Proposition 50K1489

Projet de loi relatif aux soins palliatifs.

General information ¶

Submitted by

The Senate

Submission date

Dec. 20, 1999

Official page

Visit

Status

Adopted

Requirement

Simple

Subjects

medicine health policy patient's rights

Voting ¶

Voted to adopt

Groen Ecolo PS | SP Open Vld MR

Abstained from voting

CD&V LE N-VA FN VB

Party dissidents ¶

• Alfons Borginon (Open Vld) abstained from voting.
• Richard Fournaux (MR) abstained from voting.

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Discussion ¶

May 15, 2002 | Plenary session (Chamber of representatives)

Full source

Mr. Speaker and Mrs. Minister,

Dear colleagues, I regret the departure of Mrs Avontroodt, Chairperson of the Public Health Committee, as many things have been said since the beginning of this debate on the position of this committee. I have participated in this committee with others which allows me to correct some things. I will do so in his absence and I suppose that he will be told of my words that I will tell him in a loud voice.

First of all, I will communicate the position that the PS group defends through this bill initiated by Senators Roger Lallemand and Philippe Mahoux.

The right to die in dignity concerns all citizens. The debate on euthanasia and palliative care is not limited to parliamentary assemblies, far from there. It takes place within the society and engages doctors, care staff of institutions and patients that we are all. Regularly, patients alert the public opinion about their condition and ask for a solution to the situation in which they are.

The challenge is, in the draft on euthanasia, to give the patient with an incurable disease the right to declare that the physical and psychological sufferings imposed on him degrade his life to such a point that it becomes unbearable. The postulate underlying this project is that unnecessary pain is unacceptable, that a majority of the population agrees on this point and that it is required that the legislator incorporate this new data into our legal system.

Euthanasia, as defined in the bill, constitutes an act performed in absolute respect for the freedom of conscience and the enlightened will of the persons concerned. Any individual who may be brought to participate in this act is free to do so or to refuse to do so. The project also attaches great importance to dialogue as it makes it appear at the heart of the relationship that must be established between the patient and the doctor. This element is essential because euthanasia today is practiced and this, without that dialogue exists and sometimes even, without the patient being conscious.

The draft law stipulates that the doctor to whom the request is addressed must, before practicing euthanasia, consult a second doctor, who must ensure, on the basis of the patient’s medical record, that the condition he suffers is of a serious and incurable nature and that the physical or psychological suffering he is suffering has a constant, unbearable and unbearable character.

Mr. Speaker, I would like to take a look at what Mr. Mayeur just said and point out a contradiction. Mrs. Avontroodt and others express their great confidence in the deontology of the doctors, while you, Mr. Mayeur, say that people are killed unconsciously and without consultation. This, however, contrasts with the great confidence in the doctors behind which some might hide. This belief is no longer a valid argument for me.

If I have expressed myself this way, it is because legislation is absolutely necessary to frame the practices of doctors. This was the definition we adopted. The doctor must therefore talk to a care team, if any, and the latter must include — as the members of the Public Health committee have unanimously stated during the discussions — the palliative care team possibly in charge of the patient. I will return to it because the fact that the palliative team is included in the dialogue does not mean that a prior palliative filter is imposed. This would be an abuse of interpretation of the unanimous opinion of the Public Health Commission.

If necessary, the care team will also need to have contacts with relatives but it should be clarified that these contacts are intended to inform the doctor consulted and not to judge the case. There is therefore no "tribunalization" of the decision in the bill as we are going to adopt it.

Some would have wanted, contrary to what the bill provides, to limit its scope to patients in the terminal phase. I regret that the PSC is no longer there. The problem with this limitation is that the terminal phase is impossible to define. I said it in a committee, I regularly questioned in a committee on this subject all academic and other authorities who have come to talk to us — doctors, lawyers, philosophers — there is no clear and precise answer to the question of the definition of the terminal phase. In addition, I interviewed doctors at the Jules Bordet Institute. I said it before but I repeat it and I will cite my sources, I would like the PSC or the CD&V can do the same. Dr. Bron, who is head of service at the Jules Bordet Institute, is a remarkable man and an authority recognized by his colleagues. The latter indicates that the notion of terminal phase cannot be defined correctly and accurately, and that it cannot be distinguished from a non-terminal phase. Doctors are also asking lawyers for a definition, if there is one. If one considers, for example, that this period begins when there is no more curative treatment, it could cover years before death. On the other hand, if we limit it to agony, it would imply that a person’s suffering would not be relieved during the weeks or even months preceding the agony. According to these doctors, the only criterion to be taken into account to allow euthanasia is that of constant, unbearable suffering that cannot be calmed.

The PSC gives a definition that it has introduced – I note because I did like them this time, but in committee I had not done it – speaking first of the summits that had grounded on the definition. We never gave names, but we were told that there were a lot of summits. Therefore, we use the argument of authority, or, I understand, it is a technique of debate. But what about the given definition? The content of this definition seems to me quite close to the definition of agony, of course, when the patient can still express himself. Indeed, when one is faced with a patient who suffers from an incurable condition, with a set of infectious, metabolic, cardiovascular and other complications — one does not know which ones — and that one is still going to agree with him to know what to do, I have the impression that we are at a stage well beyond the terminal phase, it is practically already agony. More fundamentally, I questioned Erasmus doctors, Professor Englert to quote it. With the argument of authority, I try to replicate in the same way as the argument put forward by the PSC. What does Professor Englert say? “The definition of the terminal phase given by the PSC removes the patient from the decision regarding his fate. In fact, in order to bypass the obvious impossibility of defining the terminal phase, it actually gives the doctor the right to arbitrarily decide when the patient is in this phase.

Moreover, the text is very ambiguous because after defining the terminal phase as one where it is no longer appropriate to do etiological treatment, we find in the justification the notion that it follows an active palliative phase. Although it is said that this so-called active phase cannot constitute a therapeutic hardness, this notion is also arbitrary, because it does not refer to the will of the patient. Finally, the absolutely fundamental justification of euthanasia as a response to the existence of an unreasonable suffering is completely ignored and replaced by a medical estimate that wants to be objective. The very meaning of the bill is thus wiped out of its substance. I hold the replica of an honorable, important doctor, who also has letters of nobility and academic to assert, at the disposal of my PSC colleagues.

I would say that what is important is the chain that is proposed. It is said that there must be a state of necessity, that we must be in the terminal stage as defined – but we have seen that it was complicated – and that there had been a pre-obligatory palliative filter. This chain is obviously a mechanical chain that does not respect the will of the patient and that, de facto, “tribunalizes” completely the decision with respect to the patient. Roger Lallemand said, “At the heart of our humanism, there is this conviction that the assessment of the validity of a life cannot depend on any scientific assessment, a diagnosis, of any third person because the value of a life is an invaluable right for the doctor, for the medical team or for any authority.” And to quote for example the doctors or politicians who, today, believe that from a certain age, a number of pathologies, serious diseases, should no longer be treated. And one eminent Nobel Prize in Medicine is quoted as suggesting that, for patients who have exceeded a certain age and with severe cancer diseases, it is indicated in their file "NTBR" - not to be reanimated, not to be reanimated - in such a way that there is abstinence from medical intervention. This is where to take two notions that are those that are contained in the PSC amendment proposal, that is, not that of age, it does not appear there, but the notion of pure medical diagnosis to say: "you do not intervene."

What we put in addition, and mr. Van Parys has told me at times that it is the difference between us — and he is a thousand times right — it is the will of the patient, repeated, who says persistently that his suffering is unbearable for him and that it is therefore necessary to end this suffering and that he requires the humanistic intervention of a doctor to end it in conditions worthy, acceptable and respecting his dignity until the end of life. This is the difference between us, the choice of the individual, the will of the patient, enlightened, without elitism, contrary to what has been said. For us, all men are worth each other, including and ⁇ at this final stage of life. All men are worthy. There is no intellectual, social, economic elitism in relation to suffering. So, indeed, this is what must count, and it is necessary to trust man from this point of view as to the enunciation, the expression of this suffering and the will to end his state.

Mr. Speaker, colleagues, if I follow Mr. Mayeur, he has not said so much about the position of the PS. Did I understand correctly that your position expresses a fairly large mistrust towards the doctors? You have already given a few examples. You also gave citations. You actually play the patient in front of the doctor. You say that the doctor is not very trustworthy and that it is up to the patient to express his will. Remember that it is the doctor who will have to perform the euthanasia, because otherwise we are talking about suicide. I do not understand why you are constantly talking about the contradiction between doctor and patient, although they are the core of the law. You seem to play them out against each other. I really do not understand this. You are breaking the position that Mrs. Avontroodt just built up.

In my opinion, the fundamental difference lies in the fact that the diagnosis does not justify everything. He is important. It is put by the doctor who tells his patient that his illness is incurable. But in itself, this does not justify the fact that the euthanasia act can be made. There must also be the will of the patient. There is therefore no mechanical link between a diagnosis, a scientific state and the act of euthanasia. This is exactly what is proposed in the law. The patient’s state of illness is noted. The latter says that he suffers, that his suffering is not relieved and is unbearable for him, and he asks for a dignified end to his existence because he is confronted with an incurable disease that makes him suffer and that he cannot endure. This is something else than a mechanical decision based exclusively on a diagnosis with the consultation of the doctor and a number of other people who will ultimately decide. We will then decide in the place of the patient, which I think is an unacceptable choice.

The possibility of allowing the euthanasia law to incorporate minors into its scope is obviously not excluded. But we decided quite rightly that it was necessary to proceed step by step and with caution. That is why the bill does not yet provide for this possibility, which would not meet, in the current state of affairs, practically no demand.

With regard to patients with exclusively psychological suffering, the project provides that euthanasia can only take place if the suffering can not be calmed. Psychological suffering that can be calmed, such as those found in most depressions, is therefore not targeted. by

The law provides that the patient must be both capable, conscious, informed that his suffering cannot be calmed. However, it is extremely rare that purely psychiatric conditions meet all these criteria. The Dutch experience demonstrates this.

However, it would be inhumane to refuse, in a priori and in a block, the taking into account of any suffering of psychiatric origin in all very exceptional but ⁇ painful cases where it meets the other criteria. In this case, of course, the patient’s psychological state should also be taken into account. But I repeat that the mental state as such does not open the possibility of the act of euthanasia. There was unanimous agreement on this issue in the Health Committee and in the Justice Committee. The text is clear on this subject and there is no need to amend the law so that the Health and Justice committees give their unanimous interpretation on this subject. by

Those who today say that we will be able to euthanize demons simply because they are demons make an intent trial on the text, have not read it and obviously do not respect the will of the legislative majority in this matter.

The draft law on euthanasia meets the expectations of the population. I cited in commission a survey published in a French-speaking newspaper, La Libre Belgique. This poll showed that 75% of the population would support the project.

If you must definitely give yourself time to develop a quality law, you must nevertheless be aware that there is urgency in the matter since patients are waiting for its adoption and that it is indispensable to fill the legal blur that exists around this problem. by

The [...]

The Public Health Committee of the European Parliament has already examined the problem of euthanasia and has issued an opinion. France has just opened the debate on this issue and is consulting the medical bodies. In other countries, this issue is being discussed. Do not believe and do not pretend to believe that only in the Netherlands and Belgium is concerned with this problem.

Applications brought before the European Court of Human Rights, which you have long mentioned, show that there is a need, a request for an answer to this type of problems even though, as we have already said, it is not the problem covered by our bill.

What separates us—and we must dare to say it because it is not embarrassing to say it—is the fact that we do not have the same philosophical conceptions. This is respectable and it deserves confrontation and debate to a certain point, however, because at some point we will not agree philosophically. One explains, one gives his point of view and then, there is something irreducible between what some and others think of the place of man and his ability to manage and make decisions that concern him.

We talked about pharmacists. Here too, I would like to return to what was finally admitted and said. It is important to prevent pharmacists, and especially those who work in hospital offices, from imagining that it is legally dangerous to provide a doctor who requires them with products for practicing euthanasia. Pharmacists must therefore be given the most absolute legal certainty and reaffirm that they cannot be prosecuted for euthanasia practiced under conditions not in accordance with those described in the law once they have delivered the medicines in accordance with the prescriptions of the doctor.

Article 14 states that no doctor is obliged to practice euthanasia and no other person is obliged to participate in euthanasia. Pharmacists therefore have the right to refuse to deliver the necessary products and are free, like nursing staff, not to participate and to invoke their conscientious clause.

If, nonetheless, the pharmacist executes a lethal prescription, it is obviously the doctor who assumes the responsibility for this prescription and not the pharmacist. The same is true for the nurse who would prepare an euthanasia solution on the doctor's order. It is unclear what an amendment would specify on this subject. Article 14 is clear.

I believe that if there was a unanimity within the Public Health Commission on the theme of the legalization of euthanasia (the commission has unanimously accepted it), what separated the members of this commission is the fact that some provided it in the terminal stage difficult to define while others believed that other criteria should prevail. by

I recall this because the vote 8 against 8 which intervened in the committee simply indicates the position of those who were present in the committee of Public Health; it does not obviously mean that we will witness a 50/50 distribution of the vote in the plenary assembly and ⁇ does not reflect the vote that intervened in the Senate. This vote 8 against 8 indicates that everyone has accepted the principle of euthanasia. I repeat it because when I said it in the Justice Committee, I heard horrifying screams from members saying that they had never accepted euthanasia. Yes, dear colleagues, you accepted it, but at a terminal stage difficult to define.

If, as was said in the Justice Committee, this is not true, it follows that it was a political vote tinted with a lot of hypocrisy. If this is the case, I believe that one cannot honestly rely on the outcome of this vote.

The [...]

You were not there, Mr. Van Parys, in the Public Health Committee! It is not you that I question. And in the Justice Committee, I think we didn’t vote 8 against 8 on the subject!

I was there from the first minute to the last. I understand that Mr. Mayeur wants to attack us, but I find it even difficult not to get into it. Three points characterize the position of the PS. It is a big party, as was written in a Flemish weekly newspaper this week. Thus, that party has three statements about euthanasia: first, they have no trust in doctors and therefore the will of the patient must also contribute — that would still be lacking; second, the patients ask for it, they are waiting in long rows; third, the main question is who bears the responsibility for the lethal drugs, the doctor or the pharmacist. Those are the three things I have heard in the statement of one of the biggest parties of this hemisphere. Their

Mr. Mayeur, with permission, if that is the ideology, then it resists sharply against the well-founded statements. Whether we agree with it or not, we have already heard much better things here from many smaller parties, who at least still struggled to say what their ideological standpoint was. You explain it purely mechanically and now you’re coming out to us too. I don’t even find it difficult to react to such a flattery.

You are right on one point: the size of the parties does not make the quality of its speakers. I have often thought about CD&V, the same way you think about PS. However, it remains that no matter how you caricature my position and that of the PS, you do not answer the question: are you for or against euthanasia? Yes, even in the terminal stage, yes, you said in the Health Commission. If not, then you have practiced a political game at the tribune. You must admit it and get out of the hypocrisy into which you wanted to draw everyone.

So far, the debate has been relatively serene. It was an exchange of arguments. As far as we are concerned, the actions are missing after the words of Mr. Erdman. He said that we always listened to each other, but the result was that even the most basic amendment, which aims to correct a clear legal error, is not accepted. Mr. Mayeur, I am very surprised that you now suddenly change the tone of the debate. It proves very clearly that some have not listened to us or may not have understood it. However, we have said it so often, in the Committee on Public Health, at the mouth of colleagues Goutry, Brouns and Vande Walle, and in the Committee on Justice. I say it again, so that you may understand, for we do not want to be placed in the camp where you want us to be placed. What is the position of CD&V on this matter? The point of view is the following, I will try to explain it to you very clearly and clearly and I hope you will want to understand it: we have everything for auction that people at the end of their lives can live in human conditions in an environment where they are cared for, where they are assisted, where they are assisted and where they should not suffer pain. That is why we are so strongly committed to this palliative care and palliative support. When all other means have been exhausted and euthanasia is the ultimum remedy, this must be able and therefore is the justification of the state of emergency. That is the position we have defended from the beginning, which can be found in the bill we have submitted to the Senate and in the amendments. If you are now provoking a war of positions, I find it truly incomprehensible and unworthy of the attitude we have always taken in this debate.

This is therefore strikingly in line with other statements I heard at the beginning of the session this afternoon and which were not so clear. I therefore take note that this refusal to flee is not entirely a political and hypocritical vote, that it is based on a clear will to arrive, after a palliative stage, and that I respect.

The [...]

The little hypocritical political game, I do not respect it. If it is something else, then it is very good.

Come to your conclusion, Mr. Mayeur.

Mr. Speaker, it is still necessary to know under what conditions the debates took place in certain places, especially in the Justice Committee, and did not happen in the same way in the Public Health Committee. Read the reports.

The [...]

You can regret anything you want. I regret that in the committee, at some times and this is quite extraordinary, it is the opposition that confiscated the debate. Sometimes we couldn’t debate in the House Justice Committee and I’m not the only one who thinks so. I’m probably the only one who will tell you, but it’s not important, I’m not afraid of you. by

I tell you: let us actually debate philosophical positions, let us actually debate positions on the substance. I have expressed my opinion and you can caricate it if you wish. I would like to respect your position if it is consistent and consistent and if you assume until the end what you have voted including. by

But to argue that there has been unanimity in the Health Committee on your interpretation of the palliative filter, it is false, Mr. Germs and others are there, that’s not true! To argue that there was a very tight vote in the Public Health Committee (8/8) on an euthanasia with a pre-defined terminal stage, it is false! You know very well that things have been much more subtle than that. You train the members of the public health committee in a logic that means that this committee had a different opinion but that in the Justice committee, the debate was chained and the members of the health committee were not followed. This is false and other members are there to testify to the way things went.

What we said is that in fact, it was necessary to consult the palliative team in advance if it was present. This seems to us indispensable. While palliative work can relieve the pain of patients, of course it must be supported and developed.

Of course, we’ve all said, I understand, that the government will have to put resources at the disposal of the palliative teams so that they can develop. When representatives of the palliative care federations were heard, they were asked what the bill would change for them. They answered us that this would not change much, except a legal recognition. On the other hand, they expect additional funds, the establishment of programs, etc. This is exactly what we expect from the government and we are still discussing it today. by

Imposing a palliative filter before euthanasia is a step that we have not accepted. You have the right to provide it as an additional phase, but do not say that was the position of the Health Commission. It is not true. We consider that this would be “tribunalizing” the procedure and weighing it without adding anything to the patient’s treatment.

Since you have asked me, I come to my conclusion. For us, what matters, of course, is freedom, the exercise of the individual rights of citizens. The State, that is, the law, must not hinder what falls within the individual and democratic consciousness, which falls within ethical conceptions, provided that these are respectful of others. On the other hand, the State, the law, must allow us to live in accordance with our philosophical choices, even though these recognize, for some of us, the right of every man to anticipate his death, and it brings him — I quote here Mr. Lallemand — “the affirmation of a sovereignty over his life.” This is what matters for us.

Mr. Speaker, colleagues, first of all, I would like to thank the services of the House for the report and for the many and quick work that they have done in absolute anonymity, not always in grateful circumstances and sometimes late hours.

If one would ever look back at this time with the question of how everything could go so wrong with democracy and democratic decision-making, or if one would ever look for examples of flagrant political misleading, of extremely bad and dangerous laws, then it would best be possible that the euthanasia law will be pushed forward in the manuals and university courses as a type example and enlightening illustration.

I will explain this in six points. First, the design has not been dealt with by the right people or those with the best expertise in the matter. Secondly, the parliamentary debate has not gone well. From the beginning it was clear that nothing could change under any circumstances. Third, the law does not do what it says to do. She swims in an atmosphere of manipulation. Fourth, the law is not the correct answer to the needs and current problems in healthcare. Fifth, the guarantees to protect the weakest of our society are not present. Sixth, there are no closing guarantees of control at all.

This is a very bad and dangerous law. I explain myself more closely.

First, the design is not treated decisively by the right people or by those with the best expertise. The text has interfaces with the domain of Justice, but also and ⁇ with Public Health. Therefore, the texts were discussed in the Senate in a double committee, namely in a joint meeting of the Justice Committee and the Public Health Committee there. This was not allowed in the room. Later it became clear why: not for reasons of efficiency, but because in the committee for Public Health, at least with regard to the VLD, the biggest critics of the euthanasia proposal were. They were not the least. These are doctors such as Commission Chairman Yolande Avontroodt and Jef Valkeniers. They could jeopardize the liberal consensus that existed in the Senate. Therefore, it was decided not to give these people the right to decide but only the right to advise. Unfortunately for the violet-green majority parties, the Committee for Public Health took its task quite seriously and succeeded in delivering a well-founded opinion containing some remarkable grievances and warnings regarding the existing text, including that purely psychiatric suffering should never give rise to euthanasia and that in any case a so-called palliative filter should be installed, which is a great word for the mandatory information of the patient about the possibilities of palliative care by the local palliative unit. Both major corrections were unanimously approved by the Plenary Committee on Public Health.

Surprisingly, eight of the sixteen members of that committee wanted to add that only terminal patients would be covered by that law. That important aspect thus did not ⁇ a majority in the committee, but the perspective existed in any case that after a fair treatment in the committee for Justice a change of the law could also be possible here. It should not have been.

Secondly, the parliamentary debate has gone all but well. It was clear from the beginning that nothing could be changed under any circumstances. Their

The very clear and sharp opinion of the Committee on Public Health and the constructive atmosphere that prevailed in the committee fed the expectation that this opinion would be taken into account and that this thorough work of the committee would not be in vain. I quote Mrs. Avontroodt in the Gazet of Antwerp of 22 January 2002: "Our advice will ⁇ be taken seriously. I hope that the scheme for non-terminal patients will be updated."Unfortunately, from the first moment of treatment by the Justice Committee it was clear that one wanted to do the forcing, that nothing would be changed anymore. From the first moment we read on the steel face of PS'er Mayeur that enough time had been wasted. He immediately said that nothing could be changed, because that was about the whole country waiting for the law." Mrs Avontroodt was indeed allowed to speak in the Public Health Committee, but she was not really welcome in the Justice Committee. There were the real dragons of the party of the VLD, the real decision makers who listened to the oekazes of the PS. VLD group leader Coveliers says that his party is a free party and that everyone according to his conscience can speak and vote, but we have not noticed much of this in the Justice Committee. Mrs Avontroodt was not really welcome in this committee to come to contradict her group members. She has joined us only once. Then we could have heard that the opinion of the Public Health Committee was intended to make text changes and not merely to interpret the text.

Then there was also the treatment of both drafts by the committee itself. All the opposition parties have tried to deliver meaningful work and have put forward numerous serious arguments to amend or repeal the law in whole or in part. It was a dude conversation. The arguments were hardly heard. They were drawn into the ridiculous. Too many relevant questions were left unanswered or ridiculed. The hurtful highlight was, of course, the farm language of polite Hugo at the address of Joke Schauvliege. I admit that the chairman of the committee was the proverbial exception to this. Indeed, President Erdman has made regular attempts to respond to the criticism, but he was almost the only one. This became more than obvious at the time he was replaced, because that afternoon we were suddenly talking against a wall and the purple-green no longer was given a cock. The great argument of purple greens to change no komma, no jota to these texts was the so-called loss of time that would be accompanied by this. The texts would return to the Senate and what would we all experience? Then it may not have been for this legislature, as shown in an interview with Mrs Avontroodt. We asked, then, whether it was true that this government hanging with hips and eyes together would not sing it for a long time and therefore would quickly add the euthanasia law to its carous palmares before breaking up shortly before or after the summer.

However, I think there is a second, much more important reason why the majority parties hold so tightly to their texts. This is clearly a symbolic struggle. A number of parliamentarians who have been working on this issue for years want to strike their battle today. They want to claim the paternity of a revolutionary, extremely extensive law. That law is the proof of their great right.

Every change torn to their reputation and is a smash on their blaze. Here, to a significant extent, there is a debate from the past, with old arguments, in which it is settled with old opponents, and in which some great egos want to penetrate their great equals before they go to the Elephant Church. All that comes afterwards, subsequent changes, only relate to beauty defects.

Dear colleagues, soon here a law will be passed which is known to be serious risks, which is known and recognized to contain serious deficiencies. However, for better knowledge, especially for symbolic reasons, one wants to keep them unchanged. It is somewhat like with the Rapid-Belggesetz. Colleague Mortelmans will not contradict me. We know that it is a very bad and dangerous law, that the control mechanisms do not work, that it opens the gate wide for abuse, but nevertheless no jota can be changed because it has become a symbol and because the government parties prefer to cling to each other so convulsively that every rise of reason or common sense must depart.

Third, this law does not do what it says to do. She swims in an atmosphere of manipulation. When I was confronted in the 1980s with the then already intense campaign around euthanasia, including through video footage, I must acknowledge that they met well and aroused compassion with the victims of therapeutic tenacity, with the dying to whom the nursing staff and the doctors who did not want to listen. Until this day, one remains with those who suffer unbearably, who are not allowed to die, and for whom this law should bring salvation. However, the times have changed. There is no one here who defends therapeutic tenacity. In terms of pain control, there has been a very strong evolution. So today a lot of arguments, advocating for an euthanasia legislation, have disappeared. If one statement from the discussion in the committee remains to me, it is that of VLD’er Germeaux, who at an unattended moment explicitly acknowledged — I appreciate it, by the way, that he is still present — that this law is not actually intended for the dying, for terminally sick. For this, he said, there is no need for a law. This would be part of the medical practice. This law, on the contrary, is specifically intended for non-terminals. Of course, a lot can be understood. For example, people who have a prospect of deflation and who do not want to undergo it. Important is not the terminal character, but the irreversibility. This is ⁇ extensive, of course. Here a very wide gateway is opened, which can lead to numerous abuses and which brings very large groups of people, including disabled and psychiatric patients, under the scope of the euthanasia law. I will return to that later.

Fourth, this law is not the correct answer to the needs and problems of today in healthcare. The hearings and debates in the House and Senate have sufficiently demonstrated that, if there is one great need today for new legislation for the benefit of the suffering person, it must be a final legislation on palliative care. There is too much that is lacking in this country. There are too few people and resources and too little prospects for progress. That should be the priority. When one adopts today an euthanasia law with an appendix on palliative care, it almost consists in choosing the convenience solution, for the cheap solution, in which one does not even give people the guarantee of a real choice. Professor Dupuis said, “It is cynical because of a society to consider normalizing euthanasia before providing a realistic and concrete policy on palliative medicine.”

Meanwhile, studies and testimony have sufficiently shown that in the vast majority of cases — Professor Distelmans speaks about 99% of cases — where an end of life is requested, in fact, another request underlies this question. It is too often a cry for help and help. A colleague quoted from the decisions of an investigation from Amsterdam. According to this research, there is especially a small ignorance about alternative pain and symptom control and palliative medicine in general. I quote from the report on the hearing with Dr. De Smet. “It does not deny that there are sick people who are in such a critical condition that euthanasia becomes the only way out for them, but such situations are extremely rare, 0.5 to 2%. However, they should not pose a threat to the life of other patients. The question is, therefore, whether an euthanasia legislation in itself and ⁇ in these circumstances is desirable. We think of not. Many more problems are created than they are solved. Build a well-equipped network of palliative care, evaluate that and strengthen the network and then, if you wish, conduct an honest debate on euthanasia legislation. This law would not have occurred under such circumstances. There is no longer a parliamentary majority. Mr. Erdman, I may refer with this again to my crystal ball.

