Waarom euthanasie?

This is the University of Vlaanderen. It's autumn, all the holy, all the souls. This is the period of the year when we think about who we have to say goodbye to. That's why we invited Professor Wim Distelmans today. Welcome. - Good day. Death or death is really your theme. You're an oncologist at the VUB, specialized in palliative genes, but we often see you in the media as co-president of the Euthanasia Commission. I'd like to talk about the difference between euthanasia and palliative care. Why is euthanasia necessary if you can also give good palliative care to someone? We have a client with an incredible performance of palliative care. We started it in the 1980s. And despite that, there are a lot of people who continue to suffer. We don't have a solution for that. And for those people, we actually got an approval of an euthanasia law. And that was made in 2002. Let's say for the good words what euthanasia is. What is euthanasia? Euthanasia is the absolute end of life by a doctor, but it's a simple, printable search for the patient. No one else can replace it with a patient's question. If I'm right, the word comes from the old Greek word? Yes, euthanatos. And that means a good death. But that's not so clear. What is a good death? That's why we have to define it and that's been done. And when there's a clear definition of existence, we can make a law of it. For a lot of people, it's always difficult to explain because you die with euthanasia earlier than nature has seen before. That's right, but sometimes it's necessary. Sometimes the doctor is between two quads and he has to choose between the chest and the collar. He has to be able to stop wearing the tundra, and on the other hand, he wants to save someone's life. That's a conflict of two ethical values. And sometimes you can only stop the suffering by saving life. But it's the end of the world. It's sometimes called the end of the world. The person in question who asks for four conditions and the doctor also has to fill in a few conditions. The four conditions of the patient are the following. He has to be willing, he has to know what's going on. He has to get rid of it willingly and ask for a lot of money. It doesn't mean that you can't change your mind, but that the question is true. The third important condition is that you have to suffer from a serious, incurable condition as a result of a disease or an accident. And the fourth condition is that you have to suffer unbearably. We want to talk about these terms together. Let's start with the "wils bekwame" you're talking about. It sounds logical. People have to figure out where to choose and what's waiting for them. But it becomes more difficult if there are people who suffer from dementia. How far have you been willing to go? That's indeed the point. In the case of dementia, you can't ask for more. And then we're sitting with a lacune in the law. You could say, write it down before you go. You want to clarify and that's when you've become a deep man. That hasn't been settled yet. At this point, only a person who is well aware of dementia can be a tenacious person. In the Arizona government's agreement, we're finally going to think about that to change the law eventually. Because that's necessary, you say. I think so, and the people as well. More than 80% of the people think that the law should be made available at that point. And on our website, Leven zijn informatieforum, live.be, we've got more than 80,000 signatures from Flamingen who think they can do that. Moreover, no one is obliged to ask for such a wils bekwame. It's completely free to stay and you can never force them to do it. So, in a legal sense, it's a very liberal law. But what people do now, when you're dementia? Is it too early to ask for dementia that you're still asking for wils bekwame? Think of Hugo Klaus, he's got that. Think of Jan Keulers, the former boss of the former BRT. They all asked for it too early. And that's really, really human. You have to say, I have to choose a time-ship here, because people want to live as long as possible. But they have to live for a number of beautiful weeks or months because they can't do it. Those people die too early, or they still want to. But just because it's too late, because they can't get dementia. And that's what has to be applied in that law, I think. I think it's a big lack of the law. On the other hand, it's also good that the law is strict, that there are a lot of prejudices, because misuse looms around the corner, right? Yes, but I've already said it, it's a good law and I'm very happy that Belgium has voted on the law. There are only a tenth of countries in the world with a tenancy law. So little, right? Absolutely, very little, the surrounding countries, for example, France, Germany, the Netherlands. Scandinavia doesn't have a tenancy law, and more and more of those immigrants start to understand that they can do Belgium and come to Belgium to get more tenancies. Oh really? - Yes. How many cases of tenacy are there in our country? Last year, for example, more than 100 French people from France came to Belgium to get tenacity. Of course, they have to fill in the train, but Belgium is not one of the trains. It's like getting tenacity tourism. It's not really tenacity tourism, because those people are usually not very fit to ask tenacity. So it's not like the abortion tourism in the 80s and 90s, from the previous era to the Netherlands, and today as well. But you can still talk about a frustrating idea that people have to leave their country to be able to survive in any way. A hundred French people, you say? - Yes. On a total of how many people? Last year, 399 registered tenancies. As I said, there are tens of countries with tenacy laws, but there are a number of countries where you can get aid in suicide. For example in Switzerland, which is regulated, Switzerland does not have tenacy laws, but you can get aid in suicide with a speech at a doctor. It means that the doctor gives you something with which you can end your life, drink it up, but the doctor is no longer there when it happens. It also implies that you can succeed in any way. You start to use it, or I don't know, but you can't intervene with the doctor. So that's not so evident. In Switzerland, you can't do that. You have to pay 10,000 euros for a student who wants to see your doctor. And a number of states in America can do that, like physician-assisted suicide. You can do it yourself, but it's strictly regulated. Most people who want to come there are already suffering before they can start the campaign. -Then you can get a decent tenacy law. -Absolutely. I want to go back to the new principles that Wilse came from. We've already talked about that. Another principle is that you are seriously ill. That's about your physical activities, -as well as your mental activities. -Absolutely. It's not being specified. It's about a disease that leads to an irresistible event. So, it is immediately stated that when it comes to psychotic diseases, they must also be irresistible. And that's not always so clear in the beginning. Above all, the person in question with a psychotic event also has enough wills. Some people no longer have