ANTWERP, Belgium — An Australian documentary has filmed the euthanasia of a healthy but grief-stricken 85-year-old woman in Belgium, which aired last month and drew international attention to the country’s rapidly expanding death-by-doctor policy.

Australian Dateline Special Broadcasting Service (SBS) followed nursing home resident Simona De Moor, who said she decided she wanted euthanasia five minutes after learning of her 57-year-old daughter Vivian’s sudden death following a routine surgery three months earlier.

“The moment they broke the news, five minutes later, I knew,” De Moor told filmmaker Brett Mason. “And nobody in the whole wide world will take it away from me.”

De Moor said she had lived happily in Antwerp with 94 other elderly patients and had not thought of euthanasia previously, but said, “Grief is an unbearable pain. It’s driving me mad.”

De Moor’s general practitioner, Dr. Marc Van Hoey, is also president of the Right to Die Society Flanders, a euthanasia advocacy group that promotes individuals’ “self-determination at the end of their lives.” He has lost count of the number of patients to whom he has administered lethal concoctions to since euthanasia was legalized in Belgium 13 years ago, but it is “maybe hundreds; more than 100.”

The film shows Van Hoey giving De Moor a cup of orange syrup on June 22 this year. “We all hope that you will see Vivian again somewhere,” he said as she lay down.

“I hope so, too” were her last words.

De Moor revealed in the film that she had another daughter from whom she was bitterly estranged for more than 30 years ago but did not inform her of the scheduled death. “I don’t have to justify myself to anyone,” said De Moor. “I decide.”

 

Review Process

The documentary also featured Belgian Tom Mortier, who learned in 2012 of his mother’s death the day after she was euthanized for “untreatable depression” by celebrated euthanasia champion and ardent humanist doctor Wim Distelmans.

Mortier has since publicly campaigned against the lack of oversight for euthanasia procedures in his country, noting that the Federal Control and Evaluation Commission, which oversees cases, is stacked with euthanasia advocates — Distelmans is its chairman — and it only reviews cases after patients are dead. According to the documentary, of more than 8,000 cases reviewed by the committee since 2003, not one has failed to pass its post-mortem approval system.

Theo Boer, professor of health-care ethics at Theological University Kampen, served on the commission between 2005 and 2014 and reviewed approximately 4,000 cases. Before resigning last year because he had obtained a new professorship, he became increasingly troubled over the expansive direction of euthanasia.

“In hindsight, I think both the Dutch and Belgian laws are failing,” Boer told the Register. First, because “the default option is that the doctor kills, with the patient being passive.”

“I believe that this leading role of the doctor has lowered the barrier to active killing,” Boer added. “What worries me the most is that some doctors seem to have lost all sense of killing being an intrinsically problematic act.”

The doctor who euthanized De Moor objected, however, and said that though he has lost count, euthanasia is still always difficult for him.

“Of course, because euthanasia is always a duality, you know, in your acting and in your own personality,” Van Hoey told the Register. He pointed to a 2013 documentary, End Credits, in which he was filmed euthanizing a 34-year-old depressed woman named Eva.

“You can see it on my face,” he said. “I saw it myself, when we finished the euthanasia, and we drove back home; you see my being really touched. I was really … it hit me, you know; it was a young person. It was quite deeply emotional for me.”

Asked if there were other options for this patient, he said, “Don’t forget: self-decision rights. If the patient says, ‘This stops for me,’ then we should examine, ‘Is the question correct? Can we use the procedure, and can it be done?’”

 

Death Decisions

For Van Hoey and fellow right-to-die advocates, every death decision is ethical. “As long as the doctor follows the correct procedure as it is proscribed in the law, as it should be done, then there is no problem.”

For moderate euthanasia supporters like Boer, however, the law was never meant to be so far-reaching, and there is trouble “with the definition of what exactly counts as unbearable suffering.” The case of Simona De Moor is illustrative.

“Bereavement, especially that of a child, takes a lot longer than three months,” he said. “Simona’s physician should have helped her to cope, instead of helping her to die.”