Colleagues, this law is also not used at all to enable even a fair choice and proper information of patients. The unanimous opinion of the Public Health Committee to establish a consultation with a palliative support team is a ⁇ moderate proposal and reflects only the basic right to proper information of the patient. This has been, and is called, a palliative filter. This is not a palliative filter, it is much less than that. It is just a simple contact. Well, by not incorporating that basic education, patients are pushed towards euthanasia. I quote the people of the Federation of Palliative Care from a tribune of Monday’s new members: “If the bill in its current form becomes law, then a lot of patients will tragically enough, just like their doctors, wrongly believe that their pain or suffering is uncontrollable and thus “choose” for euthanasia. Were it not precisely these false choices that everyone claims to want to avoid at all costs?"

Fifth, the guarantees to protect the weakest in our society are not present. Too often it is shielded with the right of self-determination of the individual and with the fact that all safeguards in this law would be embedded to guarantee the patient a free choice, independent of external pressure. I am absolutely not convinced of the latter. It is too often forgotten that the sick and the dying are in an extremely weak, dependent and precarious position. My greatest objection to this legislation is that one gives a signal to all these people, not that one will be assisted and surrounded at the night of life until the last moment, that one will continue to find their lives meaningful and valuable, that one will go to the extreme in pain control and give it all priority, but that it is only a matter of a choice and that one must decide for himself whether and when to leave. In this way one creates a certain pattern of expectation with regard to many people who are in a weak position and who do not want to be a burden to their family, to choose the faster solution.

Implicitly, guilt is placed on those who want to die a natural death. Why am I still alive? How much does it cost to keep me alive? In this way one creates far more problems than one solves, ⁇ because this law does not define supposedly unbearable suffering at all. The expressed desire is the only thing that counts and I quote Professor Adams: "The unbearable suffering can be almost entirely determined by the patient himself." Euthanasia on simple request.

This is even worse because the law also opens the door for non-terminal patients. I quote Yolande Avontroodt again: “As a doctor, I find that this opens the door to abuse due to the limited resources and the high workload in hospitals and in home care. The risk is unthinkable that pressure from the outside can be exercised on the patient to put an end to it. This is a bridge too far.” She said this some time ago in an interview with Gazet van Antwerpen. What she said today was even more accurate.

Nobody less than physician and senator Patrick Vankrunkelsven, however a major advocate of the euthanasia law, acknowledges, I quote, “Including non-terminal patients into the law opens a box of pandora. For example, we pose an entire category of people, including those with severe disabilities, to an existential problem. When they see that others with the same disability choose euthanasia, they will start to doubt their own existence. I think, colleagues, that this is unethical and that we should not have this on our conscience, because it degrades the lives of many people, of many people with disabilities and mentally suffering. These people, who are already having such difficulties today, are being brought into a situation of great confusion, uncertainty and doubt.”

Sixth, there are no closing control guarantees at all. The politically composed Federal Audit and Evaluation Commission, established by this law, ⁇ does not provide for a closing audit and is ⁇ not a useful tool to counter abuse. Indeed, the whole system is based on the voluntary declaration by the doctors concerned of their own records, which must reflect the medical condition and describe all circumstances. There is no serious control in advance.

Well, it is almost unthinkable that doctors will put themselves in trouble, will declare themselves as being by mentioning facts that are not in accordance with the law. This can be ⁇ difficult to imagine. In addition, the probability is ⁇ small that euthanasia files will reach the prosecutor’s office through the commission, given the heavy procedure. A maximum of two-thirds of the members should support this referral so that any ideological, linguistic or professional subgroup can veto.

Furthermore, there is no adjusted sanctions area, so that the slightest negligence can automatically lead to the most severe indictment, namely that of murder or murder. This absolute lack of sanctioning apparatus proves that one has the explicit intention not to pass on minor offenses and thus to leave them unpunished. This makes the whole system unreliable. I quote Professor Adams: "As a result of this, the committee will begin to pursue a legal policy, which is not its task, and only in extreme circumstances will advise persecution." However, such cases will not be referred to the control committee. When manifest violations of the law occur, but for all sorts of reasons that two-thirds are not achieved, it is forbidden for the members of the committee to enter the prosecutor’s office themselves.

This committee, therefore, will become, to a significant extent, a doofpot commission and undermines the last piece of credibility of this law. Like the Netherlands, we risk getting heavy international criticism of this euthanasia legislation, including on the basis of this completely unreliable and too transparent control system.

I would like to point out one last aspect: the minors. Even here, the bill is not sincere. It is said that minors are in principle excluded, but nevertheless they have very deliberately smuggled and held in the deprived minor, while the figure of the deprivation in the distant distance has nothing to do with this problem. The unleashed minor is deliberately subject to discrimination in the sense that there are no objective grounds for distinguishing between unleashed and unleashed minors in this type of matters, as confirmed by colleague Avontroodt. As soon as the Court of Arbitration is caught up with this problem — here I oppose colleague Erdman — the new discrimination will be abolished and euthanasia will also be possible for the other minors. This is, in our view, the real purpose of enforcing the minor in the law: it is a break iron to extend the scope of application to all minors as soon as possible. Their

Colleagues, today, during the final spurt of this bill, we read in a Flemish newspaper that uses to call itself quality magazine, suddenly critical articles. Finally one dares to write that the Netherlands is skipped with this bill, because also the mentally suffering are eligible for euthanasia. We have the most liberal legislation in the world. These articles came too late. If we are faced with this extreme legislation today, it is largely the result of the complicity of all kinds of media that have played struts and confused critical journalism with beate solenoid licking of the purple-green majority. In any case, the Flemish Bloc is not proud of this new blast on our international blaze, which is merely the result of the rigidity, the neck rigidity and the revanchist attitude of the applicants. Therefore, tomorrow we will vote against this immoral law with great conviction.

Mrs. Van de Casteele has the word. After Mrs Van de Casteele, I will suspend the meeting as planned. I will ask to keep the restaurant open for colleagues a little later.

Mr. Speaker, Mrs. Minister, colleagues, ethical debates are difficult, which is clear again today. I will not make a lengthy presentation here today either, because I note that in the hemisphere only the colleagues who have experienced the discussions in the Committee for Public Health and/or for Justice are present, not to mention a few exceptions. Most colleagues have read that we have taken a serious part in the discussion in the committee. Their

My group has decided to make judgment on this subject, as well as on all other ethical issues, by everyone in honour and conscience. Nevertheless, we all think that it is not good to keep talking about euthanasia. We are all asking for a legal arrangement that allows to die in dignity. The central question in this debate is for us how society can, should and should fulfill its obligations to protect an individual and ensure that a person can not only live in dignity, but also die in dignity. For us, dying is part of life. Their

For us, this supports dying in dignity on two feet: on the one hand, palliative care must be available to everyone, on the other hand, euthanasia must be made possible within clear boundaries.

I want to talk about these clear boundaries. In the then People’s Union there was an ethical committee, which included Vic Anciaux, Patrick Vankrunkelsven and myself, which has been curved over this problem. Our definition was then: euthanasia is the deliberately life-shortening act of an incurably sick patient whose life can no longer be saved and who suffers unbearable and hopelessly. This definition is largely reflected in the definition contained in the present draft law. However, there are some clear nuances.

The definition had two important components. It must be a terminally sick patient and there must be an intolerable and hopeless suffering. This unbearable suffering must be understood sufficiently broadly. Research has shown that not so much the pain causes people to apply for euthanasia, but the general feeling of weakness, fatigue, dependence, loss of dignity and disobedience.

The figures mentioned during the discussions in the committee were enlightening and showed that euthanasia at the request of the patient actually occurs in a very limited number of cases, namely 1.1%. Many acts at the end of life do not fall under the definition of the draft law. For us, all of these fall under the term "help of doctors at the end of the patient's life". They can be divided into four categories. The first type of action consists in stopping meaningless therapeutic actions and pushing up the pain posture. Such practices should not be regulated by a law. A second type of act is euthanasia, a third type is assistance in suicide and a fourth type is euthanasia without the patient’s request. This latter is, of course, unacceptable; it must be excluded and is also impossible according to the present bill. Orthothanasia, a term used by Professor Velaerts, refers to the first category of acts, such as stopping medically meaningless acts, pushing up painkillers, or disconnecting life-enhancing devices. These practices belong to the good medical practices and do not belong at home in a discussion about euthanasia. Trust in the doctor and the importance of the relationship between doctor and patient remain central to us.

During the discussions, I have often been upset by the fundamental distrust of some colleagues towards doctors. Doctors were almost by definition suspected of asking anyone to commit a murder on a patient. This is not correct. For us, the doctor occupies a central place and his capabilities for good and responsible medical action should not be limited. The legal certainty of doctors and patients should be regulated in the Patient Rights Act, which is currently being discussed in the committee.

Even those who can no longer express their will have the right to a dignified death. This is also discussed in the bill.

From the beginning, we have tried to assume our responsibility to answer the questions about euthanasia and to enable legislation that could rely on a wider majority. Senator Patrick Vankrukelsven approved the draft in the Senate, but he pointed out three points in the bill that were serious shortcomings for him. He hoped that those points in the Chamber could be adjusted. Our amendments reflect those three points and the concerns of my party in these.

For a moment I hoped during the discussion in the Committee on Public Health that we would succeed together, at least for two of the three points. We were able to take quite unanimous positions, but later it turned out that the discussion was preceded by an agreement. The committee could give an opinion, but that opinion could not result in a text change. It was clear that this should be avoided at all costs and that weighed on the discussions. It is advisable to prevent such conditions in the future. Political agreements do not belong in ethical discussions. Their

We have defended our amendments in the committee. I will return to some elements, but I must point out that, like other colleagues, I was disappointed by the discussion in the Committee on Justice, where initially also at a high level and with a lot of willingness to listen to each other’s arguments. At some point, however, it became clear that there would not even be a change in the text yet. Since then, party politics has begun.

Our first concern was, as already stated by several colleagues, the introduction of a palliative filter. I can only state that the term chosen causes a lot of confusion. Some believe that one should get the palliative filter and the palliative care before one can formulate the question of euthanasia. I think this is a wrong analysis. The palliative filter should filter out an incorrect request for euthanasia. The reasoning of the amendment proposed by the Federation of Palliative Care Flanders and adopted by several colleagues also makes it clear that the intention must be to detect the obscured questions of care, attention, assistance and pain control through the mandatory consultation with the palliative support teams. I fear that the argument that this would mean an aggravation of the procedure is merely a false argument. The only reason for the rejection of that filter was the fear of an aggravation of the procedure for discussing this law. If the House approves an amendment, the text must be returned to the Senate and that was absolutely avoided.

Our second major concern was the limitation to terminal patients. I have read our own definition. It is clear that this was intended for us from the beginning. The discussion in the committee has also made clear that a large proportion of the applicants, under the motto of the right of self-determination, intends to make euthanasia applicable to non-terminal patients. The criterion "seriousness of the condition" is then indeed no longer a threshold and loses any meaning because the emphasis comes on the subjective assessment of the individual of his own condition. Which diseases or disabilities will then be considered serious? Who is going to talk about this outside of the patient? Literally speaking, the description in the draft applies, for example, to persons suffering from a serious physical disability from birth or from an accident — at least if I interpret it literally — or to persons suffering from a serious but not deadly disease such as multiple sclerosis, ALS, Alzheimer’s, and the like. In fact, they also fall under the definition as currently included in the draft law. Even for mentally disabled persons, in so far as they are not incapable of action and their request meets the legal conditions, the conditions as contained in the draft law apply.

What about chronically depressed patients? It has already been said here that depressed patients do not fall under the conditions because there are remedies for treating depression. For chronic recurring depression, however, those remedies do not exist, so the patients who suffer from it also fall under the terminology of the bill.

It is indeed correct that for those cases a supplementary mandatory consultation of a second doctor is provided, as well as a waiting period. However, the examples that the Dutch SCEN doctors gave us during the hearing spoke book parts. It revealed what such an interpretation can lead to in older people who consider their condition to be unbearable because they see themselves as harming their loved ones. In the Netherlands, euthanasia is applied to those persons if they only insist sufficiently and repeatedly give their request for euthanasia. Their

This is a purely subjective assessment of a situation, which, in our view, cannot form the basis for a socially responsible regulation. Euthanasia committing to people who are not in the death phase is a completely different problem. I do not exclude that this may be discussed at a later stage. One could have created a much wider support area if one had limited itself in the bill to the persons who are in a dying phase.

For this reason, the amendment we have submitted in the committee is also submitted in the plenary session – it is one of our main points of criticism of the current bill – while a number of other amendments that did not even get a single vote in the committee are not submitted again in the plenary session. Their

This applies, for example, to aid in suicide. However, I remain convinced that this issue should also be settled. After all, aid in suicide can be considered as an alternative to euthanasia in individuals who prefer to take the initiative themselves and who are also able to do so. In my opinion, it is illogical not to allow this under the same strict conditions as for euthanasia. There may be a legal gap. Of course, I understand that the terminology is especially difficult. It is not our intention to arrange suicide assistance for non-terminal patients. In this regard, for example, I think of the case that received so much attention in Great Britain. For us, it was really about aid in suicide as the minor of the multiple that is euthanasia. By the way, we also feel strengthened by the foreign examples, by Professor Adams who also said this during the hearings, and by the opinion of the State Council which states that there is discrimination and that assistance in suicide can be considered — according to the current criminal code — as the non-assistance of a person in danger, so that a doctor who actually commits the least would remain punishable.

These were our three main concerns.

Mr. President, Mrs. Van de Casteele, I have followed your speech in the committee with great attention. I have seen your amendments and I also know the views that Mr Vankrunkelsven defended in the Senate in that sense. At first glance — we might discuss this — it seems that there has been a contradiction in your position. You say we have to trust the doctors. I agree with that, because this is a cornerstone of the foregoing text. If one does not associate this with a confidence in the doctors and at the same time a belief in their deontological approach to the problem, one actually has no text. Within the framework of all the obligations imposed on them to not commit a crime themselves, they must act so deontologically that guarantees are indeed embedded in them. We start together from that point, but you say that that palliative filter — whether or not the correct terminology — is still an essential element. I argue that the text includes an obligation for the doctor to provide information to the patient which he will have to report in the file. If he does not have it, he has the deontological duty to seek out that information in order to be able to transmit it. If, on the other hand, it is established that in relation to what you still call non-terminals and I those who are not immediately in mortal need, additional conditions are incorporated, which involve even stricter rules for the doctor, then I say that there lies the guarantee. We will not slide into what is sometimes hanged up as a horror image. Their

As for your last comment on help in suicide, I think we will have to discuss it at some point. Let us not forget that the actuality has once again pointed us to the situation that can arise if the help is not necessarily provided by a doctor. The guarantees of deontological action are provided. We are talking about the choice of the person concerned, not necessarily associated with disease, but possibly a suicide drive that is not criminalized in the person concerned, even in England. This is a very different matter. I can understand you when you say that this is an indicative data. Some have talked about grey zones, such as therapeutic persistence and help with suicide, but this is, in my opinion, a completely different approach, otherwise one will mix the different situations together.

Mr. Speaker, Mr. Erdman, on this last point, we continue to talk side by side. I see in that help in suicide a method of euthanasia where only the means is different. I am not talking about non-terminal patients. Then we really talk about someone who is tired of his life. So far I ⁇ do not want to go. I do not want to go so far for euthanasia and I do not want to go so far for help in suicide. Assistance in suicide was included in our amendments within the same framework, with the same conditions and due diligence requirements as in euthanasia. Only the method in which it happens is different.

Second, you say that a good doctor, according to his deontology, will obviously explain the offer of palliative care. I hope it and I also have a lot of confidence that many doctors will do it effectively. However, it could not hurt to include that additional guarantee in the law, which was requested primarily from the sector. I believe that this need can be best assessed in the field. I regret that colleague Valkeniers almost accuses the palliative care teams that they have made their proposed amendment from a suction for more resources, that it is a money issue for them and that they thus want to strengthen their own action. I think the question that came from that sector was an emergency cry, because those who are most in contact with palliative care have established that now, in the first phase, the doctors have not been taught the necessary knowledge, which must be remediated, and that it is necessary to provide in a provisional phase. I’m not talking about the situation in ten years when everyone will be sufficiently up-trained. I can only regret that it did not happen. I regret that there is also no restriction on terminal patients. Of course, the doctor will be careful. This is mainly about the signal that is given. However, we have received a lot of responses from people who find that the door is opened too wide, which they are obviously afraid of. Maybe it wasn’t necessary to do it in the first phase.

I would like to point out a number of other points that we are concerned about. I am speaking, inter alia, of the lack of clarity regarding the possible complicity of a pharmacist who delivers an euthanatic without knowing that it is an euthanatic or without knowing whether the doctor who practices euthanasia does so within the framework of the legislation. I suspect, and I still remain, that he could be complicit in those cases. We will come back to it someday, colleague Erdman.

Then I share the concern with colleague Avontroodt about the minors who, according to the bill, have no right to die worthy, while in them also terminal diseases can hit very acutely. In addition, they can sometimes very sharply assess their situation.

Another point we are concerned about is the role of the primary physician in emphasizing primary medicine. Finally, we also preferred to include given euthanasia in the Criminal Code as a separate crime and to provide grounds for forgiveness. We thought that this could give a strong signal to society, where there is a fear that euthanasia will become impunity, while life in all situations is still worthy of protection. I fear that the majority today gives a different signal, especially when I hear that Belgium will approve the most liberal euthanasia scheme.

Colleagues, I recently, after the discussions in the committee, myself experienced a very close death situation. I can tell you that I then experienced that terminally ill patients who are accompanied in a loving environment by competent doctors and nurses, every month, every week, every day, every hour, continue to find it worth fighting forward, many do that too.

My concern is especially about those who do not receive that care, who, for example, for financial reasons, cannot choose to die where they like to die, who cannot choose to say goodbye in the confinement of their own hospital room, to those who visit a doctor who has not received the necessary training in pain relief or palliative care, to those whose close family does not have the opportunity to free time to assist them through palliative leave. Colleagues, during the debates, I have especially been reminded that there is so much fear among some colleagues for a heartless, calculated society in which those who can’t participate are dismissed as soon as possible. I think we must unite our forces to create, with the limited resources of politics, a real society in which people deal with each other with care until the last day and until the last hour.

May 15, 2002 | Plenary session (Chamber of representatives)

Full source

Mr. Speaker, Mrs. Minister, colleagues, allow me to briefly outline where I came with my presentation. It is good that a competent minister, though forced, has taken the effort to be present at the debate. It seemed for a moment that it was a symbolic choice to dismiss the Minister of Economy this morning. We are afraid of “economic euthanasia.”

This morning I had begun to say that it must be clear to everyone from the beginning: we too are against unnecessary suffering; that is inhuman. We also want an euthanasia scheme, but we fundamentally disagree with the way this draft has been developed and completely reject the conditions included in the draft.

Furthermore, I have noted that the draft is done to the Dutch "crocket policy". One puts money into a machine and there is a sandwich croquet out; make a request for euthanasia and there is euthanasia out. We have always been willing to work together on a arrangement and to reach a consensus. However, there was a manifest unwillingness from the majority. The law must become a purple-green pamphlet, and this at the expense of a solid legislation with a broad social consensus. The result is ugly and opens the door for abuse.

In the debate, the medical reality was completely overlooked. Euthanasia does not stand by itself; euthanasia cannot be seen apart from a global system of patient rights. I explained why this morning and also asked questions, such as what is understood under the terms "medical record", "willful decision" and "trust person".

I have not received a response to this. Furthermore, the discussions in the committee were often understated and there were not always answers to the questions raised.

Now that the Law on Patient Rights is pending in the Public Health Committee and we are fully engaged in the discussion, I was happy to get answers to my questions. I think that legal certainty is important and I would like to see the answer included in the report. I hope that the Minister will soon give me an adequate answer.

Second, I outlined this morning the need for a global arrangement around medical action at the end of life. This was deleted in the current bill, probably to cover up disagreement within the majority. The absence of a global arrangement entails dangers. Euthanasia is just the tip of the iceberg, the decision-making of medical decisions about the end of life such as pain control, strikes or omissions of medical treatments is missing. This will lead to a lot of questions and even give rise to the use of sliding roads. However, statistics demonstrate the importance of a general regulation. Euthanasia should be regulated within a broader framework.

For CD&V there are five major obstacles in this design. First of all, euthanasia cannot be in a non-terminal phase. Euthanasia can, according to the above-mentioned design, also be used in purely psychological suffering as well as in the case of wilsonbekwamen. Furthermore, we consider that this draft does not provide for sufficient due diligence conditions and we find it unheard of that there is no separate punishment for euthanasia.

I explained the first three reasons in detail this morning, after I had regretted that no consensus had been chosen beyond the boundaries of majority and opposition.

Part of the current majority did not see the development of a scheme for euthanasia in concert with CD&V. In the Justice Committee there was also a substantial debate. Only the President, Mr. Erdman, has struggled to answer a number of questions. We also received very few responses from the other applicants of the proposals. All amendments were rejected, including purely technical and legal improvements such as the amendment by which we meet the reference in the Act on Palliative Care to a law that no longer exists. This is incomprehensible, it goes beyond our pocket. Everything apparently had to get through Parliament as soon as possible, because this is more a political pamphlet than a law. We were ⁇ willing to come to a good debate in order to seek consensus, but it should not be.

Now I come back to the five major block blocks, which makes the CD&V faction unable to accept the design. I recently explained that it is unacceptable for us that euthanasia is possible for non-terminal patients. The limits of medical need are exceeded. It is an affirmation of the right that anyone who no longer sees it sitting can give the order to end his life without providing the other possibilities to a person in need.

I also pointed out the lack of intellectual logic. It is said that the term “terminal” cannot be defined or is irrelevant. However, I note that in the draft there is a different arrangement for terminal and non-terminal patients. The procedural guarantee is one month of mandatory consideration period for non-terminal patients. Their

This actually means that an application for killing is equated to the purchase of a vacuum cleaner. Those who order impulsively have a moment of reflection, but that is what it remains.

A second major obstacle for us is the fact that it is unacceptable that pure psychological suffering can also lead to euthanasia. Depressed and psychiatric patients, dementia and Alzheimer’s patients cannot be counted within the scope for us. The law is frightening in this regard.

A third reason why we can’t approve that draft is the fact that euthanasia can also be used in people with disabilities. The draft thus lacks the most essential condition: the free will of the person concerned. Those who are unable to formulate their request for euthanasia can still be euthanized if a declaration of will has ever been drawn up. That declaration of will may date up to five years before the request. One is never certain that that free will is still the same at the moment when one can no longer express his will. The doctor is thus reduced to a death officer or an executive master and can not come together with the patient to a solution or decision that in extreme urgency it should be passed to euthanasia. That arrangement surrounding the declaration of will does not allow for surveillance, openness and controllability. For those who are willing, there are fewer conditions than for those who are able to express their will. This is unacceptable for us.

Here is my brief overview of the explanation I gave this morning. I now come to the fourth major block of obstacle why it is unacceptable for our group that this law would be passed.

The fourth obstacle is the fact that there are too few careful conditions included in this law.

Mrs Schauvliege, if you say that the doctors are the executors, can I ask what role do you think the lawyers have if you speak in the same tone about the people? Are the lawyers then the nails on the coffin? I don’t understand your tone when you say that doctors act as executors.

I did not say that doctors act as executors. I have said that what is in the draft leads to the fact that the doctors will be able to do nothing but apply euthanasia.

That is the same. That is your interpretation.

It is not the same. That is something completely different. I didn’t talk about doctors in general.

Mr. Speaker, I thought it was clearly stated in the law that no one is obliged to cooperate in the implementation of euthanasia. This applies to both parties. Only the patient can request euthanasia. Only a doctor can respond to this, taking into account and agreeing to all criteria. No doctor, by the way, can be obliged to participate in euthanasia. The limitation applies to both parties, both for the patient who has to make a request, and for the doctor who has to agree to participate in the process.

I talked about the wilson skills and the fact that a declaration of will can be drawn up in advance. I can only state that the law, when it comes to wilsonbekwamen, provides for fewer safeguards. That is dangerous. This can lead to abuse.

If I have read the law correctly, we are not targeting the incapable. We speak of an early statement for people who, at that time, are no longer conscious. But there is a particular procedure to be followed which seems to me to provide a series of guarantees.

I can only state in the present draft that, when one is willing, there are fewer guarantees inscribed in the law.

Mr. Speaker, I do not like to interrupt, but when one uses a legal term, one should look at it within the context of that legal term. You talk about someone who is no longer at consciousness and catalogs them as willing. There is a huge difference in this regard. Wilson-capable are people who can no longer express their will in all possible circumstances. Here only the law stipulates, by the way, within the framework of other conditions, that the declaration of will applies to someone who is no longer at consciousness and will no longer come to consciousness. This is not a willful capacity.

For a person who has made a declaration of will and who can no longer express his will, there are fewer guarantees inscribed in the law. That is dangerous.

That is incorrect. Article 4 § 1 states clearly: "...a working adult or a discharged minor, if he is no longer able to express his will, in writing ...". There are as many conditions connected to it as to the other method. You should tell where you see those less guarantees.

It is logical. If at the time the question is asked, the person cannot express his will, and when it comes to a statement five years ago, that person can assess the situation very differently. How can you guarantee that the person who asks for euthanasia today has the same will as five years ago?

This is provided for in the article which states: "The declaration of will can be drawn up at any time. It must be drawn up in writing in the presence of two adult witnesses, at least one of whom has no material interest in the death of the patient. It must be dated and signed by the person making the declaration, by the witnesses, and, where appropriate, by the trust person. If you say that you do not trust it, you may not execute any self-written will.

For twenty years, I decided that my body would be incinerated. I will die late, at 133 years old, I was told! While I still enjoy all my abilities, I chose to be incinerated. In the name of what will I not respect my will when I die? It is the same thing. Dear Madame, I could also sign a paper, twenty years earlier, stating that I do not wish that my life ends in the worst sufferings but that, on the contrary, they help me to leave in dignity, without too much suffering. It is likely that, when the time comes, I will be unable to reaffirm the position I had expressed twenty years ago.

I want my wishes to be respected. I think that those who make a choice in their soul and consciousness while they have all their faculties, desire that their will be respected at the end of their lives. You do not have to make feelings about unnecessary questions.

About 30 speakers are registered. All opinions are valid. I appreciate a discussion where the participants speak, but I ask you to be brief.