enough wills, just because they have a psychotic event. For example, they don't have any physical insight. -What do you do then? -Well, they don't come to work. Because they may be in a hurry, you can say that all principles of the law have been fulfilled. And then, unfortunately, we don't have enough people to take care of. Is it difficult for you as a doctor to determine what the patient who is in front of you needs? Well, I've been in the palliative care for about 30, 40 years. So, I start to understand a little why people are busy on the end of the day. And some choose to go for a good palliative care, other people immediately from Asia. Personally, I think it's up to the person in question to determine what he or she doesn't want anymore. What's the difference between a good palliative care and a non-Asian care? A good palliative care is to offer everything to people who are ill. To ensure that they don't have too many complaints, that they don't have too many symptoms, that they don't have any pain. It's a very well-prepared offer to offer today, as well as to provide for the existing suffering, the conditions. Think of a woman who has been sick for 40 years with two children. She asks herself why she was born and so on. These are all things that we try to catch up with the palliative care. So we can help a lot of people in that way. But, as I said, there are always people who, despite all the anxieties of a palliative care, continue to suffer unnecessarily. They say, "I want it to stop." But some people in the United States ask for a non-Asian palliative care. For example, someone who is completely infected by a disease, unnecessarily and despite good revalidation, they don't want to live any longer. They say, "I can't believe I'm lying here 24 hours a day in a bed, I don't want to live this way, I want it to stop." And that kind of possible treatment can only be done in Belgium and the Netherlands. Belgium and the Netherlands are the only countries in the world where it can stop people who are still not terminally ill. They may still be able to continue for years, but still wear clothes because of what is going on, such as a revalidation to an accident. Can a doctor refuse to make it stop? Absolutely. A doctor can refuse perfectly. But thanks to the scientific evidence of 2024, he must share that with the patient within seven days. As long as the patient has the time to look for another doctor himself. In the past, it was the case that the doctor didn't dare to say that the patient was suffering from an atlantic disease and that the patient was no longer in state to look for someone else. Why refuse to make it stop? Doctors refuse to do such ideological reasons. But that's not always the majority. Psychological reasons. Some doctors say, "I've known the patient for 30 years and now he's asking you to see it." That's very difficult for me to go into that. I personally don't think it's an argument, but I respect doctors who do think so. And then, as far as I'm concerned, doctors are a control freak. Doctors like to keep their own routine. And when it comes to Euthanasia, a patient who actually says, "I want you to end my life on my request." And we don't keep that in mind. That patients take initiative. So it's something that often happens. It can also be that the doctor is afraid to get into trouble afterwards. I think, for example, with the patient's family, if he's not in a good mood with the choice for Euthanasia. In the past, there were cases where there was... We think, "This is the process of tinnitus. We've done research on liver cells." "Live liver cells are the doctors we've trained through the Life and Information Forum to ask other doctors about these difficult lives." And the research shows that doctors are less willing to take Euthanasia out, even with a terminal cancer patient. So the process has had a negative impact. -Until today? -Until today. What's wrong with it, because the law is very clear. And when the doctors respect the principles of the law, there's no risk at all. -Is that so? -It is. -Are they fully aware of it? -Yes. Especially because after the treatment of Euthanasia process, a law has said that doctors who give advice to Euthanasia, for example, live liver cells, can never be followed. The Euthanasia process also has two advice-giving doctors. They can't do that. Do you see a number of requests in the future, here in our country, just to get up? Yes, up to now I'm getting up every year. And I can ask you every reason. I suspect that the fact that the law has become more and more popular in the beginning of 20 years, there weren't too many people who knew what the possibilities were in Belgium, but now everyone knows that there's an Euthanasia law. And people don't want to see it anymore at the end of the day and say, "You can stop it for me." So I suspect that there will still be a time to go on that path, until we reach a plateau. Why is Euthanasia necessary? Why can we, with good palliative care and pain control and comfort, not know for sure that people die slowly? We can do a lot with palliative care. And unfortunately, it's not always very well known to many doctors. But we work hard in the palliative team, both at home and in the hospital, in the care center. Of course I know better, but let's say that even with optimal palliative care, you can't get a lot of pain control. We simply don't have the means to really get pain control, and to optimally provide other symptoms. Moreover, there are still factors that have absolutely little or no impact. For example, that existential suffering and psychological disorder and so on, despite the fact that psychologists do really good work there, there are still people who, despite all the tensions of palliative care, keep suffering unnecessarily, often physically or psychologically, and most of the time both physically and psychologically. And then it's only good that there is a country where there is a emergency, where people can say to themselves, "Because of everything I've tried, I don't want to go to the emergency and want to survive." People don't just do that, they don't want to die. But some people don't want to live longer, that's a subtle difference. Some are relieved, when they get the green light and say, "There's a date, an hour, and I'm sitting there telling you." I've heard from people at the party that the champagne was included. Absolutely. And couples, hand-in-hand? It all came before, I've already made it, that the champagne had to be taken by the patient, that there was a risk of falling. So it all has to be possible. Thank you, Professor Wim Distelmans, from the VUB Palliatieve Genese. If you want more information about palliative care and euthanasia, you can always go to the website that you just mentioned, live.be, the vital information forum that you have shared with us. I would like to see you again at the University of Vlaanderen. Thank you. This was a podcast from the University of Vlaanderen. It's great that you listened. Thank you to our partners, the University of Vlaanderen, Cahue Leuven, Gent, U-Antwerp, VUB Brussel and U-Hasselt, the Young Academy, VRT, the Vlaanderen government and the players of the National Lottery.