“She was not perfectly healthy,” objected Van Hoey. “She was suffering from an unbearable psychiatric wound, which would never, never heal. I have been the general practitioner of Simona for 25 years. I know this lady.”

He said the story would be represented differently if De Moor had thrown herself in a river to drown. “What would be written then, in that case? Would I be described as a murderer? Would I be a doctor who would not listen to his patient?”

As for making decisions reserved for God, Van Hoey responded, “I don’t think I am putting myself above anybody. I must consider for myself and for the patient’s benefit what is possible for that patient; that’s the most important thing for me.”

“If they compare me with Dracula or Frankenstein or whatever, when I see myself in the mirror, I think of myself as an honest, open man,” he said.

 

Secular Support

Belgium was the second country in the world to adopt euthanasia, following the Netherlands. Most opposition to euthanasia comes from the Church, which has always taught that “putting an end to the lives of handicapped, sick or dying persons” is a “murderous act, which must always be forbidden and excluded” (Catechism of the Catholic Church, 2277).

But the country has rapidly embraced organized secularization, and its euthanasia laws are widely seen as a sign of its progressive modernity; Distelmans is a celebrated champion, and three out of four Belgians reportedly support childhood euthanasia. Humanist philosophy is taught at state schools in a “free-thinking” course called “non-confessional ethics,” which is more popular than the alternative religious-studies course, and euthanasia is part of primary-school curricula.

Demand for euthanasia has increased year after year, as have the reported number of Belgians dying with doctors’ help. Between 2011 and 2012, the number climbed 25% from 1,133 to 1,432, and then rose again in 2013 to 1,816. And in 2013, the Belgian Senate voted overwhelmingly in support of allowing euthanasia for children of any age. “It was assumed that euthanasia would be taking place in a medical context, but the reasons for wanting it have expanded dramatically,” Boer said, pointing to the fact that 95% of patients euthanized in the early years of the law’s practice were terminally ill, whereas today that figure is only 75%. “A law may create its own dynamics,” Boer said. “What the Dutch and Belgian laws show is that supply creates demand.”

 

High-Profile Cases

In addition, a number of recent high-profile Belgian cases have illustrated just how far the country’s medical euthanasia program has extended. This summer, Belgian doctors granted a depressed 24-year-old approval to end her life in the hospital. In 2013, Nancy Verhelst, a 44-year-old transsexual who claimed doctors had botched her surgical attempt to become a man, was killed by Distelmans. In December 2012, Distelmans also euthanized 45-year-old deaf twin brothers Marc and Eddy Verbessem, who were afraid of going blind.

The Dateline documentary also features a 33-year-old father of two boys, Peter Ketelslegers, who suffers from rare and agonizing cluster headaches that have caused him to lose the family farm. It is hard to gauge from the film how much his financial woe and sense of failure is affecting his decision-making, but in Belgium, he has already received two of three required doctor’s approvals for euthanasia. If a brain surgery carried out in October is unsuccessful, according to the documentary, he will choose death.

“What I hope is that the Dutch will realize that the law has unwanted side effects,” Boer said. “We have to divert our focus from ‘euthanasia as a preferred option’ to ‘euthanasia as the last resort.’ At this moment, I dare not hope for any more radical change.”

But more radical change may be in store for Belgium. The right-to-die movement’s next front is extending euthanasia to mentally disabled patients, said Van Hoey, who thinks people should be able to state in advance if they want to die in certain conditions, including dementia.

And the humanist stance can be unforgiving when a person changes his mind at death’s door. Confronted with one such lucid old man objecting loudly to his euthanasia in the documentary End Credits, euthanasia pioneer Etienne Vermeesch said: “He no longer has an opinion. We should not ask him again. Some people have a problem with this. But they should recognize that an incompetent person is an incompetent person.”

Continued Vermeesch, “Just give him his normal treatment and add a heavy narcotic. Then, when he is asleep, you administer an injection, and the case is closed.”

 

Register correspondent Celeste McGovern writes from Scotland.