Mr. Dufour’s presentation is interesting. Together with Mrs. Schauvliege, however, we bring the following consideration in the debate: to what extent is one today able to decide on a situation that will occur in four or five years, when one will exist in totally different circumstances, namely in a situation of unconsciousness? At that moment one will no longer be able to express his will. Our principle is that anyone should be able to spend the end of his life quietly, humanly. We say that because it is precisely for this that palliative care offers the possibility. Only when palliative care cannot guarantee a worthy existence can we, in such an extreme situation, switch to euthanasia.

Our fundamental criticism is that today it is impossible to say what will happen in four or five years. The legal validity of a declaration of will, dated to today on a situation over so long time, completely different circumstances, we fundamentally question.

Mr Van Parys, you are registered as speaker and will be given the opportunity to express your point of view.

I need to keep the debate a little in hand.

Mr. President, I would like to briefly communicate to Mr. Van Parys that one must know what one wants in life.

I fully agree with your position. We just want that will to be expressed very clearly and purified. What one wants must be expressed very clearly. We assert that what you will want in four years will not necessarily be the same as what you want now.

Mr Van Parys, you, like Ms. Descheemaeker, are also registered for the debate. I think Mr. Germeaux is also registered. I’ll leave a short reply and then Mrs. must finish, otherwise she’ll still be here tomorrow morning. It doesn’t bother me because it’s good here.

Mr. Speaker, I would like to

I would like to answer the comments of Mr Van Parys and Mrs Schauvliege. If you look at the declaration of will, I think you can make a choice years in advance. What changes is that this state is irreversible according to the state of science. If there is one dynamic, it is science. It will evolve over the years, which will change the situation. You can make a choice years in advance.

But you will no longer be able to make a choice.

Mrs. Descheemaeker, you can conclude your presentation.

In the meantime, I refer to page 12, article 14 of the law that we are talking about here. “The request and the declaration of will, referred to in Articles 3 and 4 of this Act, have no compulsory force.” There is always a certain relativity. This is literally in it.

Mr. Van Parys, you will soon have plenty of time to clarify your position. Mrs. Schauvliege, you have already interrupted. I like these kinds of debates, but the speaker must also be able to develop his mindset.

Mr. Speaker, I would add that there is a fundamental difference between someone who decides during his life what may happen to him after his death and someone who decides that his life may be put to an end. That is a big difference, because it is irreversible. If that will is not detected, then there is a big difference, because whether or not there is an end to life.

The [...]

I will now talk about the fact that, in our opinion, too few due diligence conditions were incorporated in the bill. The State Council has rightly pointed out that an euthanasia law is only compatible with Article 2 of the ECHR, which protects the right to life, provided that the law incorporates sufficient safeguards and provides for an adequate control system. We believe that the due diligence conditions in the draft law are insufficient. Both the a priori procedure and the a posteriori control are, in our view, inadequate in providing adequate protection to the right to life.

I will later return to the recent judgment of the European Court of Human Rights. I would have liked to hear the government’s position on this issue.

Why do we think there are too few careful conditions embedded in the present draft law? In the procedure a priori a clear and full-fledged palliative filter is lacking. The bill subordinates palliative care to euthanasia. Palliation is not considered a real treatment alternative. According to the design, it is sufficient to point out a moment in the margin, along with a lot of other information to be communicated to the patient. This represents for us a disregard of the current possibilities of palliative care. It is also a disregard for the involvement of so many, professional and volunteer forces that engage in palliation on a daily basis.

Anyone in Flanders who is closely or far involved with palliative care understands nothing of a design on euthanasia without a palliative filter. Therefore for us, in addition to the consultation of another doctor and the nursing team, the advice of a palliative expert should also be obtained. The question of euthanasia is an exceptional, but often ambiguous question. The patient who is in a situation of physically unbearable and untreatable pain often expresses something different in his question of life termination than he really intends.

A number of CD&V amendments call for the inclusion of palliative care as a social signal in the law on euthanasia. It belongs there at home, given the necessary connection between the two concepts. A separate law on euthanasia, in fact, underestimates the complexity of reality and does not establish the necessary links. Also the well-known judgment-Jabot of the Dutch High Council, stated that the government is obliged to offer palliation and that if a patient refuses palliation, it does not create for itself the emergency state that answers the question of euthanasia. Article 2 of the ECHR also states that palliative care should be developed in response to the question of euthanasia. The replica that always comes from the applicants states that palliative care is regulated in a separate law. However, this does not convince. It rejects the claim that palliation is an alternative to the demand for euthanasia. By arranging palliative care separately, one rejects this test and becomes just a choice. Palliation is then regulated in a law where nothing can actually. It is one of the many empty boxes we have seen pass through in Parliament in recent years. Their

Again and again, the image of the autonomous patient is misrepresented, taking a decision with full strength and full understanding, after receiving an explanation. This image does not show a dialectical view of man, in which decisions are made jointly, in which one is listened and in which another is asked for advice. The majority proposal is based on a doctor who presents a menu from which the patient at the end of his life can choose. Their

The hearing, however, has shown that the patient who asks for euthanasia does this in the first place not in the hope that it would be approved, but rather to hear and see someone, someone who comes to knock on the door and says to stay with him. The relational care approach is essential, not the equalization between palliation and euthanasia. Palliative care is not an alternative or a choice between care and death. The idea that the relationship between doctor and patient is equal to the relationship between a buyer and a seller is an unacceptable simplification. The starting point should be that the doctor always has the patient’s well-being in mind. Almost all witnesses heard during the hearings confirmed that the sincere requests for euthanasia, as envisaged in the bill, are quite exceptional. Decoding was a key word. The patient expresses in his request his fear of future suffering, increasing dependence, loss of dignity, therapeutic tenacity, and so on. The sick patient is still in a state of dependence and he needs to be protected. Their

The authors of the Civil Code demonstrated a great psychological understanding of society when, so many years ago, in addition to the voluntary character of the will, they also included the provision that doctors and pharmacists who have treated the patient at the end of his life cannot benefit from that will.

There is therefore an undeniable presumption that social pressure can be exercised on weak persons. Guarantees are therefore necessary to detect the actual will of the patient. Therefore, it is also incomprehensible and unforgivable that the majority parties have voted out of the proposal the requirement that the request must be unambiguous. At the end of September 2001 and this week, the Federation of Palliative Care Flanders correctly pointed out that in the proposed euthanasia procedure no palliative filter was installed. A palliative filter is needed to detect incorrect questions about euthanasia, due to poor or missing palliative care, or because the patient feels lonely or anxious. The CD&V amendments rejected in the committee, which provided for the necessary opinion of a palliative expert, are therefore again put to the vote.

In addition, the names of the Federation of Palliative Care Flanders and the palliative care doctors during the hearings show that the concept of palliative care is also much broader. It is a real palliative culture that requires further extended education, research and education. They confirm, in particular, that the expansion of palliative care in Belgium has not been sufficiently developed. These critical comments are crucial as the same doctors and nurses confirm that palliative care makes the demand for euthanasia exceptional. A second evidence of the insufficient care guarantees in the design concerns the opinion of the second doctor.

The advice of the second physician is now limited to reporting on the persistent, intolerable and unleashable nature of the pain or of the distress. This opinion must be opened to us, as, by the way, is also stipulated in the Dutch law, to which the applicants of the present draft are so gladly referred.

The advice should also cover the taking of all decisions as a whole. The second physician must also express his opinion on the gravity of the medical condition, as well as on the medical outlook and the like.

A third point of criticism of why there are too few safeguards included in the design is the fact that the control subsequently leaves completely desirable. The a posteriori control is virtually impossible because it was not determined which sanction is associated with the non-compliance of each condition. Among other things, it is unclear which crime a physician who applies euthanasia and fulfils all conditions, but does not report this within the specified deadline, is guilty of. This is not specified, not even in Article 5 of the draft.

A legal regulation, especially for a delicate issue such as euthanasia, stands or falls to the extent to which its compliance can be controlled. In this regard, we ask ourselves questions and, in addition, we fear that insufficient safeguards have been built in.

Such control can be positively completed. It should ensure that sufficient legal certainty is created and that it can be verified whether the doctor acts in good faith. This gives the patient much more legal certainty.

However, what is the benefit of entering precise terms into the law when doctors are not or insufficiently willing to take accountability for their actions? It is not or hardly possible to exercise any control to ensure compliance with all conditions. Their

The CD&V amendment therefore provides that every treating physician must send a written report to a physician specialising in forensic medicine within 24 hours of the euthanasing act. That doctor should immediately verify that all care requirements have been met. In the event of apparent non-compliance with all requirements of care, this physician shall submit a report to the Prosecutor of the King. On this basis, the parquet can then decide whether or not a terrace order can be passed. If the doctor does not find any irregularities, he shall send the report, together with his findings, to a regional review committee to be established. This formula offers better guarantees to the patient, but also to the doctor. It is good that there is a buffer so that not everything would be automatically transmitted to the parquet. In such a system there is room for consultation and there are opportunities to come to an objectivizing decision-making without immediately falling into the criminal sphere. A realistic and feasible reporting and enforcement scheme takes into account this buffer principle, but also introduces a targeted control of the truthfulness of all reports. If tax returns are checked, why not an euthanasia declaration?

The majority proposal, which initially provided for a direct notification to the prosecutor’s office — which after numerous hearings turned out to be ineffective — was amended by the majority group leaders to the other extreme. Now a non-sanctioned report is provided by the doctor, by sending a registration form to the evaluation committee.

Only if the assessment committee has doubts about the compliance with the conditions can it – it is not even obliged – with a two-thirds majority send the file to the prosecutor’s office. This system makes any real control impossible. It is the royal inscription to organize a mere administrative control. The structural prosecution policy is left to a committee. As the draft shows, the question will be whether this committee will be composed of representatives who already have an a-priority point and of whom it is known in advance from what ideological thinking framework they are reasoning. Such a committee, on the contrary, must have a certain distance and should be composed of persons whose opinions are known in advance. Instead of a buffer, this evaluation committee is rather an autonomous body that, instead of the prosecutor’s office, will advise on the need for an administrative prosecution. Their

The State Council also noted that this evaluation committee cannot exclude the powers of the Prosecutor’s Office. The so-called buffer is actually deprived of all its usefulness. The public prosecution may still prosecute, but in fact the evaluation committee will keep track of all files and ⁇ very little will be ⁇ .

Finally, there are still many questions to which no answers have been given. Hopefully soon there will be another answer and we will finally get a clear answer to a lot of questions. Why was a two-thirds majority elected in the committee? Why is there no ethics in the committee? What is the statute of this committee? Is it an administrative law college? Can a doctor appeal against a decision of the committee?

In addition, there is another problem. In Belgium, the number of bodies buried is among the highest in the world. According to specialists and forensic medicine, this is due to a lack of clear rules related to the establishment of the cause of death, the reporting to an expert government and the verification of the truthfulness of the stated cause of death. Especially now that an administrative euthanasia is being permitted, it is necessary to establish a transparent reporting system, which must also be controllable. Moreover, the majority proposal does not provide for the possibility of autopsy before the funeral takes place. However, the Dutch system also provides for such prior authorisation. It is clear that even these rejections by the applicants of the majority proposal are only aimed at enabling a full depenalization of euthanasia, excluding all criminal risks.

A fifth important trick why this draft is unacceptable to us is the fact that there is no single individual punishment for euthanasia. Article 2 of the draft defines euthanasia, but makes it very general. In this case, the terms are used as "by someone other than the person concerned". It is also incomplete: the circumstances are absolutely not cited in Article 2.

When reading that definition, we get the impression that it was intended to include this in the Criminal Code. Article 3 also gives the same impression. However, the draft leaves euthanasia out of the criminal code. Either one chooses to include euthanasia in the criminal code and then one provides in a separate law the grounds for the exclusion of the penalty, or one leaves euthanasia outside the criminal code, but then the definition must be rewritten and it must be clear about what act it is, who can make it and under what circumstances.

It was too easy to say that the legislator must allow euthanasia because it happens in reality. Other social behaviors, such as tax evasion, excessive speed driving and violence, should also be allowed. When society incorporates a certain act into criminal law, it simultaneously makes a judgment on it. In the context of this debate, this means that a principle ban on euthanasia in criminal law is a signal that this is not a normal medical act. Conversely, a depenalization of euthanasia is a signal that this is a normal medical act and this could drastically change the expectation pattern around the death bed.

When are there the most chances of abuse? with a terminal patient. When is the patient’s self-determination right the weakest? When he is dying, during the last eight or fourteen days of his life. At that moment, all possible forms of manipulation, pressure and lack of autonomy are most present. It is not about the principle of autonomy, but about the actual autonomy of the patient. At the moment he is the weakest, he must receive additional protection. The principle criminal character of euthanasia cannot therefore be reduced to a symbolic adherence to an unchanged criminal code. When a decision is made to remove euthanasia from the criminal law, it is necessary that it is based on a worst case scenario. Such legislation has a whole range of derivative consequences. In addition to the intensity of human life, there are a whole host of other matters at stake. There is concern about the moral integrity of the medical profession, to abuse, neglect or misunderstanding with respect to very vulnerable people. It is a mistake to close the eyes to such situations from boundless optimism.

The Deliens study showed that annually in Belgium 1,903 patients are killed by doctors without their request. This should be the starting point of every decision making. The country should actually be in rear and roar. The fact that there is no special punishment in the euthanasia law is really a problem. It means that in the event of violation of the euthanasia law the already existing provisions of the Criminal Code apply. These are the provisions relating to murder, regardless of whether it is an important or less important provision in the euthanasia law. Simply disregarding a purely formal obligation, such as failing to properly declare legitimate euthanasia, can thus lead to the imposition of a punishment which, even given the applicable minimum penalties and the possibility to observe mitigating circumstances, can be deemed to be in a reasonable proportion to the indictment. This will lead doctors to avoid risks: either they will not commit euthanasia out of fear in cases where it is fully legal and ethical, or the euthanasing act will be camouflaged as pain relief. In any case, doctors will want to avoid their behavior being tested at all costs. This undermines the judicial and social control of euthanasia – which, according to the applicants, is one of the main objectives of the law – completely. The Belgian law will not pass the test of the European Court of Human Rights at this point.

When a scheme for euthanasia is to be adopted, it should provide the doctors with the necessary legal certainty. This is only possible by formulating formulas relating to a preliminary examination so that the doctor knows, on the basis of certain parameters, that he acts within the limits of what is permissible.

Legal certainty can only be guaranteed by putting in concrete sufficient safeguards into place. These safeguards should not only be there to protect the patient from accident, but are also important for the doctor. The argument that legal certainty is provided by removing euthanasia from criminal law is therefore not valid. On the contrary, the legal certainty of the patient is completely undermined by it. The doctor also has insufficient reference points to reasonably assume that he will not be punished.

For CD&V, the state of emergency provides the best legal structure to regulate euthanasia. By using the emergency state by the doctor, it is emphasized that allowing euthanasia is not a normal medical act. It is a social act for which the doctor must be accountable. The concept of emergency state expresses very well what situation one is facing. This is something quite different from a listing of the conditions under which life termination is possible.

With this design, the majority of the Dutch croquet policy.

Madame, you are always talking about the state of emergency, a concept that was also brought up here years ago when discussing another ethical issue. A state of emergency is, however, by definition, something that one cannot foresee, something in which one himself does not cooperate — it is sometimes called "le fait du prince". This is not about such a situation. How can you now say that it is an emergency, when you provide it yourself and cooperate with it yourself? This is not an emergency. Otherwise, you have introduced a different concept of emergency. It may be a Catholic state of emergency, but this is not a state of emergency according to the current concepts.

Emergency means that the doctor who is confronted with a patient and who wants to protect the right to life establishes a need and can only borrow that need.

If I understand it correctly, let the doctor fully judge the patient’s life, according to your understanding of emergency.

In consultation with the patient; you have not listened properly.

But if the patient asks for it, there is no emergency, because then he creates it himself.

Colleague, I just explained that when a patient who is at the end of his life and asks for euthanasia, it does not always mean that he wants to die. It is a question of help.

So he asks for euthanasia, but you think he meant something else.

He asks for help, but that needs to be checked and decoded. I just explained that.

This way you can explain everything. You say yes, but you actually want to say no. It is new, but original.

Colleague Coveliers, with this design, the majority of the Dutch croquet policy: one asks for euthanasia and a question comes out. For us, euthanasia does not mean overcoming a checklist. It is not about merely filling conditions and then simply entering into the question. The doctor is in a state of emergency when he is faced with a situation in which he wishes to continue to assist with his medical expertise, but where the medical resources at his disposal are no longer sufficient to borrow the physical need of the terminal patient. The mere subjective invocation of a subjective state of emergency by the patient, followed by a number of procedural acts, may not be sufficient to remove euthanasia from its criminal character.

In summary, the fundamental difference between, on the one hand, an approach invoking the state of emergency or force majeure and, on the other hand, the conditional legalization of euthanasia is that, according to the first approach, the criminal character of euthanasia remains unshorted, but that the individual circumstances of the case can lead to no guilt and therefore no punishment. However, the general rule remains intact. However, the legalization of conditional euthanasia has the effect that the criminal rule “you shall not kill” is not applicable in certain cases and that therefore the protection of life cannot be presumed as a general principle in all cases. Some lives seem to need to be protected more than others.

The majority’s proposal assumes that there would be a social consensus to depenalize euthanasia, while this is not shown at all in the hearings. On the contrary, critical questions are asked about the majority proposal, ⁇ about certain aspects of it. What is most striking here is that the vast majority of those heard do not argue for or against the right to self-determination, but rather about how a number of dramatic circumstances at the end of life can be solved in a human way. The counter-argument of legal uncertainty, which would be eliminated by a depenalisation, is thus refuted by the majority of stakeholders themselves. The depenalization of euthanasia could be an easy argument to stop making maximum efforts to guarantee a full supply of care at the end of life. Euthanasia is not included in the Criminal Code, nor is it included in the draft. The Dutch legislature has incorporated euthanasia in the criminal law, to then provide for criminal exclusion grounds. In this sense, Dutch legislation has actually decriminalized euthanasia. This means that euthanasia is removed from criminal law under certain conditions. The Dutch doctor who applies euthanasia and thus meets the requirements of care, is thus not punishable. The present draft says the same thing about the Belgian doctor, but completely overlooks the previous steps. In fact, the draft goes far beyond the Dutch legislature. It does not decriminalize euthanasia, but it legalizes euthanasia: euthanasia is allowed under certain conditions and provided that it follows a procedure. The doctor who does not comply with these conditions is not guilty of committing euthanasia — that crime does not exist — but of committing another crime. In this regard, the prosecutor must demonstrate which crime it would be. Is it involuntary killing, murder or failure to provide assistance to people in need? Our proposal therefore consists in incorporating, in analogy with the Dutch law, euthanasia as a crime in the criminal code.

These are the five key points in the present draft.

Recent judgments of the European Court of Human Rights in Strasbourg in the Pretty case require me to comment on this. Following that case, the Court of Strasbourg has devoted a number of principled considerations to the scope of the provisions of the European Convention for the Protection of Human Rights and Fundamental Freedoms. Those considerations are separate from the concrete case Pretty and have an impact on the scope of the draft that is put to the vote here today. The judgment is not just about the unique situation in Britain, but generally about whether the government can hinder someone when a person, in his own judgment, suffers unbearably and wants to seek the help of others to be able to die. Article 2 of the European Convention for the Protection of Human Rights provides for the protection of human life. Article 2 of the ECHR provides for a positive obligation for the State to take the necessary measures to protect human life. This obligation implies a concrete and effective criminal legislation to protect human suffering. Euthanasia cannot be decentralized. Article 2 does not imply the right to self-determination or the choice between life and death. Article 2 of the ECHR thus provides no right to die, regardless of whether you like it or not. The applicant, late Mrs. Pretty, ...

Mrs. Schauvliege, Mr. Pieters wishes to interrupt you. Then I would like to ask you to formulate your decision.

Ladies and gentlemen, I would like to note the following. In principle, the speech time in a general discussion is 30 minutes. However, I find that topic too important to impose fetishistic restrictions. I would like to ask for the best possible cooperation of everyone. That topic is important and I have no problem with a longer speech time. Between the time of speech prescribed by the Rules of Procedure and the enormous time that a speaker rightly considers to have to take, there can be a huge difference.

Mr. Speaker, I would only like to repeat my question from now on under the Vice-Presidence. I already said that the judgment brought about a new fact. We may hear several speakers who will give their reading about it.

First, is it possible to obtain any objective information about it? I think of the text of the judgment.

Secondly, I just asked if the government can take a position on this. In our external relations, the government is responsible. Can the government say whether that judgment will cause difficulties in the provisions of the euthanasia bill?

I have asked this question before and I will repeat it now.

I agree with what Mr. Peterson says. I will repeat this question again later.

Mrs Pretty argued before the European Court of Justice in Strasbourg that Article 2 implies that every individual has the right to die and that the State has the positive obligation to incorporate this possibility in its domestic legislation. The Court of Strasbourg expressly rejected this interpretation. Recommendation 1418 of the Council of Europe provides for an absolute ban on the deliberate termination of life of incurably sick and dying persons. Whereas, on the contrary, the right to self-determination cannot constitute a legal justification for acts intended to deliberately end life, the Court expressly states that Article 2 of the European Convention on Human Rights obliges States to take the necessary measures to protect human life. The reasoning of the judgment fully corresponds to the position of the CD&V Chamber group during the discussion of the draft law. The euthanasia proposal of the majority is substantially and legally based on the right to euthanasia, independent of the concrete, objective situation. One puts one’s own subjective question at the center, which, in addition, must be approached very carefully. Since the majority euthanasia proposal provides for the right to active euthanasia, it is contrary to Article 2 of the ECHR.

Weilen Mrs. Pretty also called out that she had the right to protection of her private life. According to Ms. Pretty, Article 8 of the ECHR provides for a right of self-determination. The European Court of Justice ruled that this is not the case and that it is permissible for the government to make certain decisions that are necessary and that the State interferes in the private sphere because the public authority needs to be protected. In a democratic society, certain measures must be taken to ensure that the rights and freedoms of everyone, including the weakest in society, such as the sick, are protected.

The Court responds that the ratio legis of the British provision is precisely the weakness of the persons to be protected. As CD&V predicted during the discussion of the draft, the Court also emphasizes that, in relation to such legislation, in the first instance, possible abuses and derogations must be taken into account. We have repeatedly pointed out the dangers of an euthanasia law that does not provide adequate careful guarantees. The current euthanasia law, which we have confirmed by the judgment of the European Court of Justice, cannot, in our opinion, survive the review of the European Convention on Human Rights. I would like to ask the government to formulate a clear answer to this.

Before finishing, I have one last consideration. This is the last discussion of the draft law on euthanasia in the House. It has been shown that there may no longer be a change of jota. Also here, this morning, the tone that was put during the discussion in the Committee for Justice was held. It is a fact that there is no debate, that there is even no interest from the competent minister. Not so long ago, PS chairman Di Rupo stated that this government will make the difference in ethical files. Indeed, after the drug debacle where no one in the political and public world now knows what the norm is, what is and is not allowed, we are now dealing with euthanasia here. Belgium would be a hostage country. However, the guide appears to have drunk too much and is waving in the wrong direction.

This is supported neither socially nor internationally.

At the end of July 2001, the United Nations Human Rights Commission issued a very critical report on the Dutch law on euthanasia and aid in suicide. The commission is rightly concerned that the Dutch law will lead to a routine practice in the absence of control. She advocates that the Netherlands should revise its law to ensure that the procedures provide sufficient safeguards against abuse, including as a result of pressure from third parties. The committee stated that strict controls should be provided in advance and sanctions afterwards.

Because there is only a certain control afterwards, it is possible that a life is ended without the fulfillment of the legal conditions. It is important to take into account this observation of the United Nations, in particular since the Belgian bill goes beyond the Dutch law in no less than seven points. This is the difference in ethical records. If the United Nations rejects the Dutch policy so strongly, then it will surely accept the Belgian arrangement, which goes much further on seven crucial points, with open arms. Belgium will have the most liberal euthanasia legislation in the world. The authors of the draft have made the law on euthanasia a symbolic file, a political fetish. What lies ahead of us is a political pamphlet rather than a law. The worst thing is that the majority knows that this is an imperfect law. Her answer is: “The law will still be changed.” That reminds me of policy on payment. Half work to deliver something. The majority thought that with this proposal they had invented the hot water. They invented the water. The draft law on euthanasia is seawater: the more one drinks of it, the more thirst one gets. The more one studies this design, the more one becomes convinced that it is even worse than having no arrangement at all.

Mr President, Ladies and Gentlemen,

But too often the question of euthanasia is raised in dichotomical terms as being that which opposes the principle of individual freedom to life in collective, the Christian world to secularism, life to death. Euthanasia is not that. He does not participate in this manicure. The debate on euthanasia presupposes another questioning on the human dimension, invites to look at the finitude of the human being, interpels our becoming as beings and subjects of law in contemporary society, with all that it involves in terms of scientific, social and economic progress.

Dr. Marianne Desmedt, speaking in the Justice Committee, said: “We are evolving in a world that, by continuously seeking to push the limits of the possible, has managed to postpone the deadline of death and strengthen the human fantasy of immortality. Moreover, by privileging materialism and productivism, it has generated a system of values where the physical well-being and the economic utility of the individual occupy the first places. Death and dying have been driven out of our environment. “The

There is no more room in our Western societies for economically weak people, for those who do not reach a certain degree of profitability, for the sick and the dying. Those are immersed in solitude, abandoned, abandoned without hope of accessing once again to any kind of well-being. In this context, what is this individual freedom that some claim with loud cries? What can this right to die represent, which is nothing more than the expression of the despair of being abandoned, relegated to the rank of used and unusable object, definitively deprived of any profitability and therefore of any interest? How many of us can still claim to be real subjects of law, free to act freely and without external constraints when confronted with the question of the end of life? Peter’s ultimate victory is that of being able to exercise a freedom conditioned by imperatives over which the individual has no control. Is this the model of society we want? Is this the message we want to transmit to our children? If this is the freedom that some offer, it would be time to re-examine the copy. I am also surprised that, in the ranks of the majority, some can so easily adhere to such a project of society that consecrates the social fracture and ultimately benefits only an elite of society, the one who has the necessary financial and intellectual means to access knowledge, knowledge and, inevitably, the power and freedom that these latter provide.

Our group refuses to join such a company project. We refuse to sign up for a project that does not incorporate any notion of solidarity.

Our demands are part of the new political project of which our society is in great need and which my party has strived to define in the Charter of Democratic Humanism. We want to build with all those who want to find an alternative to contemporary individualism and materialism a new political path: democratic humanism that transcends the right-wing split and meets the expectations of the society of the twenty-first century.

At the heart of our political goal is the happiness and prosperity of man, of all men, I insist. Human progress must become the alpha and omega of all political action and must highlight a demanding and valuing conception of man, considered in all its dimensions of identity and spirituality and in its social dimension. The humanism we want to defend in politics is not one that can decide to sacrifice a few individuals for the benefit of the collective. Nor is he the one who believes that man can define himself independently of the relations he has with other men.

The humanism we want to defend is that which considers that man exists first and foremost in his relationship to the other and that this relationship gives him his meaning and dignity.

