a deep breath and think about for a moment how society would look like if we let that principle slide and this should be crystal clear to anyone.

Now, there have been several attempts to make a spin on the case settled today according to which it is not about a real legal issue, but rather about a more hazy underlying problem of an ethical nature. The idea has been that the critical issue is whether doctors are allowed to take risks in order to achieve effective pain reduction in dying patients. However, albeit indeed being an interesting issue in its own right, that has never been the centre of discussion in the present case. Doctors are allowed to take such risks according to Swedish law, end of story. But they are not allowed to murder people as this is defined in criminal law. It is the latter that has been the base for the prosecutor's claim in the case decided today. 


Instead of making my own explanations of how I read the court's decision, I have made a quick translation of the court's own press summary. The Swedish original is here. Read for yourself and make up your mind!

Solna District Court today acquitted the doctor who was prosecuted for manslaughter or attempted manslaughter of an infant at Astrid Lindgren's hospital in Solna fall of 2008. The district court has not found it proven that a crime has been committed. The district court has not found it proven that the doctor has done something that was not be medically justified.
The district court has not found the evidence sufficient for showing beyond reasonable doubt that a crime has been committed. The prosecutor's claim is based on an analysis of forensic evidence, which has demonstrated an exceptionally high concentration of thiopental in the blood from the deceased child. The district court has not considered this result to be sufficiently reliable to fully serve as the basis of a conviction. The district court does not believe that one can draw any more far-reaching conclusion of the analysis results than the one that thiopental, although observed in a high concentration, it is unclear how high the concentration was. Given this uncertainty about how high the concentration was, it is conceivable that the occurrence can be explained by the fact that the child had received thiopental on previous occasions during hospitalisation. This means that there is no evidence that a crime has been committed and the doctor is already on this ground freed of the charges made.
 The district court has not considered that the prosecutor with sufficient certainty has proven that the doctor has acted in any way that was not medically justified when the child died.
In the debate related to this case, it has been claimed that the case concerns the distinction between what a doctor can and cannot do when it comes to relieving pain and anxiety in end of life care. This is not correct. The prosecutor's contention is rather that the child has been poisoned, that the child has been receiving a very high lethal dose of thiopental administered in order to effect that the child would die, not in order to relieve pain or distress. There is no doubt that such conduct, if it had occurred, is punishable as manslaughter under Swedish law, whether or not it had been prompted by reasons of compassion and whether or not the child would have died anyway within a very short time. As has just been said, however, the district court did not consider it proven that such a criminal act had in fact taken place.