The humanism that we defend opposes a contemporary individualism that excludes and isolates. A human and solidary society presupposes that the social link is placed at the heart of our social project, that meaning and labels are given to persons, that a true role of responsible actor is entrusted to each, that the market and science are regarded as means in the service of men and not as a purpose, that everyone is given, through appropriate education and training and through unreserved access to information, the possibility of access to this role of responsible actor. We will adhere to legislation on euthanasia only if we have the inner conviction that it meets all of these conditions. Let’s understand, our party has never been opposed to the adoption of legislation on the end of life. I say clearly that we have never been opposed to a regulation of euthanasia. But we have always demanded that very strict conditions come to specify the exceptional cases justifying that a doctor is called to practice an act of euthanasia. That is why we had submitted amendments to the Justice Committee and put a number of amendments back in the plenary. It is also for this reason that we are again submitting to your vote various amendments that replicate the five minimum conditions without which we will not agree to vote on the bill under consideration.

These five conditions are as follows: 1. The act of euthanasia may be practiced only in exceptional circumstances justified by the state of necessity. 2nd The act of euthanasia may be practiced only in the terminal phase of a serious and incurable condition. 3 of 3. Palliative care is a mandatory priority. 4 of 4. The act of euthanasia cannot be practiced on a minor, even emancipated. 5 of 5. Only a doctor can perform the act of euthanasia.

The fundamental social bond that welds our societies and enables them to survive through time is and remains the prohibition to kill.

Dr. Marie-Christine Païen, who unfortunately was unable to be heard by the committee – which I deeply regret – writes in her book that she is always struck to see how much those (patients, relatives or caring personnel) who request euthanasia admit to experience difficulties in the idea of making this act themselves, signals that this is a gesture that goes against our deepest way of thinking.

In a committee, Dr. Païen could indeed have held other statements than those.

Mr. Mayeur, I only refer to the book written by Dr. Marie-Christine Païen of which I just read you a passage.

I am referring to practice.

Mr. Mayeur, if you ask for the word, I will give it to you and your words will be included in the parliamentary documents for eternity.

The prohibition of killing is one of the three founding principles of our society along with that of incest and anthropophagy. This founding principle is not affirmed with sufficient force in the definition of euthanasia given to us by the bill. Euthanasia is defined as an act committed by a third party that deliberately ends a person’s life. I say “who intentionally puts an end” to a person’s life. This definition is, in our view, far from satisfactory due to its imprecise nature. It is our responsibility as legislators to convey a clear, unambiguous message to civil society. by

This message is that according to which the act of euthanasia is an ethical transgression that may, if necessary, justify such transgression. The debate in the committee has shown that this is the will of the legislator. This will is in accordance with the standards of international law which are imposed upon us, as the European Court of Human Rights has recalled recently in its recent ruling in the Pretty case, on 29 April 2002. by

I would really like the Government to give us its opinion on this Strasbourg decision.

The European Court of Justice grants priority, among the provisions of the Convention which it considers primordial, to Article 2 which protects the right to life without which the enjoyment of any of the other rights and freedoms by the Convention would be illusory. by

In all of the cases it has had to know, the Court has emphasized the obligation of the State to protect life. It considers that Article 2 cannot be interpreted as conferring a diametrically opposite right, namely a right to die, and that it cannot create a right to self-determination in the sense that it would give every individual the right to choose death rather than life.

Therefore, the Court considers that it is not possible to deduce from Article 2 of the Convention a right to die, either by the hand of a third party or with the assistance of a public authority. by

These principles must be transmitted unambiguously in the legislative arrangement we will adopt. by

First, the act of euthanasia can be practiced only in exceptional circumstances, justified by the state of necessity.

Far from us is the idea of pretending that there is no situation that escapes the prescribed prohibition of killing. Nevertheless, as it is a principle which underlies the very existence of our societies, it can only be derogated from it in a quite exceptional manner. To merely say that the provisions of the Criminal Code remain applicable to a doctor who would transgress the conditions of exemption provided by the law is not sufficient, nor is it a tautology to include in the definition of the act of euthanasia that only the state of necessity can justify that it is deviated from the principle.

It is the responsibility of the legislator to indicate very precisely in the very definition he gives of the act of euthanasia that this act remains the transgression of a legal and ethical prohibition which can only be justified by special and exceptional circumstances.

We cannot take responsibility for the introduction of legislation which, due to an inappropriate message, would banalize the act of euthanasia and open the door to all possible and imaginable deviations. by

It is not enough to say that the provisions of the Criminal Code in this matter are not repealed and remain applicable. Professor Neste has not failed to recall that a law dealing with an existential theme such as euthanasia must contain clear and binding norms rather than pious vows. by

As I have already pointed out, in our increasingly utilitarian society in which economic logic prevails, the becoming of simple or vulnerable people is threatened. At a time when we all defend the concept of man subject to law, can we only say which of us is still subject to law? In our consumer society, man and woman have become themselves consumer objects and the deviations denounced in the use of health care are right there to demonstrate this. In the name of economic profitability, many medical acts are made without these acts being really necessary to improve the patient’s health status. by

Certainly, we cannot lose sight of the fact that it is, among other things, the developments in medicine and biomedical technologies that lead us to debate today the demand for euthanasia. by

Thanks to these technologies, life expectancy is increased. We have been equipped with state-of-the-art medicine whose results are unexpected, and the medical-technical and pharmacological industries are stepping up the advances of medical sciences to the point that could resurrect our old dream of immortality. by

But in this struggle against disease and physical degradation, the sick tries in vain to understand a little bit of what happens to him and places all his hope in the zeal and genius of the doctors. Even in the best of cases, the sick can only suffer this effervescence without being able to play an active role in it, on the one hand because he is incompetent in the matter and he hears nothing of the complexity of these gestures and, on the other hand, because his emotional involvement prevents him from evaluating the situation objectively.

At this stage already, the patient is no longer a subject of law and a responsible actor but becomes in some way an object of science and an object of consumption in the hands of the medical power that holds the knowledge. by

What happens if the funds fail to meet health care needs? It would be to cover up and deny the obvious that believing that the deviations and risks of improper use of an euthanasia legislation do not exist or could not occur. by

In our consumer society, when an object has become useless or does not provide the services that are expected of it, when its profitability is reduced, that object is destroyed or replaced, when it does not destroy itself.

It is this derivative of being made object that we must try to avoid – I say rightly “that we must try to avoid” – and that is why the transgression of the prohibition of killing must remain in the domain of the exception, a fundamental principle.

Secondly, the act of euthanasia may be practiced only when the person is in the terminal phase of a serious and incurable condition and reports of a constant, incurable and unbearable physical and psychological suffering, which cannot be relieved by any other means and which results from a serious and incurable accidental or pathological condition.

We have always tried to limit the exemption given to the doctor to the act performed during the terminal phase of life. We were rejected by the impossibility of defining the notion of terminal phase. by

In the general discussion in committee, Mr. Mayeur, you affirmed to us that the terminal phase was almost impossible to define. Per ⁇ the auditions that followed almost shaken you in this peremptory assertion? No to? Because you were not very attentive.

Mr. Arens, not only did I participate in all the work of the Public Health Committee – which you did not do – but in addition, I participated in the work of the Justice Committee, of which I am not usually a member. I followed all the works and listened long. I have not heard you, you, or any of your CD&V colleagues—and I’m not talking about the others—clearly define what was the terminal stage and the non-terminal stage. I asked the people who came to explain it to us to determine it and they did not. I asked the doctors who practice in an institute – I think of Mrs. Païen of the Jules Bordet institute – and who are facing patients with incurable diseases, what was for them the terminal and non-terminal phase. They answered me that it was impossible for them to clearly define these concepts on the medical level. They specified that if lawyers could do so, they were applicants. by

No one has done it and I’m waiting for your definition. It should be clear and immediately applicable by doctors. You do not bring it. Maybe there will be a miracle this afternoon in the plenary session? I am willing to hear anything, provided that it is realistic. If you have a specific proposal on the subject, it will be examined. I am afraid that this miracle will not happen.

Mr. Speaker, I thank Mr. Mayeur for staying on his position, which will allow me to share with you the definition given by the scientists of the terminal phase.

The legislator is daily confronted with the difficulty of defining concepts he intends to erect into legal norms. However, this does not prevent him from continuing his work. Today, I say that it is not impossible to define the notion of terminal phase. It is enough to have the political will. But you may prove the opposite, Mr. Mayeur.

Mr. Arens, I’m waiting for a definition, that’s all.

Mr. Mayeur, if you expect a miracle from me, believe that I expect it from you too.

To be clear, I clarify that I am not in favor of the distinction you want to make, precisely because I think that it does not meet the will of the patient — I will explain it soon — and that in addition, you do not know how to make the distinction you claim to want to impose.

Mr. Mayeur, do not change your mind now. We propose a definition of the terminal phase of the disease. It was developed by prominent practitioners of the art of healing. It is the result of a long experience and the daily confrontation of these practitioners with end-of-life situations. It implements scientific principles confronting a concrete reality. This definition cannot therefore be suspected to be either too theoretical or deprived of any scientific character.

For these practitioners, the terminal phase is the phase that begins when the doctor, after consulting with the patient and the caring team, considers that not only the incurable condition but also the set of complications that the patient suffers - infectious, metabolic, cardiovascular and other complications - should no longer be the subject of etiological therapy and that only symptomatic care, focusing only on the patient's comfort, should be continued. by

This, dear colleague Mayeur, is the definition given by scientists, not by politicians. I hope, Mr. Speaker, that it is being distributed to all members.

( ... ...

Mr. Mayeur, you will read it carefully and you will intervene on this subject later.

The names of these scientists will be communicated to you later since we have nothing to hide, dear colleague. I will ask you to tell me about yours.

I have already cited them.

An additional guarantee shall be acquired against possible errors and deviations if the person concerned is provided with all the moral and medical, curative and palliative assistance necessary to alleviate his moral and physical suffering and preserve his or her dignity. by

Who among us can claim today to know death and the journey that will be his toward a life end that we all wish sweet and without suffering. The human being, if he is the only living being to have consciousness of his death, cannot imagine it on the unconscious level. by

The suffering that we all wish to be able to remove at the end of life, as in the rest of life, is not only physical suffering, but it is also psychic moral suffering. It is that of the anxiety of death, of disarray, of separation, of the rupture of the social bond. It is also the suffering and anguish of the relatives in the face of this separation. Finally, it is also the suffering and anxiety of the care staff and the doctor, facing the failure of his science. It is also the difficult confrontation with the death of the patient.

Providing each one a sweet death means allowing each one to approach his end of life in maximum comfort, outside of that anxiety that annihilates the will and alienates the individual, by regaining the positive image of his person, in his relationship with relatives and the persons who accompany towards the end of life. by

It also allows everyone to take the time they need to finish their life. The current society, that of fast food and that of “ready-to-throw” is not inclined to give us time, either to be born or to grow. So talking about giving people time to die may seem incongruous.

The request for euthanasia is also, first and foremost, a request for help to imagine this passage from life to death, to accomplish this passage. The approach of palliative care is then primary as an accompaniment to the end of life and must be conceived as a mandatory priority. This approach will also ensure that the person decides in full freedom of consciousness how he wishes to end his life. I say rightly that the person decides in full freedom of conscience how he decides to end his life, for if some of you are supporters of the free choice of the individual, know it, we are also the fervent defenders of it. The greatest advocate of this free choice is, unfortunately, not present at the moment. We are fervent advocates of this free choice, provided that it is really a free choice, consented in full knowledge of the cause and in all freedom, provided that we are guaranteed that this choice is exercised without any contingency, without pressure of any order, without economic or psychological constraints, provided that the intellectual or financial means are given to each to exercise this choice, provided that this choice is the choice of a being subject to law and not of a being object of consumption, provided that the exercise of this free will is not reserved to an elite of society that has the financial and intellectual means to access knowledge, knowledge and inevitably the power and freedom that these latter provide.

Let us not forget, as Dr. Marianne Desmedt recalled, that a sick man or woman, weakened physically, psychologically and socially, decides, in all freedom of conscience, how he wishes to end his life, even if only because existing for a human being depends on the presence of the other, from the origin to the end of life! To survive, the baby needs a presence that speaks to him and names him. This look of the other on himself will be, until the end of life, the foundation of our humanity. The human being builds on its relationship to others, first to the mother, then to both parents and grandparents. In adolescence, it is through peers that he seeks his identity. Without this look of the other on himself, the request for euthanasia is not possible. by

But it is also the other’s gaze on himself or the absence of that gaze that can, in a perverse way, give rise to the request for euthanasia. Thus it has been highlighted, by a study by Bruce Jones, published in the Journal of medical ethics, that the desire not to be resuscitated of a number of elderly, seriously ill patients, is closely linked to their social isolation. I insist on this point. by

Emile Durkheim, in his study on suicide, also highlighted the fact that, deprived of attachment to a group, the subject can only help to self-destruction. To this extent, it is obvious that no one can make the decision to refer urgently and immediately to a request for euthanasia without questioning its meaning. by

The approach of palliative care is also the guarantor of the integrity of the caring staff. The palliative care is here, Mrs. Minister. And I would like that in your replica, you explain more about your policy on palliative care, that you let us know the budgets you intend to devote to it, because know well that in the coming weeks, we will question you on this point. Ms. Marie-Christine Païen writes: “Legifying euthanasia can be dangerous for patients, but ⁇ also for doctors. What are the psychological challenges of such control over life? How can the human being who is the caregiver ensure such morally heavy acts? What arrangements will he have to find with himself and with others if he is brought to repeatedly transgress a universal taboo? Even if this act is authorized by a law, it will remain, at the symbolic level of order, a radical and impossible transgression without major psychological repercussions, whether one wishes it or not. What role does society risk to play to the doctor who is charged by the patient to carry death? Touching the life and death of other human beings is equivalent to touching archaic mechanisms and sometimes triggers violent emotions and transitions to action.”

The European Court of Human Rights has stated that it considers that States have the right to control, through the application of criminal law in general, activities harmful to the life and safety of others. It indicates that many people suffering from a terminal disease are vulnerable and that it is the vulnerability of the category they form that provides the ratio legis of legislative intervention. by

Fourth, it is in this same ratio legis that we draw the principle that the act of euthanasia cannot be practiced on a minor. The problem of euthanasia applied to minors deserves special attention and specific protective provisions. No one can argue that minors are a category of people ⁇ exposed in our modern society. Ensuring their protection in the case of euthanasia is an extremely delicate issue that requires thorough reflection.

For these reasons, we cannot accept that the craft of legal fiction, which is that of emancipation, is used to justify access to euthanasia for minors.

The President, Mr. Arens knew very well that I would interrupt him at this level of his exhibition. In fact, he knows very well, first, that minors have been voluntarily excluded, despite the dramatic situations experienced by some minors, not to mention those around them. We consider that the complexity of being able to bring together all the decision-making elements was such that, in the context of the current debate, the legislator could not intervene. Second, I said in committee that I was not very happy with the exception made for the emancipated minor. For emancipation has an entirely different scope, which corresponds rather to the materialist plane, since it eventually allows it to make certain acts. It is then a minor of at least fifteen years old, for which the judge intervened to grant him the emancipation, considering that this minor, in the social context, was able to make decisions. It was under these conditions that we considered that this minor could be considered for an act of euthanasia.

I told you – and I don’t hide it – that I’m not very happy with this approach but it was a choice to make, since – you just stressed it yourself – indeed, with regard to minors, there was a problem. We did not want to resolve it because of the difficulties. This may be done at a later stage. We will see the evolution of society on this point.

We are all approached by concrete cases where, not only those around the minors but the minors themselves have gone petitioners. Therefore, the concession we made by including the emancipated minors is indeed a step, ⁇ not very happy, I admit. In any case, we considered that in this case, it was someone whose ability to express a will had been judged by a judge.

Mr. Speaker, this is a good example, although this may not be a very important part. This is something that everyone in the committee agreed on, namely that the emancipation of minors and this here have nothing to do with each other. Abduction of minors, for example, allows them to conduct trade. We know that, we look at it and we refuse to accept amendments on this point. This is not a serious parliamentary work. One must explain to me why one refuses to accept an amendment even on such points, which do not even touch the core of the matter, on which everyone agrees that the two things have to do with each other. That can only be because of a bulldozer policy.

(...) absolute maintenance of the paragraph on the abducted minors because it is indeed a very arbitrary criterion. This deliberately introduces a discrimination between the abducted minors and the non-abducted minors so that one can go to the Arbitration Court and on that basis soon have a break iron to break the law open, also with regard to minors. That is the intention. It is for this reason that this artificial figure is introduced here. They want to break the law soon through the court to open to the minors. That is why they wanted to maintain this mordicus.

Mr. Speaker, I would only like to respond to the statements of Mr. Laeremans, who constantly surprises me with the crystal ball he has. He can read in the minds of those who write the texts. I just said what the purpose and scope of the text was. It is comparable in genes to the situation of non-abduced minors. If Mr. Laeremans would follow the case-law of the Arbitration Court, he would ⁇ find that there are sufficient objective elements to incorporate a different approach to the non-abduction and the abduction of minors into the law.

Thank you, I will continue with the Chairman of the Justice Committee on this issue. by

You know, Mr. President Erdman, I consider you to be a great ruler of law in Belgium and I repeat this constantly. In the amendment to the final phase... Yes, I am addressing you, since at times you all agreed to say that this was a parliamentary debate rather than a debate between the government and the parliament, but I would also like to have the opinion of Mrs. the minister that we are lucky to have among us, because I really believe that these are very important elements. by

While preparing the exhibition, I told myself with the collaborators who worked there that by integrating this notion of terminal phase, many problems would be solved, I guarantee you. That is why I really do not understand that in a debate of such importance, you have made it just a political debate. For a great lawyer of your size, it’s really low, Mr. President, excuse me for being so hard.

Mr. Speaker, I would like to support the position of Mr. Arens. I think the value of the initiative he has taken is that he has submitted an amendment defining the terminal phase.

During the discussion in the Justice Committee, we were confronted with the argument of the majority that this cannot be defined. On the basis of expert advice, Mr. Arens has managed to draw up a definition of what the terminal phase is. In this way, we can counteract the majority argument that this cannot be defined. Colleagues, we should at least succeed in limiting the possibility of euthanasia to the terminal phase because in this way it becomes objectivable and we step away from the purely subjective element that is currently being handled.

I would like to invite the colleagues of the majority to take note of the amendment of colleague Arens that defines the terminal phase. In this way, we can at least check whether the majority can agree to a limitation to the terminal phase as defined. In my opinion, this is very important and in this way the legislation becomes somewhat acceptable in the international context.

Mr. Speaker, when I submitted my first bill to the Senate years ago, I shared the opinion of Mr. Arens. I was convinced in the discussion. I will repeat the arguments later.

I just want to ask Mr. Arens a question. You believe that an individual who suffers heavily and whose situation is irreversible has the right to leave this life with the assistance of a doctor. How can you legally distinguish between an individual whose doctor says he suffers terminally and another individual whose doctor says he is not sure about the terminal nature? On what do you base this discrimination?

I have taken the definition. I don't have the text in front of my eyes, I don't have the privilege of mr. Van Parys but when I take your definition and try to understand it, it seems to me that we are closer to the definition of agony than to a terminal phase. It is necessary to know what is said, when we accumulate all this and that doctors find after consultations that the condition is incurable and that you list a bunch of pathologies that further complicate the condition of the patient, we are in agony. by

Second, there is an aspect that you omit anything at all, because the problem of definition is a problem that arises in itself, but beyond that, there is something that naturally lacks in your project: it is the personal will of the patient, you completely abstain from it. The patient, what he is, the man, is where the difference is between us and we think — and without elitism because there is a form of elitism to believe that those who have no means and the poor are not able to make a judgment on their own state; it is then to really take the poor for fools — that your approach is frankly not very resounding. by

Then each individual, and that is the difference between you and us, has the right to dispose of his body, his life, and the way he wants to face pain and suffering. That, you do not want it, you do not ask him for his opinion, you omit his opinion and you give his opinion to a court that is the doctor and his colleagues in consultations. This is what we fundamentally reject.

Mr. Speaker, I would like to step into the words of Mr. Coveliers, who, in my opinion, uses a strange reasoning. He says that we are trying to impose a certain restriction and make a better description of who may be eligible for euthanasia. In this way, we want to determine whether a person has arrived in a state so that that person can be helped to end his life without anyone being prosecuted for it. He applies this to the definition of Mr. Arens that intends to reduce the group and to limit euthanasia to terminal patients. He also says that this is a subjective criterion that can be difficult to objectivize. All that is stated in the law is subjective. All procedures to be undergone, all criteria and all medical reviews are subjective.

The [...]

That are reviews of doctors who at some point say that this is unbearable suffering, we cannot help that patient in any other way.

There is even a statement: according to the state of science. This is a moment recording. What we know today may not be done in ten years. So that is subjective use of something in an emergency with which one should be able to help people. Moreover, you should actually endorse Mr. Arens’s statement. I do not understand your reasoning.

I remind you that these interventions are interesting, take the ground of the debate, but they can also lighten the presentations later, so to speak.

Of course, Mr President. I agree with the previous speaker. I also find the reasoning of Mr. Coveliers strange. He says that one cannot distinguish and asks on the basis of which criterion one will distinguish between terminal and non-terminal. However, he does so himself in his draft law in paragraph 3: "If the doctor is of the opinion that the patient apparently will not die within an anticipated time, he must also ...". You divide them into two categories: those whose doctor is of the opinion that they will die within the foreseeable time, and the others. This is also a subjective criterion, also there should be divided as in the case of terminal and non-terminal patients. I even think that one is quite strongly matched with the other.

You are given the word for a short replica, Mr. Coveliers. You will have the word soon.

Mr. Speaker, I will do my best to explain it later in a shorter manner than the previous speaker.

Therefore, I now also accept the debate.

The difference lies precisely in that I assume the right of self-determination of the patient. I cannot accept that from the very beginning, from the beginning of the procedure, a number of people are excluded from which they are claimed to be suffering, that they are incurable, that there is nothing to change about it, but that it is not terminal according to the applicable standards. Therefore, they would not be eligible from the beginning. That is the difference in vision.

I would like to emphasize the importance of this definition of the terminal phase. “The terminal phase is the one that begins at the moment when the doctor, after having consulted with the patient and the caring team...”

I start asking myself another question from everything I have just heard. In fact, I wonder what is the goal of the majority by making this law passed by parliament. From the beginning, Mr. President Erdman, I thought this was to alleviate the suffering of people in certain situations. Today, I wonder whether we are not in a situation where you see much wider. At that time, it would be even more serious. I realize that mental suffering is sufficient for... (Interruptions) We have amendments that we will discuss when they are presented. by

I find that the more I move forward, the more I listen to you, the more I realize that very dangerous derivatives are possible from the text that is presented to us. This text, as it is presented to us, we have not voted in committee and we will never vote here in plenary. However, we are prepared to re-discuss with you if you agree to take into account some of our amendments, especially the final phase amendment.

As I said, colleague Mayeur, it is after consultation with the patient and the caring team that the doctor proposes. We say that the doctor could not but should no longer do so to leave the choice to the patient until the end. I am confident, Mr. Speaker, that we will discuss this soon, on the occasion of the presentation of this amendment.

Finally, I will end by outlining the problems we face with this bill. Debates conducted both in the Senate and in the Chamber Justice Committee showed that there was a unanimous willingness to reserve the responsibility to doctors alone to commit an act of such gravity as the act of euthanasia. This principle should therefore be incorporated into the very definition of the act of euthanasia. This is what we propose in our first amendment. by

The proposed text leaves us unsatisfied on other points that we did not fail to emphasize both in the Senate and during the debates in the Justice Committee through the various amendments we had submitted. Nevertheless, in today’s debate, we wanted to focus only on the essential points. We will continue to defend them in plenary session in the coming days. by

The act of euthanasia may be practiced only in exceptional circumstances justified by the state of necessity. What if the message we communicate to civil society is that of the banalization of euthanasia that will open the doors to all deviations and endanger the rights of the most disadvantaged and our weakest fellow citizens? Is this the emergence of this kind of society that we advocate?

The act of euthanasia may only be practiced in the terminal phase of a serious and incurable condition. Any other hypothesis dangerously leads us to a society focused exclusively on profitability, utilitarism, to give weapons to those who would want, in the name of economic or other imperatives, to suppress all solidarity. Is this what we want?

The provision of palliative care should be a mandatory priority. You have a great responsibility in this area. You have made some efforts to expand palliative care but the needs remain immense and it is at this level that you must act.

How could we deny our fellow citizens the right to accomplish the transition from life to death in maximum comfort, and this to all our fellow citizens regardless of their economic and social condition?

The act of euthanasia may not be practiced on a minor without providing for specific protections. Should we already give a first sign of abandonment from the weakest? Do we no longer have the capacity to trust the evolution of our medicine? Only a doctor can perform the act of euthanasia. What right would we charge a non-medical third party to perform an act of such importance? These are the demands of our party, which will not call for any concessions on our part.

We propose to extend the tasks of the Federal Control and Evaluation Commission to ensure that it has a truly effective role in the supervision of law enforcement and, above all, in the supervision of its future evaluation.

To ensure the consistency of our approach, we provide that the enforcement of the proposed law is subject to the adoption of legislation on patient rights and palliative care.

We want a strong and precise legislation that guarantees the right of everyone to live their end of life in human dignity, without coercion and in full consciousness of the choice made, a law that prevents, to the fullest extent possible, possible deviations that no one wants. It is only under this condition that we could re-examine our position regarding the bill under consideration.

Mr. Speaker, Mrs. Minister, colleagues, the problem of the end of life has been concerned with man since the beginning of mankind. The bioethical problems associated with this are, in fact, refinements by which the last century or even the last decades sought to make the life of man from the beginning to the end as happy as possible. In a democracy where the equality of all and the equality of contribution to government are accepted as ethical norms, this happiness must be fulfilled by the people themselves. It is therefore not surprising that the problem of euthanasia, which in South African is called the death of grace, was first addressed in 1984. During the previous reign, a ⁇ interesting colloquium was held in the Senate, where the members of the Bioethics Advisory Committee explained their opinions. Very interesting things were told, even though some did not necessarily agree. Professors from different universities and with different life views brought forward a highly differentiated view on the problem of euthanasia.

It is therefore surprising that that lively discussion, which was initiated in the Senate, has led to other insights. For example, I had initially drafted a proposal with my current party chairman, Mr. De Gucht, which was limited to the terminal phase and in which there was no mention of the non-terminal phase. I will try to explain why our ideas have evolved and why we as liberals want to create a general framework within which some of us, who want to emphasize certain elements of the meaning in a different or additional way, will vote differently. They will explain their voting behavior, although they are based on the same basic principle of the right of self-determination of each individual. It has been an honor for the VLD group from the beginning that each member could freely express his opinion on this draft. We have discussed this subject long and extensively. In fact, it is evident that on ethical issues, which arise in a particular form of society, different rules apply than on ordinary political themes. It is therefore surprising that in the opposition no one takes another position than the total rejection of this text. I do not understand that.

I have heard several times the accusation that there was no debate. This is a walk with reality.

It was debated in the Senate for two years. In the committee we have to get bored, often until late in the evening, to hear the same arguments. It’s not true that we don’t listen, but listening is the same as agreeing with you. It is not. I assume that some arguments can be formulated, but it is not true that there has been no debate.

Mr. Speaker, I do not understand exactly what Mr. Coveliers means when he says that the opposition “en bloc” rejects whole proposals and rejects any discussion. That is a terrible distortion of reality which may be explained by some rhetorical exaggeration, but such rhetorical exaggerations do not belong to this debate that should be conducted in all serenity. Mr. Coveliers, you know this is just wrong. There is a total blockade when it comes to the amendments submitted by the opposition. I will return to my example concerning emancipation. Everyone agrees that it has nothing to do with it, but it can’t because it shouldn’t. Who then blocks “and block,” the opposition or the majority? (Applause of Applause)

Mr. Peters, I would like to give you this expression of support from the colleagues.

I only try to make it clear that during the discussion and voting in the committee, the opposition took a completely rejecting stance. I was surprised that no one could separate himself individually — as in our party — from all the details of those ideas and thus accept the same position globally. In addition, this text has been discussed endlessly, especially in the Senate, and there was finally a solution. There was also a debate in the House. We have said which statement we would defend and we will defend it anyway, in order to reach a solution.

Mr. Speaker, I am also surprised that Mr. Coveliers does not know that in the Committee on Public Health, Environment and Social Renewal we had actually found a consensus on the special difficulties and came close to a global agreement. You can read this in the report. I therefore do not understand exactly why Mr. Coveliers wipes this out of the card and here now comes to claim that only the opposition would have blocked everything.

Mr. Coveliers asks why the opposition relates to the majority as a single block. This is due to the design that is extremely extreme. It is the most liberal law in the world. Therefore, it is not abnormal for the opposition to protest against it. He said there was an extensive debate. The only one who has thoroughly and frequently responded to the questions and comments of the opposition is the committee chairman, Mr. Erdman. On the day he was unable to chair the committee and Mrs. Herzet replaced him, the whole majority did not give a kick. There were no answers to the dozens of relevant questions from the opposition that afternoon. We stood in front of a wall. We did not want any debate. That was the attitude of the majority parties and you have contributed to it.

Mr. Speaker, the Chairman also submitted a summary of all the submitted amendments, including a comparison with those submitted to the Senate. It is totally unacceptable that you abuse the two-chamber system to re-submit these amendments to the House. The debate was basically right. Today you are proving that you want to extend this debate as long as possible.

Well, if you think that the quality of a debate is proportional to its length, then that is your democratic right and I will not protest it, even if I have a different opinion. From the outset, we have tried to prevent a constructive debate. by

The reason for this is that we actually leave a different view. First of all, we assume that law is not the same as morality; we believe that society has a number of legal rules that, when it comes to criminal aspects, contain prohibitions that include what one should not do. Everything that cannot be done should be done in a democratic rule of law. Morally, there can be other norms, and there can be other norms. In a dictatorial state it is different: there one says what one should do and there one can only do what the law requires one to do. In a police state, it is the police services that determine which standards are applied.

We assume that in a democracy it must be determined what is not allowed in criminal law. That is, for the moral aspect, one can only prohibit a number of things that have a rejectionable or harmful or negative value for all. That means that when one uses the right to self-determination as a basic value, as a human right, that the constraints attached to it can only be justified either by respecting the right to self-determination of others and that applies both between individuals and between peoples and nations, or that it may possibly be limited by the very clearly accepted negative moral connotation that would exist.

As for the ethical good, I refer to the works of Vanneste, in which this theme is brilliantly portrayed. He also wrote a book about the ethics of criminal law. According to Vanneste, of course, the ethically good is only determined by the other and the ethically bad is also determined by the other. However, this cannot simply be included in a law. I will now try to explain why we come to that option—although you may not agree with it—and why I have explained the evolution from non-terminal to terminal patients. We assume that no one should be imposed any additional obligations in this regard. In other words, from birth to death — ⁇ we will have to discuss Mr. Bacquelaine’s bill on run-for-life action following the French judgment — we want to guarantee the individual citizen within the general framework of the community a life as happy as possible. We want him or her to complete it. If he or she wishes to give it a religious meaning, that is his or her right, as long as that religious meaning applies only to the man or woman and is not imposed on others. by

That is why we believe that when the circumstances of life and its quality are so poor, when death is chosen over such a way of life, every individual is entitled to it, provided, of course, that the necessary guarantees are built up to make it so waterproof. A system can always be abused. Any system can be abused, especially high-ranking groups are for example theft. We want to ensure that everyone has this right. That leads me to the late Leo Apostle’s definition of euthanasia, even before it was discussed in Parliament. His definition of euthanasia was “to deprive someone on his personal request” — which also has to do with minority — “of life in the least painful way and with the intention of freeing him from diseases greater than death itself”.

This is, in my opinion, a brilliant definition of why one should allow — not compel — that one can get euthanasia in the way it is proposed. I am somewhat surprised that one is opposed to creating a possibility for a third. No one in the community is obliged. We go even further. We respect not only those who do not want euthanasia for themselves – which is their right – but also those who do not want to work with it. In the law, we expressly say that such a person should not cooperate with it, not even to the slightest extent. So I ask the question. This is also the question I have just asked Mr. Arens, who unfortunately is not present here now. I’m talking about someone who has ended up in a certain poor quality of life and says he doesn’t want this life anymore. He asks the society, which has some technical capabilities to do so, for help — I quote the Apostle — to be "liberated in the least painful way from these ills that are greater to me than death". Where does one get the right to tell that person that such a thing might be possible if one says he is terminal? If one says that he will die from that illness, there is a possibility, but he will not be helped if that is not said in the beginning. I am trying to figure out where that right could come from.

Mr. Speaker, in our law, however, we are constantly moving to measures to protect people from themselves because we have a certain perception of the value of life and of each human being in itself. Why do we otherwise compel people to wear seat belts? Certain products, such as hard drugs, should not be placed on the market because the users are destroying themselves. If I follow your logic, is it not a free choice of a free man? Why would then the law interfere in prohibiting people from destroying themselves or from causing all kinds of evil to themselves? If necessary, exclude them from social security, then it costs the community nothing. Nevertheless, we are constantly intervening because we find that man is not an individual in itself, but in relation to his community. That community finds the person so valuable that it cannot afford that person to destroy himself. Is that reasoning contrary to what you are going to tell?

I would like to answer this question, Mr. Peterson. If a person, by not wearing the car belt, intends to mutilate himself, one can ask the question of the extent to which that obligation can indeed be imposed. This is not the intention of the legislator. Anyone who steps into a car takes a risk by participating in traffic. This person does not want to commit suicide. He wants to move with that car. In order to ensure that he can move safely with the car, we are working out a number of measures. I refer to wearing the belt, placing airbags in the car, the traffic code, speed limits, and so on. That is the reason.

The user of antioxidants does not intend to become addicted. He does not intend to bring a physical deficiency to himself. He wants a rooster. Precisely because of the effects of that rust, of that use, the legislator acts and prohibits it. The legislator also knows that a number of people try to profit from the needs of that man or woman by trafficking in narcotic drugs. That is the reason.

I will formulate a counter-argument. If your words are correct, why is suicide not included in the Criminal Code? Assistance in suicide is not included in the Criminal Code.

This is, in my opinion, an indication of your argument. It is not about someone who occasionally gets injured or dies, but about someone who at a given moment consciously declares: this is incurable and irreversible. Doctors from our group can explain this better. When that person is in such a situation, it is not someone who accidentally desires death, but someone who clearly desires it at that moment. That is the difference with the example you cite.

Where is the responsibility of the community, and where is the correction made to that right of self-determination in this text? Precisely in the incurable situation and in the series of formalities that are brought forward, for otherwise one would not insert all that. They do it precisely because they say: we, who have given a meaning to life, we cannot understand that you do not perceive that meaning. Therefore, we set a number of conditions and say that it must be "persistent", that it must be requested two or three times, that two or three doctors will be assisted, that there must be a trust person, that the possibility must be outlined two or three times to the same person, saying that the affected person can indeed still remain alive, that he can get painkillers and that through palliative care life can be continued for a much shorter period. This is the responsibility that the community takes on. Thus the ultimate right of the individual does not disappear; it persists. If the individual with full knowledge of matters says that he does not want it, then that desire must be respected.

At least, it is evident from your explanation that you, like the others with a different view, actually do not fully rely on that right of self-determination. You say that people can make a statement, but that we will all check again if they really meant it.

What distinguishes us is that one wants to go further than the other. That is respectable, but it must also be clear on both sides of this Chamber: it is precisely there that our ways separate. In fact, it is about how it is determined that what a person explains is really what he wants. That is about it.

Thereafter, it was - inappropriate - shamper uppered that, when someone expresses the desire for euthanasia, that is actually just a cry for help. It would be just as inappropriate as if I were to shame over what you say now. After all, the two statements are actually much closer together than one wishes to assume. Only I think another accent is being placed, which is as valuable as what you defend. It is important to point out this, as it also shows that what is said is not necessarily what one means. This is also recognized in your theory.

Mr. Speaker, I would like to step into the reasoning of Mr. Coveliers, on the basis of the right of self-determination.

What can be brought against the argument put forward, among other things, by the Federation of Palliative Care, namely that, in order to evaluate exactly what the patient actually wants, it is imposed that there is a preliminary palliative consultation due to the doctor to whom the request is addressed, with the intention of verifying whether the patient wants life termination or slaughters an emergency cry, a request for help, a request for assistance, a question for pain control. What can be the objection to the fact that, in order to be sure of the will of the patient, a preliminary palliative consultation takes place? I think the specialists in palliative care rightly ask the question of excluding all these risks. After all, they know that 99% of questions about euthanasia are actually questions about help and help.

Can we not come to an agreement from the reasoning that we provide in the prior, mandatory palliative consultation by the treating physician? I would also like to ask the question to the Minister of Health who can undoubtedly provide enriching insights on this issue.

The Chairman of the Committee on Public Health, Ms. Avontroodt, was pleased to have the word.

I would like to make a distinction with regard to what Mr Van Parys says. The main reason for the palliative filter — I do not stand under chairs or benches that I am also in favor of the introduction of the palliative filter — is not to assess the declaration of will or to assess the patient’s request, but involves the quality of care, starting from the patient’s right to the best care at the end of life. It is not about whether or not to assess the patient’s request. For this, palliative doctors are very clearly not a requesting party. I think that the vision of the palliative physicians should be very clearly expressed in the debate: they are not asking party to have any contribution or want to make any distinction in the patient’s request.

Mr. Speaker, colleagues, ⁇ the word “judging” is poorly chosen and it would be better to talk about “getting a better understanding of what the patient wants”. Many colleagues know of cases in family and friends that show that thanks to palliative care one comes to a meaningful and humane end of life. Why should we not incorporate in regulation the opportunity to guarantee a dignified end of life for all in this way? I would not understand why this would not be accepted.

Yesterday in De Standaard we were able to read the article of Professor Distelmans and other colleagues on palliative care. Honestly — you know my point of view on this matter — I think that in this country you can no longer find a doctor who does not know what palliative care is.

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Sorry, you know that most doctors follow up training. Almost all training courses have already talked about palliative care and pain treatment. I think that every general doctor who is faced with a patient with this problem also discusses this with that patient, otherwise he will fail. If the general doctor does not feel for it, you will not be able to go further with that palliative filter that you want to add in the legislative text. We have seen that with the pain clinics and we see that with the palliative care. Remember that the colleagues who are active in this sector are not averse to a little publicity for their own store. Sorry for the expression.

Mr. President, colleagues and colleagues, Mr. Valkeniers, I am deeply surprised by your intervention. Those who have closely followed the hearings in the Senate and the few in the Chamber will have remembered that one of the great suspicions of the people who are active in the palliative sector is that insufficient attention is paid to the training of doctors, paramedics and doctors on the palliative element. One of the classic questions of the people who are active in this sector is precisely to pay more attention to palliative care in the training, so that one as a doctor with knowledge of affairs no longer has to put people before a false choice. Every doctor should be introduced to palliative care. That is the real discussion. Now that doctors say that every doctor has sufficient knowledge, it is to walk with the truth.

We will hear from Mr. Germeaux, who is also a doctor.

Mr. Speaker, I just wanted to comment on what Mr. Van Parys said. I wanted to ask him whether he gives a terminal or non-terminal patient the right to eventually refuse palliative care. Mr. Van Parys, it is my personal experience that palliative care does not always have the beneficial effect you suggest. Do you consider that one should also be able to refuse palliative care?

First, I would like to comment on what Mr. Valkeniers said. In the course of the discussion, we became aware of the position of the Federation of Palliative Care, which, by the way, can be found in various publications. Colleague Valkeniers, I read what the Federation says about this: “Even if the palliative expertise of the average physician would greatly improve, he or she will never be a specialist in palliative care. The average general practitioner, for example, accompanies a palliative patient a maximum of several times a year: much too little to build a solid expertise. When a doctor is confronted with something so delicate, so intrusive and so irreversible as euthanasia, it is and remains appropriate that he consults a specialist, what doctors do daily for health problems that are often much less serious. The text was signed by Dr. Distelmans of the Federation of Palliative Care. Their

As a response to colleague Germeaux, I would like to say the following. I would like to answer his question with another question: where can one deny a person in a crisis situation the right to address, for example, through palliative care, the problem he is facing — the suffering, the pain and the lack of framework? This is precisely the purpose of the amendment, which we have, by the way, submitted in line with the statement of the Federation of Palliative Care. When a patient says that he no longer sees it sitting and can no longer cope with it, some assume that this is a question of life termination. In fact, the patient says, “Help me. I can no longer move forward.” Why should one reject an amendment which in such a situation offers that palliative care and which at that moment introduces the expertise on it? In the many cases that we all know, we help the patient in this way, not by ending a life, but by providing him or her assistance, either through pain control or through guidance. I think this is a much more positive starting point than the starting point that can now be found at least implicitly in the draft law.

This is a debate as I like it. I give the floor first to Mr. Erdman and then to Mr. Coveliers.

Mr. Speaker, I do not want to anticipate my speech, because I would later bored you by falling into repetition.

Mr. Van Parys, I just want to ask you the following question. Can you tell me in the current text where it says that the patient is denied the right to information or possible contacts?

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Ladies and gentlemen, I would like to give the word back to Mr Coveliers. Mr. Van Parys and Mr. Valkeniers, I allow much, but you will also hold your speech later. Let Mr. Coveliers conclude his discussion.

Mr Van Parys, you will still have the opportunity to interrupt Mr Valkeniers. As any member of our group who wishes to do so, he will speak himself, with five speakers from our group speaking, including three doctors and one economist.

Mr. Laeremans, it is essential to our thinking that we believe that everyone should be able to express their opinion on this. We accept — note this — that people with the same social view put different emphasis on that problem. With this we have no problem, on the contrary. I have already been surprised that this seems to surprise some.

Mr. Speaker, in Article 3, §2, 1°, of the text, it is literally stated that the doctor must, among other things, "inform the patient about his state of health and his life expectancy, consult with the patient about his request for euthanasia and the therapeutic possibilities he may still have...". To that, through an amendment in the Senate, after a long discussion with, among others, Mr. Distelmans — I even think that he proposed that amendment — the following rule was added: "... as well as those of palliative care, and discuss their consequences.”

Mr. Van Parys, why is that last rule added to it? Well, we just assume that every individual has the right to wish for euthanasia or not, as colleague Germeaux says. The doctor should explain to the patient that it exists. The doctor should discuss the remaining therapeutic options, as well as those of palliative care, and clearly explain to the patient. However, the right remains with the patient. Indeed, we differ in opinion on this. You believe that these possibilities and palliative care should be imposed on the patient. We do not like it: everyone must be free in it, must be given and have the possibility. Therefore, it is necessary to ensure that this palliative care exists, both intra muros and extra muros and ⁇ the most out there, but the doctor must give the patient the possibility. This is our view of self-determination. Some people deviate from this opinion. That is their good right. Those who have the same opinion could now, by chance, form this majority. We defend that too. I have no problem in defending that. I will not go into all the details again.

Mr Coveliers, Mr Van Parys wishes to interrupt you briefly. I suggest that you try to finish afterwards.

I would like to speak forward, as my predecessors have continued quietly. I do not let myself be chased.

Mr. Speaker, I will speak briefly, but we must conduct the debate correctly. The text approved in the Senate was not approved as a result of an amendment that removed the approval of Professor Distelmans. Mr Distelmans has submitted an amendment to this. A compulsory prior palliative consultation is required by the doctor receiving the request for life termination. Mr Distelmans therefore speaks of a mandatory prior palliative consultation. We have all received this amendment. That amendment is in no way consistent with the text transmitted by the Senate.

Mr. Van Parys, when the matter was discussed in the Senate, there were repeated consultations with a number of groups, including Professor Distelmans. Professor Distelmans then agreed with this text.

Mr. Coveliers, that is formally wrong.

Everyone who has experienced these discussions knows that this was so.

Here is the text of the amendment that appeared on Monday in The Standard.

Mr Van Parys, let me speak! CD&V has been speaking here for three hours. Now it is my turn.

Mr. Van Parys, I deny anyone the right to submit another amendment. I say that the discussion in the Senate on this text has taken place and that Mr Distelmans has been consulted on this subject. He knew this and he did not comment on it. The element of palliative care came into the text only later. At first it was not in it. Initially, there were two texts, one about euthanasia and one about palliative care. Since a number of people found that palliative care should also be mentioned in the basic text, this has been inserted into the article. That is the historical course of affairs. Fortunately, there are enough witnesses who have experienced this discussion.

I think we should at least conduct the discussion honestly.

I think that conducting an honest discussion also has something to do with the way one does it, with time, and so on. That has not happened. For me there is no problem in this regard. Everyone can, within the limits of this law, do what they want. No one has to do this. That is the difference. I do not impose anything on anyone with this law. I only ask you to be tolerant and give this opportunity to others. That is all. I only ask for tolerance towards those who think differently.

(Applause) Mr. Speaker, I have already repeated why, in my opinion, there is no distinction between a terminal patient and a non-terminal patient. This had initially to do with the difficulty of determining what the concept meant. That has evolved in the course of the discussion to the question I would subsequently formulate: why should one have the right of someone to make a certain decision depended on the whether or not limited period in which he will possibly have to endure his pain? That is the essential question. Why should one who suffers unbearable pain, whose illness is irreversible and for whom medicine no longer sees possibilities, to whom all therapeutic possibilities have been explained, to whom what palliative care means has been explained, but who, despite that everything still wants to leave this life, refuse to do so merely because one cannot determine at what time one will die? That is an appreciation that belongs to no one, only to the individual himself and not to third parties.

I have read that Professor Nys has said and written very strange and careful things about this matter. He said the discussion is not over. In a previous issue discussed in the Chamber and already forgotten, in particular the abortion, it was said that there would be other issues on the ethical level than these, which might be much more difficult. We must repeat this. Indeed, there are still many problems. Just look at the work of the colleagues in the Senate where they talk about the problem of the whole bioethics, including cloning. Sooner or later there will have to be a serious discussion about this. The question must be asked in how much this fits into the right of self-determination and does not contradict the general, fundamental interest of the individual members of the community and of the community itself. I am confident that this discussion will continue for a long time.

Among other things, in the text of Vanneste and Adams, one has, in my opinion, rightly noted that not all medical actions at the end of life are regulated. That is correct. It is precisely this matter that, in my opinion, required regulation at this time. Other subjects, which fall partly under the doctrine of medical obligations and presently cause little problems, we should indeed not regulate. We only need to regulate this problem in order to get out of that apparent state. Colleague Valkeniers will later prove to you that there is a state of appearance. This legislation is necessary to get out of this situation.

I know that there is a pain point across the boundary between aid in suicide and euthanasia. Assistance in suicide is not included in the Criminal Code. If possible, the articles of the Criminal Code on assistance to persons in need may be used for convenience. There may also be a discussion about this.

I return to the question of the sanction, which Ms. Schauvliege mentioned in her long speech. In a number of newspaper articles — insofar as they are a reference — it was stated that someone who commits a small mistake is subject to the same punishment as someone who deliberately goes to killing. This option was followed. There were two possibilities. Euthanasia could first be included in the Criminal Code and then introduced a justice basis, stating that euthanasia is justified if one fulfils the conditions of due diligence set out here. That was a possibility.

This law is the other possibility. Euthanasia is excluded from criminal law. This law only says that this intervention, this therapy is tolerated in all these circumstances. I opt for this positive option. I fully support it. This, of course, does not mean that anyone who cooperates with it and fills a wrong sheet is punishable for murder. There will never be murder, for it requires the element of premeditated counsel. It is precisely for this reason that the control committee must judge with a two-thirds majority, to examine the second section of the evaluation form and, if necessary, refer to the prosecutor. This does not mean that the prosecutor cannot prosecute. The public prosecutor can always prosecute if it considers that criminal offences have been committed. The public prosecutor will then have to explain to the court why a prosecution is being prosecuted, despite the fact that the law has been followed. Since the law was followed, the court will then normally acquire. Therefore, there is no need for a very precise description of sanctions. There is no need to say that someone who does not fill out one form receives a certain penalty and someone who does not fill out two forms receives a certain penalty. That is precisely the advantage of keeping this matter out of criminal law.

I also wonder to what extent the problem of palliative care and this problem should not be included in the legislation on the rights of patients. This may be discussed later.

There is the recent judgment of the limited chamber of the European Court of Justice in Strasbourg. It has already been mentioned. The Chamber consisted of seven judges. There were four parties in this case, because there were two intermediaries, namely the League for Free Euthanasia and the Catholic Bishops Conference. Normally, such cases can be requested within three months before the Grand Chamber, a chamber consisting of 17 magistrates. Many times, I think, there has been a change in the position.

However, I advocate that this matter and the content of the judgment be taken into account, although it does not directly relate to this case. It is about the question of the spouse of someone who was in a terminal phase — which has now been proven — to the extent to which the spouse was allowed to use assistance in suicide, taking into account the fact that this is criminal in Great Britain. This is not criminal in our country. The comparison is only partially done. However, it is important to clarify, among other things, the different ways in which our Court of Cassation interpreted Article 2. I repeat that I hope that soon there will be a much more comprehensive sentence that could be carried by the whole "grand chamber". We must take this into account. In particular, it was a question of the extent to which the right to death exists. The Court has clearly stated that this is not present. This is about the right to a quality life and the possibility to obtain the right to euthanasia in the circumstances as we include them in this text.

The members of our group will not all cast the same vote. I have already said this to you and we have also discussed this in our group meetings. The majority of our group is of the opinion that the right of self-determination leads to the possibility of euthanasia as recorded in this text. Some colleagues think there are comments to be made about this text. These comments urge them to abstain in the vote. I repeat that this is their right. Both those who feel they should support this text and those who feel they should abstain will speak during this debate and explain why they come to this decision, based on the same principles.

I would like to say that this problem is already very old. Seneca, the ancient philosopher, wrote: “If old age ever removes my mind, if it does not really let me live anymore, but only exist, then I will hurry to leave this destroyed and destroying home.” You see, about the end of life and the way it has been discussed through the centuries. I hope that we will now contribute to making this end of life happier for many citizens.

02 Communication du président 02 Communication of the President

Dear colleagues, Mr. Jean-Jacques Viseur has submitted, in accordance with Article 57 of the Rules of Procedure, a proposal for a resolution raising a conflict of interest in matters of competence distribution in order to declare mandatory collective labour agreements (CCTs) concluded in matters of regional or Community competence.

He was appointed to the Commission for the Revision of the Constitution and the Reform of the Institutions.

Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker. The House does not inherit a virgin file today. Proposals for euthanasia laws have existed in these assemblies for many years. In any case, since 1984, a series of proposals have succeeded on the same subject. I will not list them here.

Some have, however, stated that this problem was considered in the precipitation by the majority. We have often wanted to make this debate a majority/opposition topic. It is nothing in my view. Even within my group, the votes on this subject will be different.

This ethical question about the end of life has demanded for many years an open debate and a thorough reflection. It must be said that this debate was somehow confiscated by successive governments for a number of years. In their various government statements, they considered that the debate could not be initiated by parliament but was a government affair. This government, on the contrary, has considered since 1999 that our parliament, our House and the Senate, could initiate the debate on the matter. We are pleased that our legislative assemblies have been allowed to deepen the debate on this issue. The necessity of this debate does not, in my opinion, proceed from any fixation by some parliamentarians. I would like to remind you that it comes from a real interest in the public. Several surveys have been conducted on this subject, including a survey published in March 2001 in "La Libre Belgique" showing that three-quarters of respondents were in favor of legislation on the subject. I also recall that another survey conducted in the medical body showed a significantly identical proportion.

Having thus given our legislative assemblies the freedom to debate these issues, the Senate did not miss the opportunity offered to organize within it an in-depth debate, on the basis of texts, some of which had been deposited five years earlier.

Some argue that the debate was conducted too quickly and that the reflection was superficial. I would like to recall the significant number of committee meetings in the Senate on the subject: 88 committee meetings, 250 working hours, 687 amendments submitted and examined in the Senate. It was even said at some point that it would have been better to make a list of people not to audition rather than those to audition because it would have been shorter. There were 44 hearings in the Senate on the issue. Therefore, it cannot be denied that the debate was conducted in depth and enabled a constructive exchange of views between experts — but I put this word between guillemets when it comes to the problem of euthanasia — and parliamentarians.

These hearings allowed to address the problem of euthanasia from various angles.

Mr. Speaker, I do not want to contradict Mr. Bacquelaine when he communicates the statistical data on the number of hours, amendments, days and hearings. I would like to point out to him that we from the opposition have tried to conduct the debate in an open way. Mr. Bacquelaine, in your first speech in the House Justice Committee, we were confronted with the statement that no amendment should be expected to be approved. You are therefore a little difficult to put here to say that there has been an open and honest debate. There has been a long and extensive debate, but in any case you have made clear that no amendments would be adopted. This has ⁇ surprised us at someone who is known to be extremely tolerant and who belongs to a group that is open to discussion. We still regret this and I would like to say this to you. You give the impression of being open to all elements.

Mr. Speaker, for my part, I don’t think I ever said that it was impossible to consider any amendment. I said that our group would not submit an amendment on the subject. We have not submitted an amendment on the subject. Albert Claude, a former Nobel Prize winner in medicine, once said: “If you want to prevent a case from succeeding, demand that it be perfect.” This phrase could be applied to all files and all subjects. When one demands that a file be perfect, as perfection obviously does not exist, one prevents any advancement in the matter concerned.

I would like to remind you that the hearings that we have been able to get acquainted with have addressed the whole problem from various angles. Some were often in a philosophical approach, others questioned about much more technical elements. Arens spoke about it recently, in particular about the concept of terminal phase and possible trials of a definition of this concept. I think this notion, for most doctors, is difficult to understand: a few days, a few weeks, a few months, a few years... How can you be sure, from a medical point of view, that you are not mistaken in defining the terminal phase? I will return to this during my presentation. These hearings had the merit of existing and each of us was able to get to know them by reading the voluminous report that was transmitted to us by the Senate. I believe that this work was interesting, fruitful, necessary, that it was undoubtedly a source of research, analysis and reflection. These hearings should be considered, for our own work, as a positive and acquired fact. It was not appropriate to repeat this exercise within the Justice Committee of the House of Representatives. I repeat, therefore, that the files that were submitted to us were not virgin and that the work had already been largely started in our Senate Assembly, which is, you know, a Chamber of Reflection.

The present bill effectively reflects a desire to establish a missing fundamental freedom. It is indeed a freedom we are talking about today and it is the will to conquer a new freedom that is in fact at the center of the reflection at the base of the debate on euthanasia. This freedom concerns that which consists in choosing the ways of one’s own death.

At present, in the social debates we know, it must be admitted that the need to defend freedoms and rights in a whole series of subjects is repeatedly invoked. A whole series of rights are constantly claimed. It is up to us, it is true, as legislators, to make sure that we take a position on this permanent demand for rights and freedoms. These rights and freedoms sometimes concern, it must be said, strictly material aspects or sometimes even take, in relation to their object, a disproportionate scale. We work on this because our role is precisely to legislate to give citizens the opportunity to enjoy the maximum of freedoms and rights, being of course that these rights and freedoms do not impair the freedom of others. The claim for new rights is indeed incessant in all the components of our society, and sometimes, even if certain duties are not associated with them, these rights express themselves at the expense of others and of a certain part of society. Parliamentarians like us do not cease to question or question the government about the respect for the rights of individuals on the individual, social, environmental and in all matters. We want everyone to have more rights.

Nevertheless, it must be said, it is at the time when these rights and freedoms concern the most intimate, the most private spheres of the life of individuals, it is at the time when these rights and freedoms concern the most personal behaviors, where they have the least impact, I would say, on public order and on the rights of others, it is at that time that often appear the greatest reluctance and the greatest frilosity. It is, in my opinion, a paradox that probably translates a variable or even contradictory appreciation of the role of law and its relations with morality and ethics.

Our Civil Code, I recall, is based on those notions of freedom and responsibility that should guide us in our actions. Our Civil Code indicates the correlation between free will and the implementation of our responsibility in relation to the exercise of our freedom.

And every act whatsoever of man — it is article 1382 — which causes harm to another obliges the one, by whose fault it happened, to repair it.

In fact, the bill that is presented to us today proposes to add a fundamental freedom. It is important because it relates to life and death. This bill therefore has the merit of integrating a new freedom into our social heritage. This freedom is that which concerns the possibility of deciding for each of us, that at a certain moment, he judges in conscience that he no longer wants to live in the conditions of life that are his own. It is, therefore, a freedom which concerns the person itself more than all others and which does not induce any direct or indirect effect on the rights and freedoms of others, and therefore does not cause any harm to others. This project therefore concerns the individual in what he has most important to him, that is, his life and the way he wishes to end it at a certain moment if he judges that life is no longer tolerable.

This bill fills a lack of freedom. It adds an essential fundamental freedom. It is for this reason that the project is part of a commitment that is liberal according to my perception of the relationship between the individual and society as well as the role of law in a liberal society of freedom and tolerance.

As I said in the Justice Committee, even though this may have hit some, in the field of ethics, the possibility or necessity of consensus constitutes a recurring question. Can there be a consensus on the issue of euthanasia? Can euthanasia, in a pluralist society, be the subject of a homogeneous assessment? Or can we all consider the freedom to choose to die in the same way? Honestly, I do not think so! There is no consensus in this matter that is possible, nor even necessary or desirable. It is healthy, on the contrary, that in a society of freedom and tolerance, everyone may judge differently and personally of the exercise of his free will, of his right to choose or to decide.

Everyone’s position on euthanasia is closely linked to the very conception that everyone has of their own life. by

In this regard, we can identify two fundamentally different conceptions, conceptions of the degree of autonomy that can be agreed upon in relation to society or to a higher moral authority.

Some will consider that life belongs in itself to the person. They believe that they can freely choose not to prolong their existence in case of incurable illness generating suffering or distress that they alone can judge as unbearable.

Others, on the contrary, consider that they do not have their own life, that the supporters of this conception believe that the autonomy of the person collides with one or more transcendents. This is, in my view, an eminently respectable position. It may be a supernatural transcendence as in most religions: the free will of the individual must be erased before a higher will. It can also be a social transcendence perceived in certain political doctrines where the social body or the collective may restrict the freedom of the individual even if its exercise does not induce any harm to others. These two transcendents proceed in some way from an acceptance of an argument of authority. On these two concepts, there is no consensus possible. We are defending this or that concept. by

There is no third way in this regard.

After the forty hearings organized by the Senate Justice and Social Affairs committees, after the debates that took place in the Senate plenary session and after the discussions that were conducted in our Justice and Public Health committees, the gap remains. This is not surprising in so far as we are discussing a question that falls within the conception that each has of his own life and the degree of autonomy that he grants himself in relation to society or in relation to a creative principle.

The time has therefore come, dear colleagues, to decide, to decide, not by considering that one of the two conceptions is superior to the other because it is obviously not about that. For my part, it is necessary to allow everyone to follow their own conception and to remain faithful to it.

During committee debates, some claimed that the concept of free will was addressed to an elite of society. This was ⁇ today by Mr. by Arens. I want to oppose this position. Only those who would have financial or intellectual means would have access to knowledge, to knowledge, inevitably to the power or to the freedom that this latter proves; this statement, in my opinion, is quite peremptory and frigid what I would call an entirely primary elitism. In this position, only the elites of our society would be endowed with free will. I cannot agree with this position. Free will is available to anyone who wants to exercise it. This conception relies more on a dirigist, determinist positivism worthy of the nineteenth century than on an analysis adapted to our time. by

While the law prohibits all forms of euthanasia, it obviously does not limit the freedom of those who, by conviction, do not consider recourse to it. I repeat it. If we keep a law that prohibits all forms of euthanasia, it does not limit the freedom of those who do not want to hear about it; on the other hand, it prevents the exercise of the free will of those who, in all immanence, believe to be able to dispose of their own life.

Mr. Speaker, I wonder if Mr. Bacquelaine is really aware of what he is doing. He talks about arbitrary matters, about who will decide what, about how we can agree with people who hold everything or who would not even be willing to develop any legal arrangement for euthanasia.

This is not correct, Mr. Bacquelaine. From the beginning we have said that we are not blind to the problems. We know those problems. We know that there are people who do not have the opportunity to die worthy. We know that there are people who are in the greatest need at the end of their lives. We support that these people can be helped. They must be helped. These are emergencies that transcend any human dignity. All resources must be used for this.

To equate this with the agreement to go with an arrangement so that one can step out of life on his own request is another thing. It is of another dimension. You would much better be honest and say that you are leaving the point of view of self-determination. I can understand you in that. That is your position. However, our position is different. We start from the emergency state in which a patient is. Someone is in need and help needs to be provided. This is quite different from self-determination. That is our breaking line, Mr. Bacquelaine. You may repeat the opposite here until tomorrow morning, but that is the breaking line we will never cross because you are not willing to take a step back and somewhat relieve the right of self-determination, in the context for which it should serve, for that is the only thing that counts.

The text you are talking about does not relate to my presentation. I was not talking about that at all.

I simply say that the current law, a law that prohibits all forms of euthanasia, is a law that does not actually impede the freedom of those who share your conception but that impedes the freedom of those who believe they can have their free will in relation to their own lives. I say that, on the contrary, a law that allows euthanasia under certain conditions does not in any way impede the freedom of those who oppose it. It does not in any way hinder this freedom and it allows those who are opposed to euthanasia to remain opposed to it and never resort to it for their own lives. On the other hand, it offers freedom to those who desire it to be able to resort to euthanasia under certain circumstances. by

I think there is a law that can translate the possibility of remaining faithful to one’s own conviction, to one’s own conception. On the other hand, there are also laws that prevent one or another part of society from being faithful to its convictions or from practicing its own conception of things. That is the whole difference.

And I think there can be a consensus on the role of the law on this subject. by

What is the role of the law in relation to the freedom of individuals? Does the law have to translate a particular philosophical conception, hindering in this the freedom of a certain number of people? Or should the law translate the possibility for each to remain faithful to his own conviction? This is where the debate and consensus must be made on the role of law in relation to society, in relation to morality and ethics, and not in relation to conceptions that would be the same for everyone. This society where the designs would be the same for everyone would be completely anesthetized and anesthetized, and that is not what I want. I think I have expressed it clearly: I consider that the conception of each is eminently respectable but that, if one wants to seek consensus on the role of the law, it is necessary that the law translates the only method that allows each to remain faithful to his own convictions in matters of life and death.

By creating the right to request euthanasia, there is no obstacle to any freedom and I would also like to talk about that of the doctor to whom the request for euthanasia will be addressed. You will never be forced to practice it, which is of course fundamental. He will also retain his total freedom in relation to his own convictions. The conditions provided in the text are the minimum conditions that the doctor must respect and nothing obviously prevents him, in his singular colloquium with the patient, to add one or the other conviction that he would consider indispensable based on his own opinion.

Therefore, it is about the role of the law that we can reach consensus. A good law is, for me, the one that defines the framework within which the individual can effectively express his own conviction, his own conception of life, but obviously without forcing anyone.

I would now like to address the notion of suffering and thus the notion of terminal phase and non-terminal phase. The problem of euthanasia inevitably leads us to question the notion of suffering and the meaning to be attributed to it. What is suffering? And most importantly, what is its meaning? Does suffering have a meaning as such? In other words, is it useful and necessary for the individual or ⁇ for society? In my opinion, it can be perceived differently depending on each other’s philosophical convictions. For my part, as a doctor, I would say that suffering is first and foremost a signal, a warning. This signal, this warning has a meaning. It informs the person himself and his doctor that something is wrong, that there is a problem. Suffering therefore has a meaning insofar as it is useful in the diagnosis. The evolution of this suffering is useful to measure the effectiveness of treatments and therapies.

In most cases, fortunately, the treatment will help eliminate suffering or, in any case, make sure that the patient considers it acceptable. This is obviously the primary mission of medicine and our health care system.

Unfortunately, in other cases, suffering is stronger than our human possibilities and will persist despite treatment. Sometimes there is no solution, no cure, and from that moment on, in my view, suffering loses all its meaning. When suffering loses its usefulness, it obviously no longer has much meaning.

Some will consider that suffering nevertheless retains a meaning and retains in itself a meaning, that suffering is inevitably part of the human condition. Sometimes I hear these words. This conception is ⁇ respectable, but it cannot be imposed on people who do not share this view of things. We cannot impose suffering. When it no longer objectively has meaning or utility, whether it is irreversible or invincible, the person must be able to put an end to it even if, in order to do so, he must cease to live, since living is then synonymous with suffering.

This view of things — and I use this argument intentionally — prompts me not to distinguish patients in the terminal phase from those in the non-terminal phase. Indeed, if we introduce this distinction, we again give meaning to suffering according to its duration. I think it is perverse to consider that a short-term suffering — that of the patient in the terminal phase — could be abbreviated, while a longer-term suffering should be prolonged. If suffering no longer makes sense for a short period of time, in my view it has much less for a long period of time. by

I think this debate is essential. If one should question the justification of this distinction between the terminal phase and the non-terminal phase, one must first do so in relation to the meaning of suffering. If one admits that a short suffering can be put to an end during a terminal phase, one must admit that one can also do so, by compassion or by love, during a long suffering, if the patient so desires and so asks.

I return to my first consideration. In terms of suffering, there is no consensus possible. There can be no consensus on the meaning or meaning given to suffering. In this regard, everyone has their own view of things. Some consider suffering to be a transcendental necessity, or even an act of heroism, or even simply a human condition to be accepted. This opinion is obviously respectable and, in my view, it is appropriate to translate into law the conception that offers the most freedom, without however restricting the freedom of those who think otherwise.

Mr. Goutry, interruptions are not meant to cut a discourse into pieces.

Mr. Speaker, for all clarity, also last time I have clearly replicated what Mr. Bacquelaine said. I would like to take a moment into what Mr. Bacquelaine is constantly saying about suffrance. He gives all sorts of explanations, but I find it perfidious that he does not name names. He speaks of those who even find it heroic, who consider suffering transcendental and acceptable, and who even find it necessary to sublime it. Then you have to say who you mean. This is where I do not want to get out. If all the debates are silent, if the conversation in the Chamber is over, there will only be one thing left: who voted for and who voted against. Then the next step will be taken very quickly: who is for is who wants to redeem people from their suffering; who is against is who sublimates suffering and finds suffering above all. If you mean that, it would be very unfortunate. I fear this. I do not want polarization about this, because that is the worst thing we can do to each other after we have not listened to each other and have not changed the jota or komma of the texts. If we are able to blame each other now, we have completely corrupted it. I do not want to participate in games. One says who said what, but one does not divide in the supporters as the great benefactors and the opponents as the evils that sublimate suffering. That would be very wrong.

Mr. Speaker, I would like to respond briefly. I think the question is right, but the fear is wrong. Those who vote against this text are people who do not want euthanasia to be applied in this way. That has nothing to do with whether you would be for suffering or find suffering heroic in some way. By the way, when treating a number of texts on, among other things, palliative care, this will also be evident. For me, your vote against means that you say you do not want others to be given this possibility. That has nothing to do with your view of suffering, I think.

When I make the distinction between the different conceptions that one can have of free will and the sense of suffering, I think of course that these conceptions are respectable. They are unique to each person and everyone has the right to have them. But the law must allow each to live according to his own conceptions. I believe that one can vote this law, even if one is against euthanasia and one is convinced that this path is not desirable. I do not make a distinction between those who vote for the law and those who vote against it. In my opinion, one can vote for this law if one considers that euthanasia is a path to be offered to the sick, even if one considers that one should not practice it for himself. There is no contradiction in this matter. There can be consensus on the role of the law, regardless of each person’s position.

This debate on euthanasia, like those relating to drugs or cloning, raises the question of the role of law in relation to morality and ethics. Several people, of different philosophical conceptions, consider that it is useless, or even harmful, to legislate on euthanasia since prosecutions are rarely initiated against doctors who make acts of euthanasia. This is true but I share the opinion of a professor at ULB who believes that it makes no sense to maintain a criminal law if there is never a prosecution. This is a hypocrisy of democracy and it decredits the law. We must pay attention to the ambiguity of the messages delivered to citizens. The law makes such behavior or such act an offence or a crime, but it does not matter since the law is rarely applied! It is the reign of the arbitrary and the judicial power gradually replaces the legislator. It is necessary to avoid this unwanted development. It is up to the legislator to take responsibility. He must take a position and the judiciary must apply the law. by

If a majority comes out in our parliament to consider that the act of euthanasia is a criminal act, we will have to proceed. On the other hand, if a majority sets out to consider that the act of euthanasia can be carried out in compliance with certain extremely precise conditions and which, I recall, have been debated in depth, the judge will have to apply the law and condemn the doctor who has not complied with the strict conditions inscribed in the law. There is, of course, legal certainty for doctors and citizens.

The proposed law does not pretend to provide all the answers to all the questions. In fact, it concerns only patients who are able, aware at the time of their request, to intervene according to the situation or as part of a testament of life or early declaration. For them, it will allow to avoid any therapeutic hardness or, on the contrary, any controlled sedation, which would not have been requested. For others, for unconscious patients, who would not have expressed a particular will, nothing changes. The notion of state of necessity will continue to apply, but it will be the exception rather than the automatic rule. It shall apply to circumstances which are not settled, when compliance with the prohibition would result in an objectively unacceptable damage and when the extension of life would constitute a greater harm for the person than death itself.

While the proposed law does not allow us to understand all the complex aspects of the problem of euthanasia, it avoids, it seems to me, a number of scourges. First of all, it avoids what I call “tribunalization” or the socialization of death, this kind of appearance of the patient before a jury of interviewees, preferring to him the singular colloquium. She respects the patient’s privacy, guarantees her confidentiality. The patient remains free to discuss his decision with the people of his choice, to associate his relatives with his approach. The doctor confirms his own assessment of the request made to him, in the light of the opinion of a colleague and the caring team. The bill also avoids judicialization of the procedure by establishing a mechanism of a posteriori control that preserves the anonymity of the patient and the doctor, when the legal conditions have been met.

The third obstacle it avoids is the introduction of palliative care as a mandatory step. This seems to me important. Palliative care should be a patient’s right. It is in this spirit that palliative care is considered. It is a patient’s right, it is a new opportunity offered to the patient. Of course, this is not a tax. This should not constitute a mandatory step on the path to euthanasia. There can be no risk of palliative hardening. Palliative care is a right, not an obligation. by

I would like to extend very briefly on the ruling of the European Court of Human Rights rejecting the petition of a British citizen asking for assisted suicide and seen by some as a condemnation of the law that is proposed to us. In fact, the court has in no way condemned the legislation on euthanasia. The case presented was not a complaint against a law allowing euthanasia, but rather an inverse situation, namely the attitude of a country that prohibits assisted suicide. by

It is obviously impossible to deduce from the terms of the Convention a right to die which would entail for States the obligation to take positive measures, such as assisted suicide or euthanasia. The Court has in no way stated that the Convention prohibits States from taking such a measure. In fact, each State must be able, in consideration of its social, cultural and political situation, in consideration of the aspirations of its population, to take in this regard the attitudes it believes to reflect the dominant opinion of the public opinion.

Mr. Speaker, Mrs. Minister, dear colleagues, as I said at the beginning of my speech, the MPs of the MR Group will make a decision based on their own conscience and in respect of their own convictions. It is a tradition within liberal and reformist groups not to give voting orders in matters that intimately concern the lives of people. In this regard, each will therefore express himself in the way he thinks is the most sensible. by

The law proposed is probably not perfect. It may – and ⁇ – need to be evaluated, improved, modified, supplemented. No one can predict it today. And I will repeat what I said recently, citing the Nobel Prize in Medicine, Professor Albert Claude who said, “If you have decided to reject a project, demand that it be perfect.”

In my view, the law on euthanasia simply defines a new freedom, which is essential, fundamental. It proclaims that for every human being, the decision to endure suffering and put an end to it can depend only on his free will. In fact, it does not create an obligation either for the patient or for the doctor; it merely decriminalizes an act resulting from the encounter of two freedoms.

Mr. Speaker, this is a draft that has a technical, ethical and undisputed political character. You cannot be outside there. The politician is faced with the problems that lie on the table and he must assume his responsibility. I wish in this, which was my endeavour in the committee, not to open any polemics and to show respect for everyone’s approach. So I do not think that there is a gap in this assembly from the essence of the problem, but there are different approaches to the solutions offered. This approach may derive from our own philosophical beliefs or from certain political concepts in the face of the individual and society. However, we cannot say that there is a gap and that the factions would not be willing to seek a solution. It becomes difficult when a solution is delivered and one cannot find himself in the way the problem is delivered.

Mr. President, according to Mr. Erdman, there is therefore actually no gap and everyone is aware that there must be a solution. Legalization is not a good solution. We had a different starting point. Self-determination is not a good starting point for us. However, I do not understand why the speaker makes this statement, while he is well aware that from the beginning it was determined that the text could not be altered in any way. Therefore, the various views could no longer be challenged. Indeed, a fragile agreement had been reached between the parties of the majority and the text had to be dealt with ne varietur by this Chamber. Mr. Erdman, you can hardly say that there is no gap. The gap is of material nature. Despite the unanimous opinions of the Committee on Public Health, we have failed to find a consensus, to accept certain amendments from us so that the text could be improved. In this way, we could have crossed the gaps. We have made a call for that. However, this will be a debate of winners and losers. After all, you know very well that it is always suggested. That hurts because those who will be depicted as losers, if the parties who have undoubtedly rejected the arrangement, have also debated very nuanced. However, it will never be presented like this, and that is what you wanted. Otherwise the debate would not have been so polarized and text improvements would have been possible.

Mr. Speaker, an interruption is of course always welcome and I will subsequently refer to Mr. Goutry’s comment. Their

I note that this debate is a sociological debate – which has already been emphasized – in which the whole Parliament felt that solutions needed to be found. When the first proposals on end-of-life were launched, the then chairman of the Senate consulted the Bioethics Advisory Committee to examine the possibilities this pluralisticly composed committee would present. The committee proposed four possible solutions, of which we must forget the two most extreme. A first extreme solution was that nothing would be changed because nothing could be changed. The second extreme solution was that everything would be allowed. Their

However, there were also two possibilities that could be discussed within this pluralist committee. I remember, by the way, the initial reactions, both from the parties who were not inclined to act legislatively in an initial phase, as well as from the parties who were already drafting plans. Both sides acknowledged that there was a possibility for dialogue. I regret somewhat that this conversation did not continue at that time and that we entered into our pitfalls at that time. Together with colleague Roger Lallemand, I submitted a text in 1999, quite late. The solutions that were pushed forward during the 1996 colloquium were then out of the table because the elections were not far away. Their

During this period of government, the Senate provided us with a document. The first question that was addressed was whether there is a need for legislation. Some resort quite back to the state of emergency as the only legal principle that should be applied in some cases. The colleagues present know perfectly what the concept of emergency state means; the emergency state refers only to the person who commits the act, not to the “partners in the conversation”. The state of emergency is therefore in no way excluded for cases not covered by the conditions of the draft law. Rather, we have confirmed that the state of emergency will still be able to be invoked by those who may not have acted in accordance with the legislation.

In this regard, we wanted primarily to make an arrangement that would remedy a situation we know. Let us speak clearly to each other on the basis of, though to be discussed, numerical material.

We know that euthanasia is practiced in the field today, and in some cases probably in an occult manner, and, which is ⁇ disturbing to me – the figures from Gent and Leiden prove it – without the patient’s knowledge, involvement and knowledge.

The [...]

Do you see that again in your crystal ball? On that I will come back later. Apparently you become a specialist in that matter, although looking in crystal bulbs is associated with certain professions.

Mr. Erdman, of course, you are well placed to perfectly assess what the concept of emergency means. Their

The construction of the state of emergency formulated in our proposal is, of course, the starting point, the principle punishment of the crime of the termination of life, with the important objective that the Penal Code sets the norm, with the starting point "you will not kill", to emphasize the exceptional nature of this intervention and to enable and maintain the control of the prosecutor's office. The fundamental difference between your construction, the construction in the bill and our construction lies in the punishment. However, the intervention can be justified in certain circumstances because we also believe that a human-worthy existence until the end of life must be the starting point. It is only when extreme situations require intervention that we agree, but always within the basis of justice. It is justified to end life at some point when there is no other remedy, when all other means are exhausted.

Mr Van Parys, you confirm what I said earlier and to which Mr Goutry responded. Indeed, your approach implicitly does not require any change, except ⁇ the explicit inclusion of the concept of euthanasia in the criminal code, but I admit that we chose a different path.

We chose to incorporate the provisions of the Criminal Code into a separate law without prejudice — which I emphasize. Insofar as the conditions laid down in this Act are not met, the Criminal Code ⁇ ins its full force, even though in some cases there is a possibility for the perpetrator to declare a state of emergency. We opted for a formula that clearly states that no abuse is committed if the act is made in accordance with the conditions contained in the law. This is clearly a choice. Their

The paths we have taken differ from each other, and I assume that we agree on that. Later, I will return to your arguments regarding the impossibility of changing the texts.

I think there has been a global reflection in the Senate. The discussion was open and thorough. This has led to a political response to a social problem, respecting the autonomy of the person concerned or the patient. In the text, the recognition of everyone’s beliefs is undisputedly embedded, both in the head of the patient and in the head of the doctor. It is repeatedly forgotten that an initiative that comes from the patient is, of course, conditioned by his own beliefs. If, in the conversation with the doctor, it turns out that the doctor has a belief that makes him not want to euthanize the patient’s question in the spirit of his own approach, the process is, of course, immediately stopped and other ways will be approached. Their

I therefore believe that those who today invoke the point of view of the state of emergency again and again in favour of the arrangement included in this law, in this approach a different path that in no way corresponds to what we have sought in this matter.

Mevrouw de minister, mijnheer de minister, mijnheer de voorzitter, waarde collega's, wij moeten ons bewust zijn wat Victor Hugo wrote in "The Misérables": "Citizens, the nineteenth century is great, but the twentieth will be happy. We will no longer have to fear hunger, exploitation, prostitution for distress, misery for unemployment and death by strikes and battles and all the robbery of chance in the forest of events. You could almost say, ‘There will be no more events, we will be happy.’”

This is still not applicable today. Every day we are faced with human suffering to which we must be able to answer where science sees its limits. In these circumstances, the question arises what life is. What is a dignified life? What is life worth living? The quality of life is the essence of this debate. We must start from our approach that we want to effectively guarantee a dignified death for everyone. I emphasize the word “everyone” because some here have repeatedly sought to build a social stratification in it. Their

If we, as politicians, are addressed to our morality and our ethics to say that the current legislation does not provide an answer to this problem, then I can quote the following philosopher: "quand la loi et la morale ne coincident plus, c'est la loi qu'il faut changer."

That is what we try to do.

We strive effectively to construct a formula which, in one way or another, responds to the aspirations of so many, to the possibilities of so few. We have incorporated in this text a definition of what is called euthanasia for the application of this law. You voudrais when even answer to M. Arens qui, à un certain moment, a fait grand cas du fait que l'on n'avait pas inclus dans la définition de l'euthanasie, le médecin qui doit effectivement poser l'acte. This is, of course, a wrong legal approach. What do we say? In the text we begin by defining what euthanasia is. Implicitly we say, of course, that it is punishable since it is not given a freelance for it and that anyone who applies it can be prosecuted. But in the next article we say that the doctor does not commit a crime if... Consequently, it was completely aberrant to assert that one should already include that physician in the definition, since it is only the physician who is dismissed from a mere crime if he meets the conditions, without prejudice to the definition given.

I come to my second comment on the texts. I will not repeat what has already been said in so many words by the predecessors, but also in the hearings has always been brought forward and what in literature and in the press is somewhat confused. This is not an accusation. I remember one of the eminent invited speakers pointed out the fact that there is a grey zone in the different approaches to life end. This is so, because in the definitions of the various approaches one does not necessarily always have a clear delimitation of what is meant here.

It has been repeatedly sought to sow the confusion between the notions of aid to suicide and euthanasing intervention. The problem of self-determination has been repeatedly raised. In this regard, I may surprise some. I have even been told in the committee that I have not taken the word "right of self-determination" into my mouth, because this text does not give the right of self-determination. This text gives a right of initiative to the patient, gives him legally the possibility - and therefore a right - to approach a doctor and ask him whether he wants to act euthanasically, within the framework of the conditions listed by the law.

Colleagues, furthermore, this patient has no possibility of forcing the doctor, nor of forcing the actions. This should be clear because we will probably soon have to discuss the scope of the Pretty judgment.

I will return to that later. In this text, no right is granted to the patient, except the right to initiate the process as described, with a free choice to opt out of euthanasia after contacts and information about the possibilities by the doctor. There is no right of self-determination; there is a right of initiative to initiate the process as defined in the law, on which there may be any response.

Nor is there any obligation — and I think no one will allude to that — of any doctor to comply with the request. The only deontological duty that the doctor has, when he, because of his conviction, does not want to address any question, is to inform the patient. When the doctor comes to a negative conclusion during the procedure, as described, the process will be stopped.

Mr. Erdman, I fear that the engagement of the debate is still greater and that it is not as non-binding as you propose. You say that you have designed an instrument and that whoever is against it does not have to use it. Of course that sounds good. This also applies to drugs. You could say that there are drugs, but that you are not obliged to use them. This is a fundamental difference from what we are advocating. Ultimately, it comes down to the questions of what mentality we want in our society, what signals we send to the population, what boundaries we want to lift, and what is discussable and what is not discussable. You can, of course, argue that the people are large enough to decide for themselves how to think and act. The reality is that people everywhere, including in the countries around us, are looking for a hood, standards and rules. Take a look at the Pim Fortuyn incident in the Netherlands. They do not find it, if one makes up the mentality where each person chooses what is best suited to him or her. It is not so simple. It is not enough to say that you do not obligate anyone. Euthanasia cannot be placed on the floor to choose from; it is up to no one to choose whether he or she wants to live or not. That is my first objection.

My second objection is that you solve only a fraction of the problem. You also need to communicate honestly. After all, there could be the expectation that the debate is closed once and for all: the supporters now have an instrument and the opponents should not choose euthanasia. This is just as bad: nothing is resolved. One of the six end-of-life problems is solved, with the patient himself still in the possibility of requesting euthanasia. All other problems around the end of life remain untouched, while the doctors have it just so hard with it. Why would they otherwise oppose the proposed method?

Mr. Goutry, I will not introduce in my discussion a number material, which we both know, but if a single problem can be solved by this law in all openness and with medical guidance, then it has support for me. When you tell me that so many other problems are not solved, I tell you, along with the one quoted by colleague Bacquelaine, that not everything, ⁇ in ethical matters, can be described in the strict corpus of legal texts.

What I am especially concerned here is that, starting from a free and repeated expression of the will, after explanation, consultation and medical evaluation, a conclusion is drawn that offers a response to intolerable human suffering. That is the essence of the whole text. Do not expect that with this text all problems will be solved. As Professor Nys this week in the debate in Leuven, I have repeatedly said that the debate is not closed. It is, of course, not closed, because this is an element of the evolution of a society in its approach to the issue. I will soon read a text that dates back to much earlier, but that shows that already then ⁇ the germs were laid of what we are trying to arrange today very scourgeously.

I come to the discussion of terminal and non-terminal patients. I have said that I do not like these texts. I have put forward the terminology of the irreversible situation. The effort now made by colleague Arens does not convince me. Remember that this text, according to him, applies to terminal patients and that the first procedure, prescribed by law, is burdened. At the same time, the same definition ends with the possibility of opening up palliative concerns. It is about an aggravation of the procedure for those whose doctor judges that death will not come within the foreseeable time. This is an assessment that is carried out by the doctor. I have already repeatedly stated that, taking into account the application of new legislation and its evaluation, we have the certainty that not within a foreseeable time but within imminent moments that death will occur — but what is a certainty? This is a completely different situation.

The so-called palliative filter turns out to be a sensitive point. It is in fact not a screening, but for some, the tool to keep this question out of the same patient, who has asked the question, is to persist.

This is not the content of what is called the palliative filter. What is called the palliative filter means very concretely that, before receiving the patient’s request, the doctor is obliged to consult a palliative expert, and that in this way the patient is opened to the possibility – if I can so say – of being delivered from his suffering, in a way other than ending life.

This is the palliative filter.

I believe that there can be no reason — and that is why I have come back to it so many times in the debate — because I wonder how it can be that mandatory consultation or filter is rejected. This is not necessary to bring people to other ideas, but to make sure that what the patient says is also what he wants. The consequences of the exercise of will are not small, because it is about ending life. I would therefore absolutely ask you to consider the question of accepting the pluralist organized federation of palliative care. By the way, the National Order of Physicians and the Committee on Public Health of the Chamber have taken the same position.

I would like to ask you not to claim that the palliative filter would consist of the patient’s will to bend. It is absolutely not.

Mr. Speaker, I would like to read very briefly a sentence from the unanimous opinion of the Committee on Public Health: "...and after consultation with the palliative support team of the own institution to the local cooperation association on palliative care..." There is "consultation". No more than that. It’s about a contact or a conversation, but no more. Many colleagues have already turned that into a filter through which the patient has to go. That is not true. It is just a contact and nothing more than that. Therefore, the claim is not unjustified at all.

Mr. Speaker, I would like to repeat this discussion, but we have already conducted it many times. I still argue that the aggravation of the procedure pursues a certain purpose, independent of all disputes about it. I only note that in Article 3, §2, §1°, the same doctor whom we defend from a crime and whom we should subject to the screening of a committee, imposes that ...

The [...]

Would you have preferred "with a simple majority"? Calculate that for a moment and then look at it for a moment. I ⁇ didn’t want that, but that’s another discussion.

(...) for any persecution policy that would apply the same persecution policy here too. That is another fundamental criticism. This text ensures that the prosecution is not prosecuted by the public prosecutor, but that the monopoly of prosecution is transferred to an evaluation committee, which with two-thirds of the votes will decide whether the file will be transmitted to the public prosecutor. Thus, either the group of doctors, or a major ideological direction, can keep the persecution under control.

I would like to translate this as well. If there is a controversial case of euthanasia in Diksmuide, Antwerp, Gent or anywhere else, the French speakers will be able to block it. This real situation has been created with regard to the prosecution and enforcement policy. You will say that the prosecutor will always be able to prosecute. This is not the case, because the monopoly of information lies with that evaluation committee. This is embedded in the system, which is rejectionable in this regard.

Mr Van Parys, I have planned not to fall into polemics, but if you use the community argument in one direction, you should also use it in the other direction. The Flamings will therefore eventually also have to judge on a file from the French-speaking country.

I return to the obligations imposed on the doctor, which are expressly contained in the law. Mr Coveliers has already commented on this. The doctor should consult with his patient about his request, discuss with him any remaining therapeutic possibilities, as well as the possibilities of palliative care. Now you say that you have a text from the Federation of Palliative Care Flanders stating that the general physicians are not properly placed because they do not know the essence and scope of palliative care. I tell you in large letters that here it is a deontological obligation of the doctor to provide the information that is imposed upon him here by law. When he does not have it, he must obtain it, fully document himself, and possibly even appeal to others. You do not say here that the same paragraph begins without prejudice to additional conditions that the doctor wishes to attach to his interventions. You have listed a minimum of requirements. The doctor can do whatever he considers necessary and useful to make a decision on this matter and make a reflection of his decision making in his report to the evaluation committee.

What colleague Erdman says does not coincide with the evaluation report on the application of the law in the Netherlands. I quote from an evaluation report on the application of the law in the Netherlands by Bernardina Wanrooi of the department of domestic medicine of the Amsterdam Medical Center: "According to the research of Dr. Wanrooi, a large part of the euthanasia requests arise from a small ignorance of alternative pain and symptom control and palliative medicine in general". This is the reality of things. Therefore, Professor Distelmans emphasizes that the prior palliative consultation is necessary because its finding, as well as the finding in the Netherlands, is that the knowledge regarding the general physicians in general and the physicians in particular is lacking. In this way, many opportunities are missed to help people who could be helped with palliative care.

We have had this discussion four to five times this afternoon. Mr. Valkeniers and you have agreed on this.

Mr Parys, I think

You will not be able to convince each other. You can ⁇ not convince me with Dutch states, not even today.

The declaration of will has since been repeatedly misinterpreted as a document that could potentially lead to accidents, even by wilsonbekwamen. I repeat what I said subsequently in my interruption: it is not about disabled people, it is about people who, as a result of circumstances, are not conscious and who, in addition, have made the free choice to submit and register a disability declaration and to be able to revoke it at any time.

Can we not now take into account a portion of the population that takes the initiative to take into account these circumstances in the future? Their

Mr. Speaker, Mrs. and Mr. Minister, I think we have had a very thorough discussion. I do not want to finish this presentation before I have attempted to answer Mr. Goutry’s recent comment, but ⁇ I will not be able to convince him. Collega Goutry argues that there was a gap, as the text from the Senate had to be accepted unchanged in the House. You were convinced of it from the first moment. If I compare my original proposal with the present, the present at least differs from the original on two fundamental points.

The first point may be a theoretical approach. As part of the treatment of patient rights, you will have the opportunity to approach the globality of palliative care in all its facets. In my proposal, I chose to limit myself to the right to palliative care for everyone. I just wanted to mention the law, without further expansion. In the Senate, for various reasons, it has been suggested that one must solve a part problem that will somehow be incorporated into the flow of current discussions, but the evolution of legislation is so rapid that one can never predict how long a law will survive.

Mr. Van Parys, I come to a comment you just made. In my original proposal, I had indeed incorporated the reporting of each case to the prosecutor’s office. There was no interruption of the evaluation committee. I have, like you, respect for the structures of this country. The Prosecutor’s Office is mandated by the Constituent to ensure that the norms of this rule of law are respected. The Senate has established an interim with the evaluation committee for reasons of privacy, communication and evaluation that differ from a strict legal application. You have rightly worried about this. I answered you in a debate — but what are my answers worth? — that the full competence of the Prosecutor’s Office was in no way compromised by this text. In this context, a note of the Minister of Justice has been reviewed by the College of Attorneys-General. You know the letter of Mr. Ladrière, in which he very clearly states that the full competence of the Prosecutor’s Office remains.

You now say that no member of the prosecutor’s office will dare to prosecute if in a particular case the evaluation committee does not make a decision to refer.

This is the assessment of the Prosecutor’s Office in full independence. If you and I actually acknowledge the authority of the prosecutor’s office, we also acknowledge its independence. In this or that case, the Prosecutor’s Office will therefore judge after having knowledge of the file whether or not it will proceed to prosecution. Thus, it makes its own selection. If you clearly state that the Prosecutor’s Office will not intervene in all cases where the Committee considers that it should not report, it is, in my opinion, a violation of the independence of the Prosecutor’s Office.

Mr. Speaker, Mrs. and Mr. Minister, I conclude my speech with a text that I unfortunately only have in French.

Mr. Erdman, I think Mr. Goutry wants to prevent you from finishing and wants to ask you another question.

Mr. Speaker, I hear that Mr. Erdman will leave the tribune. Mr. Erdman, I had hoped that you would answer my questions related to the gap. I’ll repeat them for a moment because you’re bypassing them. My question is deadly. Was the opening there to change certain matters in the draft on the basis of debate and mutual consultation? Should or should nothing be changed in the texts?

I came to that. “The submissions of the proposal strive to ensure that the ethical debate opened in the Senate ends up in a law, emphasizing that two essential ideas must shape the entire debate on euthanasia. Euthanasia is conceivable only in a society that respects the autonomy of the individual and at the same time equally protects the life of each individual, regardless of their economic and social status, age or health status. For example, rejection of care for economic reasons should be combated even more vigorously if euthanasia or active action on own voluntary and persistent request becomes possible. Finally, it is obvious that the law cannot regulate all conscience problems and all situations related to the end of life. The law will provide the medical sector with the legal certainty that was missing so far, but the doctor will still face a difficult responsibility to identify.” Mr. Goutry, this was the end of my responsibility for my proposal and this is also my responsibility for why the text that came from the Senate in my eyes responds to these concerns. In my opinion, changes from a different perspective would damage the philosophy of the whole, and the construction—if I can use such a disrespectful word—which has been built here would be destroyed. The answer we wanted to give with this text would ultimately no longer lead to results.

In the face of death and the end of life, I do not pretend to have the correct answer. I even think that those today who are diligent to make amendments to this text, and even those who find this text insufficient and possibly want to reject it, should not pretend to have the answer to the essential question of human suffering at the end of life. Finally, I quote a text— ⁇ in French because it was the only one I could find—from 1516 by Thomas More in Utopia. “When a man without hope adds to perpetual torture, the priests and magistrates come to find the patient and he exposes that a firm hope authorizes him to evade such a life or to allow the others of the liberator, that it is to act wisdom that it is to put an end by the death to that which ceased to be a good to become a evil and obey the councils, it is to act the most pieusement and saintement.” Their

No sick person is removed without his consent, and the care of those who refuse it is not slowed down.

I would like to thank my colleagues for giving me the opportunity to speak.

Ladies and gentlemen, it cannot be avoided. The euthanasia debate has a symbolic value and symbols often leave room for multiple explanations. If that explanation is about life and death, I regret that this pure party policy would be coloured. The question to be asked is, in my opinion, double. The first question is whether this design is consistent with the value experience in our society. The second question is whether this design will change the value experience in the future.

The answer to the first question was recently given in the European Value Survey, in which Jan Kerkhof participated. I will quote him: "The biggest breakthrough may be in the tolerance to euthanasia." I have found my answer to the first question and that was also said by colleague Erdman. This design is in line with the value experience in our current society.

In my opinion, the answer to the second question is even more important. Many members ask themselves a number of questions about this because if this design really interferes with the value experience in our society, then it is a double regret that this design is not carried out wider or colored party politics. I find this regrettable and the reason for this is the fact that euthanasia is also made possible in non-terminal patients.

The principle under which this law is written is the right of self-determination of the person. The provisions of the law always relate to a person in the context of a relationship. First of all, for the implementation of the law in a doctor-patient relationship. This design fits equally well within the Law on Patient Rights. Their

When it comes to life or death, the term self-determination is more irreversible in its place than elsewhere. This is formulated by some members quite clearly as "c'est ma mort". However, when we look at the performance and the due diligence criteria, the term self-determination, self-choice — as colleague Erdman has called it — or co-decision right is better in place.

For me, the request for euthanasia of a patient at the end of life is of a different order than the request of a patient who will not die within the foreseeable time. This has a philosophical basis for me.

Everything is in relation to everything. Each individual is in relation to his environment. In other words, the context in which an individual is always determining the decision of that individual. If, then, we speak of a decision that a physician must make at a given moment in a context which is by definition undefined for the patient — the history of that patient is still in the future — then, in my opinion, the physician at that time is too much asked to assess the patient’s request in his context, in his relationship to his environment. Their

I know that what I will say now is a language that is directed to the heart. Everyone’s history is connected with everyone. The thought that everything would end someday is something for many to become desperate and flee for their own destiny. These situations may soon occur more and more, if one makes the human genome accessible not only for diagnosis, but also for therapy. In this context, the application of euthanasia to a patient who apparently would not die within the foreseeable time becomes an irreversible interference in his history and in the history of his environment. This is not the task of a doctor. As sophisticated as one has wanted to develop the instrument to enable euthanasia, one goes beyond the therapeutic basis of the doctor-patient relationship. If the world is a threat to the patient, it is the task and duty of the doctor or healthcare provider to give the best of themselves. This is the care culture I stand for and that is the model that should not be under pressure. When a man dies, you are silent. You will be flooded by the wisdom and power of the elements and you will feel small. Euthanasia is an instrument that exercises that power itself, takes it into its hands. Is the question of euthanasia contrary to the will to live to which love drives us? I am referring to Schopenhauer. That is precisely why, colleagues, the legislator had to pursue perfection here. In the room, I don’t think that happened. In the Senate, on the other hand, a lot of hearings were effectively organized. They didn’t get ice overnight. This, of course, deserves all appreciation. As the understanding in the Senate has matured, as the proposals that were originally drafted have also been modified and have led to other proposals, so may the understanding of some Chamber Members have also matured. However, they did not take the opportunity to amend the proposal. Their

The responsibility of the doctors. I have already stopped there. One cannot disconnect the patient from that relationship with the doctor, because the modalities as inscribed in the law give him or her a very great responsibility in judging subjective elements such as the considered request and the unbearable suffering. I will not stop with the opinion of the Committee on Public Health. Mrs Van de Casteele gave a very careful report and I would like to thank again all the members of the committee for engaging so constructively with the content of the debate and having managed to transcend the party-political boundaries.

That advice, in my opinion, contains a number of fears that live in people cared for in institutions. The committee has received letters from institutions that care for dementia-affected elderly and disabled people, expressing the fear, uncertainty and uncertainty that rightly or wrongly lives in these people. I think that the opinion of the Committee on Public Health and the way the Committee on Justice has dealt with this opinion has removed concerns. It was clearly demonstrated that the bill does not cover purely psychological suffering and people with dementia. This was made possible thanks to the work in the Committee on Public Health and the response and explanation given to it in the Committee on Justice. This has led that fear for a piece to turn into reassurance. At least that is my perception.

Mr. Speaker, I listen with interest to Mrs. Avontroodt’s very honest speech. However, I do not understand exactly what it is based on to say that the Justice Committee has taken into account the opinion of the Public Health Committee. In the texts I find nothing about this. Once a bill has been approved, only the law remains and nothing but the law.

reports of the preparatory work.

Only the law. Why was this fear not taken into account in the text so that a consensus was possible?

I am not the author of this bill. However, I hope that the preparatory work in both committees and in the Senate will be taken into account. Their

I think that the fear regarding the demented elderly was explicitly removed already during the Senate discussions. Another point is the conditions imposed for euthanasia for non-terminal patients. This is purely psychological or purely physical suffering. Especially the word “or” disturbs me. This is one of the reasons why I will not approve the bill. So I understand Mr. Goutry’s concerns, but I do not share them because I know that the legislation on this point is clear. Furthermore, the surveys of the Medical Journal and The Lancet have shown very clearly that no physician will be willing to apply his euthanasia to non-terminal patients who are not subject to the conditions of the law.

I have a lot of confidence in the medical team. In this I also refer to Professor Distelmans who told me that I did not have to worry because the doctors would not be willing to apply euthanasia to non-terminal patients. Therefore, contrary to you, I believe that the due diligence requirements, which are included in the law, will not give rise to abuse.

Mr. Speaker, it is of course noble to say that one is at ease, because the doctors will do self-regulation and will not apply euthanasia to a non-terminal patient. However, how can this be ⁇ ined? The only way to maintain that is the action of the Order. However, it will then have to act for acts that can perfectly under the law. This solution will shift the problem. The question then becomes: can or cannot the order prohibit what the legislator has made possible? You create an additional problem. Your reassurance is very risky. The only reassurance is the acceptance of an amendment stating that euthanasia on non-terminal patients is not allowed. When the current text is adopted, in the long run, problems will arise in the medical corps and there will undoubtedly emerge a large number of free-exploiters who will escape any democratic control.

Mrs Avontroodt, I speak to you as Chairman of the Committee on Public Health, Environment and Social Innovation. I do not share your optimism. I fear that you are too good faithful when you assume that one will strictly adhere to the consensus reached in the committee. If you, rightly, cite the Medical Journal and point out the massive response of the doctors who have made clear that they are not the petitioning party for the current text of the bill, you can also decide that amendments provide the only guarantee. We all worked together in a constructive atmosphere and with the best intentions. However, we must also dare to say that we have been dealing with the software in the Committee on Public Health and when the hard work in the Committee on Justice came on, the Commissioners on Public Health have been blown up by the disrespectful treatment by that committee which did not take into account the unanimous opinions of the Committee on Public Health. We will continue to accuse that. This is hypocrisy in an elevating ladder.

I have an infinite respect for you personally and for your discourse tonight, let that be clear, but you shoot a shortage as Chair of the Public Health Committee. With good intentions, we cannot go far in politics. In politics, only the power to improve a bad text through amendment counts. That is essential, but the Public Health Committee has unfortunately missed an opportunity here.

Mr. Speaker, I just wanted to make it clear that this will absolutely not lead to abuse. It is stated in the draft that after two years there will be an evaluation. President Erdman then spoke about a glass ball, I will not repeat those words. The built-in due diligence criteria should provide the site with legal certainty, but not fear. The evaluation will need to correct that.

But do not ask me to defend the provisions of the law, for I will not do so. I only say that good care criteria have been built into which do not correspond to doom thinking. That is all I mean.

A lot has been said about the palliative filter. I can only add that the palliative filter had been a clearer and better criterion of care, especially for the patient, as well as in terms of quality of care, but not, as for some members, a condition before approving the application for euthanasia. I am a requesting party in this area primarily because of the quality requirements. In the Netherlands, the United Nations was put on the fingers because of a too weak control a priori. Well, the palliative filter is an additional care that could have avoided this and that could also prevent Belgium from being accused of following a faulty procedure a priori. That will be the future.

I was already talking about pure psychiatric suffering, just like other colleagues, by the way. However, the research that took place must not be overlooked. A lot of scientific research has been done and it shows that when suffering is so intense that it is accompanied by a deep depression — as mostly by the way — which automatically affects the request. That is all I want to say about it. These are the criteria understood by psychically irreversible and irreversible suffering. This is a bridge too far. Euthanasia for non-terminal patients who suffer purely psychically, which for me is a bridge too far.

Regarding the invalidity of the declaration of will in certain cases, I think the report is clear, at least I hope that. The report clearly states that a request for euthanasia in dementia contained in a declaration of will cannot be responded.

The situation is different when it comes to euthanasia in minors. In this regard, I can ask the attention of the members for the opinion of the Commissioner for the Rights of the Child. I have already heard here swinging with terms such as inequality. Well, as a doctor, I cannot be convinced that a child who suffers unbearably can request euthanasia, while a child of the same age who suffers equally, but who, according to the opinion of the Commissioner for the Rights of the Child, is able to submit a request voluntarily with a judgmental capacity, cannot. This is one of the injustices that remained in the law. I am convinced that we still have work to do and that, as other colleagues have said, a lot of medical operations at the end of life are still unregulated. These questions ⁇ further research.

I come to the challenges of tomorrow. The evaluation of euthanasia in non-terminal patients, but especially the risk assessment on what I have called undertreatment, in the field, are tasks that the evaluation committee, which is legally guaranteed, cannot fulfill. These should be done in a well-founded scientific research on medical action at the end of life. There are still many uncertainties in the field. I refer to the decisions made in the departments of neonatology, where parents are placed before a disruptive choice: whether or not they should let their child get out of the machine; whether or not they should keep their child alive, knowing what the future of their child will be. That is the practice in the field.

Research on medical action at the end of life should be conducted prospectively. Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, etc. This is also the question asked by Professor Cassiers, who, by the way, points out that the Bio-Ethics Advisory Committee has only been asked for advice on euthanasia in terminal patients. There is no advice on euthanasia in non-terminal patients. I think this is absolutely necessary.

As for the comments about abroad, I can only say that with tremendous interest is looking at the day of tomorrow, if our country will indeed have its euthanasia law. The point may be included in the evaluation due to the United Nations.

I would like to conclude my speech, Mr. Speaker, by emphasizing that I do not join those for whom this draft is a threat. I am convinced that the need for everyone to remain in their value until death is the concern underlying the proposed legislation.

Per ⁇ the answer that gives me the most confidence lies in humans. I have not sought it in the distant past. I found it in a poem by Herman Van Veen of the 68s, with which I go back to my introduction. In my introduction I said that every human being is in relation to his environment. I am citing:

"There was a man who would like to commit suicide, why exactly, that was not well known to him himself, he had received that urge at his birth, like another sense of language or singing talent, and in spring he had only the desire to hang himself alone, with green branches. That is a rather modest desire, no, a man is his desire, that is his life, I say.

Only, he couldn’t do it immediately, ⁇ not as a boy, when after school time he often sat on the railway trail. Oh, he was soulfully and soulfully jumping for a train to forget, he didn’t know exactly what. He didn’t want to upset his father and his mother, and therefore he let the thought shoot over and over again. Because a conscience is something beautiful, but if you have it, you are extremely disabled. He took himself to wait for his parents' death and he was lucky, neither of them became old. But behold, a life is determined by foreign forces and in the meantime he was just married. He had an extensive stock of sleeping pills, which he counted there when the snowman came to put on. Oh, he could easily ⁇ what he wanted and yet, he did not, he had a brave wife. And when he finally died after years, he still saw the chance of his sorrow not clear to sail himself into that long-forgotten harbour. He was the father of a daughter and a son. But his patience began to slowly diminish. He was determined to drown. He had already chosen the place, it was at the bridge. He thought, “Here I do it and God, do it quickly.” It took a long time for him to finish his duties, but when he barely existed for his children, one evening he went to make a happy ending and at that bridge he then found a sick dog. He would have preferred that animal on the spot. But no, he remained there until the last snake for care and it finally gave the spirit with resentment. He thought, “What are they going to do with him, that stupid beast?” There was a man who would like to commit suicide, why, he did not know, though there were reasons. I know from my head about a few or nine, although I have never had that urge so strong. Oh, to make something true, of his favorite dreams, no one else would have taken it so closely. Anyway, that man did it. He just died like everyone else.”

This was written by Herman Van Veen and that is not the context of the request for euthanasia. It is about a man who had the urge to commit suicide.

May 15, 2002 | Plenary session (Chamber of representatives)

Full source

Mr. Speaker, in principle, Mrs. Van de Casteele and I present a report on the grouped general discussion of the two projects. Then, in the appropriate order, Ms. Schauvliege will report on the discussion of the articles relating to the draft law on euthanasia and Ms. Dardenne will intervene on the discussion of the articles relating to the draft law on palliative care.

Will Mrs. Van de Casteele also intervene?

Yes, she and I are rapporteurs for the general discussion.

In a moment, you will start your report. I suppose Mrs. Van de Casteele will continue afterwards. Who will speak after her?

Mrs Schauvliege and Mrs Dardenne will then intervene, in the order that suits them.

Could you then arrange between you, Madame Schauvliege and Madame Dardenne?

Do you agree with each other on the order?

I assume that no one will later intervene as a rapporteur.

Mr. Speaker, logically, Mrs. Schauvliege must speak before me since she presents a report on the articles relating to the draft law on euthanasia while I will talk about the articles relating to the draft law on palliative care.

For the report, I will set the order as follows: first Mr. Giet, then Mrs. Van de Casteele, Mrs. Schauvliege, and Mrs. Dardenne.

During the conference, we discussed the time of speech. There is no consensus.

I had suggested that the speaking time of 60 to 80 minutes should not be exceeded, but that is non-binding. I know there was no consensus on the speech time and say this only for information.

Mr. Speaker, for all clarity, as I said last week, my group does not feel entirely bound by any arrangement that would be on the timing.

Mr. Leterme, I say only what was proposed. I also said that there was no consensus.

I think we can start the debate now. We will see how the timing goes.

Mr. Speaker, my group does not feel bound by any agreement on time limits.

From time will how and also voorbijgaan. We will begin with the report presented by Mr. by Giet. Then Mrs Van de Casteele, Mrs Schauvliege and Mrs Dardenne will also speak.

I would ask Mr. Henry to replace me in an hour and a half so that I can go to the Conference of Presidents.

Mr. Speaker, my dear colleagues, first of all, I would like to thank the services of the House for their assistance in this ⁇ laborious work of dealing with bills relating to euthanasia and palliative care.

After planning to dedicate a single general discussion to the two draft laws on euthanasia and palliative care as well as the attached draft laws or resolutions, the committee dedicated nine sessions to their examination.

At the end of the general discussion, it was decided not to continue the review in the Justice Committee of the draft resolution on the development of a patient-focused palliative care plan and the draft law aimed at establishing access to palliative care and improving the practice of palliative care. These texts were returned to the Committee on Public Health, Environment and Renewal of Society.

I would like to clarify that the written report contains the summary of the hearings. In the annex to this report is – it is important to emphasize – the opinion of the Committee on Public Health. Permit me, before I relate further before the debate, to give you a reading of the definition of euthanasia as mentioned in the text: "There should be understood by euthanasia the act performed by a third party who intentionally ends a person's life at the request of that person."

Thus, in order to respond to an existing situation, any major and minor emancipated person could manifest the will that he be put to an end of his days in compliance with very strict conditions, both formally and substantially: the patient’s state of health, obligations imposed on doctors, deadline to respect, written document. by

A disposition of the text that is proposed to you allows an early statement by the patient, recorded in writing, in the presence of two major witnesses, an early statement by patients who, at the time they write it, do not know if they will one day be unable to manifest their will but who want to ensure that their will is respected by specifying their approach and their choice. Neither the request nor the early declaration of will have binding value. They can be removed or adjusted at any time. by

Thus, the doctor who practices euthanasia does not commit an offence if he complies with a number of very strict criteria listed by law. On the contrary, the doctor who did not meet these criteria at the time of the act would indeed have committed an offence. by

A Commission of Control and Evaluation of Practices is established to control euthanasia and to verify, on the basis of registration documents to be completed by the physician who practices euthanasia, whether the legal provisions have been properly applied. This committee hears the doctor concerned and reserves the possibility of referring it to the Prosecutor’s Office. In addition, it will regularly provide statistical reports, reports concerning a description and an evaluation of the application of this Act and will communicate any recommendations to the legislative chambers.

With regard to palliative care, the project aims not only to soothe pain, to make suffering forget, but also to provide an acceptable quality of life. by

Prior to the general discussion, we took note of the work and recommendations provided by the Public Health Committee, several members of which regret that the role of this committee has been limited to giving an opinion.

In the general discussion, the interventions of the various members can be synthesized as follows. But above all, I would like to point out that I prefer to consider them as personal interventions rather than the reflection of a position of political groups. by

One member insists on the need to provide for constant assessments, explanations, revisions, adaptations and improvements of the law. In his mind, it would be presumptuous in this delicate human problem to pretend to be able to regulate all aspects of the matter in one and only legislative adaptation.

The speaker wanted to insist on the purpose of the euthanasia law: to provide a response to human suffering and allow man to have control of his own death. It supports the legislative initiative because it allows: to put an end to certain abuses; starts from the principle that everyone can decide about his own death; and sets as another essential principle the dialogue between the patient and the doctor as well as the exchange of information and the taking into account of the patient’s questions.

The interviewer then developed some reflections; thus on the euthanasia of the patient without the consent of the interested party, the project to be examined will put an end to these abuses and therefore limit the decision-making power of the doctor. Then, the general notion of a state of necessity remains applicable even though particular laws such as the one proposed to us today on euthanasia may provide for exceptions.

There is no confusion between euthanasia and suicide. This latter concept occurs when people are not in a medical situation without a way out and nevertheless decide to put an end to their lives. Euthanasia is an independent and informed decision of the patient and no one can replace his will with his own.

Another member found that the text on euthanasia translates the will to consecrate a fundamental freedom, not yet recognized by our law, which allows the citizen to decide under certain conditions to no longer continue to live since it concerns the person himself and has no direct or indirect effect on the rights or freedoms of others.

Individual conception of life allows everyone to follow their own convictions. This does not prevent those who oppose euthanasia from resorting to it. In addition, the speaker noted that the problem of euthanasia leads us to question the notion of suffering and the meaning to be attributed to it and therefore to make no distinction between patients who are in the terminal phase and others. Indeed, when suffering cannot be calmed and the person wishes not to suffer it anymore, it would be senseless to prolong it, especially since this suffering can, in such cases, spread over long periods. Finally, he considered it necessary that a law be adopted allowing everyone to live and die according to their own conceptions.

One member stressed that the right to die in dignity concerns all citizens and that the debate on euthanasia and palliative care, far from being confined to parliamentary assemblies, is also held in society. The speaker welcomed not only that euthanasia, as understood in the text, constitutes an act carried out in absolute respect for the freedom of conscience and the enlightened will of the persons concerned, but also that it involves the establishment of a genuine dialogue between the doctor and the patient. He also adhered to the legislature’s choice not to limit the scope of the text to the patient in the terminal phase, this terminology being impossible to define. Finally, he considered the possibility that the law could in the future apply to minors.

One member specifies that, even if the principle of self-determination must be corrected by the imperatives of life in society, it still implies that one cannot force a person to endure suffering of an unbearable and irreversible nature. The speaker stressed that the adoption of legislation in this area would enable, on the one hand, to end the legal insecurity of persons who submit the act of euthanasia and, on the other hand, to reassure the sick who might fear that a deterioration of their health will lead others to decide for them of an euthanasia.

It is not illegitimate that a person suffering unbearable suffering may also request, even if it is not in the terminal phase, that an euthanasia be practiced. In addition, the speaker clarified that while everyone should enjoy the right to live as long as possible, it is not normal to force someone to live when acceptable conditions are no longer sufficient in their eyes. The speaker also said he supports the right to palliative care.

Other members have fully supported the project, believing that the law provides consistent and balanced answers, but are still questioning the resources reserved as well as the training of doctors. For them, the principle that must prevail in this matter is that of the free choice of each person and therefore, a legal framework is needed to precisely define the responsibility of both the individual and the society. They also find that the text does not provide for the automatic right to euthanasia in the patient’s head, nor the obligation to practice euthanasia in the doctor’s head. They also add that, sooner or later, we will have to look at the issue of euthanasia for minors, people with dementia, as well as the problem of suicide aid.

According to other members, moral truth requires an in-depth democratic debate between the different philosophical currents. It is important to know whether the principle of the free will of the human person should be ⁇ ined when it comes to death, a principle that they do not share because they think that man is not capable of making a decision in this matter.

Consequently, they question the fundamental starting point of the bill. For them, we can neither capture nor define death. Therefore, the criteria of autonomy, will and the right to self-determination of the patient are not relevant. The project becomes the absolute expression of triumphant individualism.

In reality, the request for euthanasia is often only a request for help, assistance, a cry of distress.

And then advocate for the establishment of a preliminary palliative consultation that would filter requests that are not real requests for euthanasia. In the current wording of the text, it could be inferred that if palliative care relieves pain and euthanasia is practiced, there would be an offence. The practice of euthanasia to patients who would not be in the terminal phase is inadmissible in their opinion and there is fear that it is a response of ease applied to people who would be considered a burden. They warned against the risk of abuse that could support the elimination of people with depression and mental disorders. They refused to take into account an early statement because the patient is, by definition, unable to predict the concrete emergency situation that he will later experience. It cannot have any legal value. Its members admit that there will always be extreme situations where euthanasia will be the only solution. The norm “you will not kill” can sometimes be broken by the doctor who will then act in the state of necessity. His act will remain punishable but, given the circumstances, the punishment may be avoided. Their actions must remain under effective social control.

The Federal Control and Evaluation Commission, as planned, could notify the public prosecutor only if a two-thirds majority comes out. This means for its members that, for example, French speakers could prevent the prosecution of a case of euthanasia in the north of the country.

Another speaker is in favor of a legal regulation because he disapproves of the other possible solution, the policy of tolerance. Nevertheless, this regulation must be subject to certain conditions: a legally capable patient, limit euthanasia to patients in the terminal phase, and pre-emptive euthanasia of palliative care.

He also expressed concerns about suicide aid, which should not be equated with euthanasia, about the provision of products by pharmacists and their role in practicing euthanasia, and about the application to minors.

Finally, some members requested that one first question the human being. Supporters of the free choice of the individual, they insisted on the need to see certain conditions fulfilled and to ensure the authenticity of the choice. According to them, the concept of free will that some defend is addressed to an elite, the one who has financial and intellectual means to access knowledge, knowledge, and, inevitably, power. They advocated for a human and solidary society. The human being is a being of relationship, a being in relationship and the fundamental social bond that welds our societies is and remains the prohibition of killing which is one of the three principles of our society with that of incest and anthropophagy. It is essential that this act remains an ethical and criminal transgression and that only the state of necessity can justify such an act. In a society where economic logic prevails, the future of the weak or vulnerable persons is threatened and it is necessary to avoid the derivative of being made an object. According to the speakers, the request for euthanasia is also, first and foremost, a request for help in dealing with this transition from life to death. No law should allow the carer to make the economy of a thorough and interdisciplinary analysis of each end-of-life situation. It is only at the end of this analysis that a necessarily collegial decision can intervene. We need a strong and precise legislation that guarantees the right of everyone to live their end of life in human dignity without constraints and in full consciousness of the choice made, a law that prevents to the fullest extent possible any possible deviations.

Finally, these members clarified a few other main axes of their reflection.

1 of 1. Acts of euthanasia practiced must be subject to real control. However, the planned commission acts as a parallel body that sorts the files and the decision to return the case to the Procurator of the King must be taken by a two-thirds majority, which will never occur.

2nd Moral and medical assistance is a prerequisite for carrying out an act of euthanasia. However, this priority is absent from the proposed project.

3 of 3. The obligation of a collegial consultation should appear more clearly and broadly in a text of law.

4 of 4. Failure to comply with the conditions set by the law to be able to practice euthanasia must be accompanied by sanctions.

I think thus, Mr. Speaker, dear colleagues, I have summarized the different opinions that arose at the time of the discussions in committee. by

The euthanasia bill was approved by 10 votes against 6.

Mr. Speaker, colleagues, I would also like to thank in advance the services and especially the Secretariat of the Health and Justice Committees for the proper preparation of the debate, for the guidance of the work and for the excellent report.

Colleagues, I have come to the conclusion that this report, of course, corresponds to some extent to the report presented by Mr Giet, but I believe that this debate is important enough to report on the work that has taken place in the committees also in Dutch. The Justice Committee has decided to dedicate one general discussion to both draft laws submitted by the Senate. The discussion therefore concerned both the draft law on euthanasia and the attached bills as well as the draft law on palliative care. Members of the Public Health Committee attended the discussion and formed an opinion to the Justice Committee in a quiet and pleasant atmosphere in their committee.

As an introduction, the Minister of Justice stated that the government agreement states that the government does not engage in ethical issues. Consequently, he only gave a general overview of how the designs came into being. Since 1984, several attempts have been made to make the possibilities for suffering people to die in a dignified way debatable in Parliament. During this legislature, the debate was initially entrusted to the Senate. It was intended in this way to conduct a business and serene discussion, not based on party-political statements. I have my doubts about this, but I will return to this in my personal intervention.

In the present draft, euthanasia is defined as the deliberate acts of life termination by someone other than the person concerned at his or her request. Who is eligible for this? All acting adult or discharged minors. The draft law stipulates the following without inclusion in the Criminal Code: "The physician who applies euthanasia does not commit a crime if the patient is capable of acting and conscious, is in a medical state of persistent and intolerable physical or psychological suffering that cannot be cured and that is the result of a serious and incurable condition, caused by accident or disease, and provided that the request is voluntary, considered and repeated."

The prior tasks of the doctor are set out in the draft law. He must inform the patient about his health status and life expectancy and he must consult his request for euthanasia. He must also assure himself of the persistent physical or psychological suffering of the patient and of the persistent nature of his request. In addition, another doctor should be consulted about the serious and incurable nature of the condition. If there is a nursing team that is regularly in contact with the patient, the doctor should also consult with this team in advance about the patient’s request.

In the draft law, two cases are distinguished. If the doctor considers that the patient will obviously not die within the foreseeable time, he must consult a second doctor, a psychiatrist or a specialist in the condition concerned, in addition to the conditions that I have just cited, and must allow a period of at least one month between the written request of the patient and the application of euthanasia. In addition, any acting adult or discharged minor, in the event that he is no longer able to express his will, may draw up a declaration of will. This statement must be drawn up or confirmed less than five years before the time when the person concerned can no longer express his will.

The doctor may apply euthanasia if he has assured himself that the patient suffers from a serious and incurable condition caused by accident or disease, that he is no longer at consciousness and that this condition is irreversible according to the state of science. Also here is provided in the consultation of another doctor and consultation.

The bill also stipulates that no doctor can be forced to apply euthanasia. In case of refusal, he must inform the person concerned in a timely manner. The person who dies as a result of euthanasia is considered to have died a natural death. The doctor who has applied euthanasia shall, within four working days, submit a fully completed registration document to the Federal Audit and Evaluation Committee consisting of sixteen members. The Commission shall examine the registration document. It shall verify whether the euthanasia has been performed under the conditions and in accordance with the procedure laid down by law. If the committee, acting by a two-thirds majority, considers that the conditions laid down in the law have not been met, it shall forward the file to the King’s Prosecutor. Every two years, the committee shall issue a statistical report containing a description and evaluation of the application of this Act and, where appropriate, a number of recommendations drawn up for the legislative chambers. In connection with the draft law on palliative care, a representative of the Minister of Health referred to the measures already taken by the Ministers of Health and Social Affairs to improve palliative care, both in home care and in intramural care. The support function in the general hospitals was strengthened. In the palliative care nursing departments, 360 beds were provided and an improved fee for palliative care was introduced.

The RVTs received additional funding for the training of their staff. Both the procedure and the means of recognition and financing of palliative care are now a fact.

Mr Vande Walle and Mrs Descheemaeker gave explanations to the opinion of the Committee on Public Health.

Regarding the draft law on palliative care, Mr Vande Walle stated in advance that the members of the committee did not understand why their role was limited to providing advice, although it was a draft law that concerned exclusively the provision of care. The Committee on Public Health has consulted several experts in the field of palliative care. They agreed that better structures, more financial resources and, above all, better and more targeted awareness are needed. They unanimously pointed out that the so-called palliative filter must be maximized before euthanasia can be discussed. In the medical training, much more time and attention should be devoted to palliative care. There was an extensive but open discussion in the Committee on Public Health, which resulted in the unanimous recommendation that palliative care cannot be strictly limited to the end of life. The committee also expressly stated that there is an urgent need to proceed to a legal establishment of the patient’s rights. Meanwhile, a bill on this subject is being discussed in the committee.

On the draft law concerning euthanasia, the committee organized a hearing with a number of Dutch experts, including some stage doctors. Scen stands for “support and consultation in euthanasia in the Netherlands”. These doctors receive specific training to advise and assist the treating doctors who are faced with an euthanasia request.

The Dutch legislature has decided to decriminalize euthanasia. Euthanasia is included in criminal law and there is a law that does not have any rights attached to it, but that gives the doctor the opportunity to help the patient, provided that he complies with the criteria of care.

The Public Health Committee discussed the draft law on euthanasia in a constructive way, with a lot of listening willingness and appreciation for the different views. The committee gave a unanimous opinion on the fact that pure psychiatric suffering can never give rise to euthanasia. All members agreed that the importance of palliative care is neglected. The recommendation to install a palliative filter a priori was therefore unanimously supported by the committee members.

There was also a strong consensus on the doctor’s consultation. The biggest debate, both between the factions and within certain factions, was around the limitation of euthanasia to terminal patients or not. The completion of the terminal remains a delicate point here. The recommendation to limit euthanasia to patients in a terminal phase was rejected by the NIPT committee. The concepts of terminal and non-terminal are, according to experts, ambiguous: for some it is a time factor, for others it relies on the irreversibility of a state.

Most members agreed that the declaration of will can only apply in the case of an irreversible comatic patient. The text of the draft is not clear in this regard and does not exclude that euthanasia can be applied to dementia patients. Following the opinion of the Order of Physicians, the members of the committee therefore stated that a request for euthanasia in dementia stated in a declaration of will cannot be answered.

The role and responsibility of the pharmacist was also discussed in the Public Health Committee. The pharmacist should be informed about the fact that he supplies a product that will serve to apply euthanasia. He must, like the doctor, be able to refuse to cooperate.

In the Justice Committee, after the introduction and after the report of the Public Health Committee, the submitters of the attached bills explained their bills. Colleague Luc Goutry lightened the strengths of his bill that recognizes palliative care as a basic right to be developed in the RVTs and ROBs.

Palliative care involves the total guidance of incurable patients, including psychological, social and moral care. Palliation should be obligatory in the training of every doctor and healthcare providers should be re-evaluated. The Senate Draft only covers palliation at the end of life. After an extensive discussion, it was decided to continue to discuss the proposal of colleague Goutry, together with the proposal for a resolution on the development of a needs-driven palliative plan, in the Committee on Public Health. Hopefully it will be approved next week.

Regarding the draft legislation on euthanasia, colleague Coveliers recalled that the basic idea underlying his proposal is the self-determination of the individual. This principle of self-determination is ⁇ not absolute and must be guided by, among other things, the demands of life in community, but it still implies that one cannot force a person to endure unbearable and irreversible suffering. With his proposal, he wanted to put an end to a certain hypocrisy and to the legal uncertainty for the doctors who apply euthanasia and for the sick who fear that others will choose euthanasia in their place. He also pointed out that according to health workers it is very difficult to determine whether a sick person is terminal or not. As regards minors, they cannot legally express their will. Therefore, it was decided not to allow the euthanasia of minors.

President Erdman, who had also submitted a proposal, notes that one may have to accept that the law will neither be complete nor perfect. It will need to be continually evaluated, explained, revised, adjusted, refined and improved. The debate, according to him, is essentially about how to approach human suffering and to what extent a person should be master of his own death. The reality is that euthanasia or assistance in dying takes place at the time of clandestine. The issue of euthanasia is related to that of palliative care. His proposed legislation therefore covered both euthanasia and palliative care. It is of the utmost importance to let people die in dignity. As François de Closets wrote, “It’s a matter here of the last freedom of man, that is, the power to dispose of the way that he left this life and to dispose of his death and conscience.”

As regards the views of the members and the discussion that followed, unlike Mr Giet, I have mentioned the names that highlighted the main statements. The names are also included in the report and I think it can be.

Mr. Mayeur emphasizes that the debate about euthanasia and palliative care has also taken place in society. Unnecessary suffering is unacceptable. He also pointed out a recent poll by the French-speaking newspapers, in which 75% of the population would support the bill.

Collega Bacquelaine noted that the bill expresses the will to raise a fundamental freedom not yet recognized by our law to rule.

This allows you to decide not to live. That freedom concerns the person himself and does not directly or indirectly affect the rights or freedoms of others. Some assume that the person himself decides about his life, while others believe that life belongs to transcendence or to society.

According to colleague Bacquelaine, suffering is an alarm signal. In some cases, suffering is greater than what our human capabilities allow. Then suffering loses its usefulness and the usefulness it retains in relation to other values than healing. Therefore, some believe that usefulness still exists in relation to other values. These opinions cannot be imposed, according to colleague Bacquelaine.

Colleague Laeremans opposed the bill. According to him, the demand for euthanasia usually derives from therapeutic persistence. The debate on euthanasia is outdated, given the significant progress in palliative care and pain control. Therefore, it would be better to generalize the palliative care. According to Mr Laeremans, then it would prove that euthanasia is unnecessary. He is especially afraid of the psychological pressure on the patient if he thinks it is a burden for the family. He also points out that most doctors are against euthanasia and that the euthanasia scheme is rejected internationally.

Ms. Dardenne pointed out in her speech that the end of life must encourage humility and respect, and that this is a delicate debate. We cannot deny that euthanasia is already being requested. If those requests are well thought out and are repeated, then they must be able to be granted. In the current situation, the medical action around the end of life is out of any control. The lack of transparency also does not guarantee that euthanasia is carried out properly and correctly.

Collega Arens said that if the debate narrows to the one side, the freedom to die and the other, the prohibition to kill, those options then seem incompatible. However, the choice to be made is not to be attributed to this dualism. He is in favor of individual freedom of choice, but under certain conditions. It must be a free choice made with knowledge of matters and in all freedom, not under pressure or from economic or psychological necessity. Everyone must have the necessary background or financial resources to make that choice in all freedom. He referred to the democratic humanism which assumes that man exists for everything through his relationship with the other and that that relationship reflects him and provides dignity of his existence. Man is a relationship-oriented being and the fundamental social bond that our society forges together is and remains the ban on killing. This prohibition may only be violated in an emergency situation. This is also stated in Article 2 of the European Convention for the Protection of Human Rights. Euthanasia should therefore remain an exceptional measure to prevent departure.

Collega Arens also referred to departure in the recent past where everything started with accepting the fact that there are lives that are no longer worth the effort of life, namely those who were seriously or chronically ill. Gradually, the number of groups in this category increased and eventually expanded to include people who were socially unproductive and racially undesirable. The suffering that everyone wants to eliminate from the final stage of his life is not only physical suffering but also moral, psychological suffering: the fear of death, the dissolving, the separation, the breakdown of the social bond. Providing a gentle death means enabling everyone to meet their end of life with maximum comfort.

This means that the patient is a worthy subject until the end. The doctor may only consider applying euthanasia to a patient if there are no other alternatives that allow a serene transition from life to death. Therefore, only in emergencies can a violation of the ban on killing be justified.

For Ms. Leen, palliative care is the active and total care for incurable sick and for those for whom death is expected within the foreseeable time, and is no longer aimed at healing but to optimize the quality of life of people who have an incurable disease and are in the final phase of life. It is a care service focusing on physical, psychological, social and spiritual aspects of life and dying that should be provided together by professionals, volunteers and mantle caregivers. She points out that dying at home is still more expensive and organizational more difficult than dying in a hospital.

According to Mr. Coveliers, the patient who is denied the right to euthanasia is put to life. Consequently, the question arises on the basis of which one acquires the right to compel someone to live. International treaties, such as the European Convention on Human Rights, anchor the right to life, but not the duty to live. It is no coincidence that suicide is not included in our criminal code. The view that life is a right and not a duty implies that the patient should be given the opportunity to voluntarily leave it. This viewpoint makes the term terminal phase superfluous. Why should a person who finds his living conditions no longer acceptable refrain from resorting to euthanasia if medicine is not able to improve his living conditions?

Mr Schauvliege argues that on a purely legal-legistic level the draft constitute a violation of Article 2 of the ECHR, which stipulates that the law must guarantee the right to life, and of Article 13, which grants the right to effective legal aid in case of violation of rights and freedoms. The draft is also contrary to Article 151 of the Constitution because the Federal Audit and Evaluation Commission is replaced by the Prosecutor’s Office.

Your rapporteur has called for an open debate. She believes that there should be a system for euthanasia, but does not defend the absolute right of self-determination. Her concern is primarily to let people die in a dignified way. Therefore, she considers that euthanasia should be limited to patients in a terminal phase of their disease. It also stressed that assistance in suicide should be provided under the same conditions as euthanasia. According to many experts, aid in suicide is less extensive than euthanasia. The main difference lies in the fact that some seriously ill individuals want to keep their fate in their own hands. Finally, it also expressed its concern about the minors that are completely excluded from this legislation. Also for them, in a terminal phase, there should be a right to die in dignity.

A personal experience has led Mr. Pieters to nuance his opinion. He is in favour of a legal regulation because he rejects the alternative to a drug policy. He points out that, by definition, this is about people who are in an extremely weak position and who should therefore be able to count on greater protection. Euthanasia should therefore remain limited to a state of emergency and should only become possible if doctors have received adequate training in palliative care and euthanasia. Ms. Colen advocates the right to good palliative care. As a result, according to her, the demand for euthanasia can decrease sharply and, according to some, even disappear. The absolute value of human life must be prescribed. This design gives doctors the right to kill. The legislature wants to legalize euthanasia at a time when the economic pressure on health insurance is increasing. In fact, scarcity leads to selection. The fundamental ban on killing should not be undermined. Our society is so plagued by materialism and by the inability to stand still with existential questions of life that people no longer feel how to deal with a dying fellow man who is driven to despair precisely by this.

President Erdman responded to some of the comments. Thus, with the declaration of will, he wants to avoid decisions being made by family members of the patients without them being able to express their own opinions. As for non-terminal patients, he points out the fact that the procedural rules are more severe when the patient’s death does not occur in the short term. In such a case, a month must pass between the request and the execution of the euthanasia. This period of consideration provides a number of guarantees. He notes that there is a consensus to discuss the issue of euthanasia. This shows that there is a problem that needs to be solved in some way. Their

However, the text adopted by the Senate is not perfect and will not definitively conclude the debate.

According to colleague Van Parys, it is the task of the legislature to reconcile conflicting ethical views. In ethical matters, a regulation can only be accepted by people when they can find themselves largely in it. The euthanasia law should not be a political retaliation. The protests of some colleagues pointed in that direction, he said. He gets the impression that the majority says it is now or never. Against the absolute criterion of the right of self-determination lies the question of whether the autonomy of man is not limited by the gift of death. The approaching death brings with it many uncertainties and doubts. That makes the criterion of the patient’s will to decide on euthanasia swing. With regard to the emergency cry of the suffering and dying man, all actors must come to the greatest possible consensus. The will of the patient as a decision criterion is contrary to the circumstances and capabilities of the man who is dying. The question of euthanasia is often not so much a request for euthanasia but a request for help, a cri du coeur. It is often a request for help, an emergency cry from loneliness, a request for guidance. We must decode what the patient’s real intention is and filter out incorrect questions about euthanasia.

A recent scientific study shows that in 40% of deaths deaths were caused by a medical intervention that shortened or even ended life. Euthanasia at the request of the patient itself is highly exceptional,only in 1.1% of cases. The other important decisions at the end of life also raise important questions. In the classical sense of the concept of euthanasia, it refers to people who are dying. In the bill — still according to colleague Van Parys — this concept has been given a new meaning: it is about people who want to die. For non-terminal patients, this applies exclusively to the subjective fulfillment of the patient himself. By linking the termination of life to a certain quality of life, a fundamental ethical problem arises. This can lead to certain life forms that are no longer worthwhile. According to him, a preliminary declaration of will can never describe a concrete emergency. One is never certain that the free will as expressed in the declaration of will is still equal to the will of the patient at the moment when he can no longer express it.

For CD&V, according to colleague Van Parys, the alternative is only that of the emergency state. In extreme situations, euthanasia can be the ultimum remedy. By criminalizing euthanasia, the exceptional character of the euthanasing act is safeguarded, an ultimate guarantee against abuse remains, the normative character of the criminal code remains ⁇ ined and the supervision by the prosecutor remains ensured. Euthanasia must be subject to effective social control. According to him, in the bill, the prosecutor’s office is out of play and, in the absence of information, control over the application of the law will be lost. Furthermore, the qualified majority ensures that no file can be transferred against the will of the doctors or against a major ideological current.

The Minister of Justice responded that the authority of the prosecutor’s office to prosecute crimes is not affected by this bill. If the Federal Control and Evaluation Commission decides not to file a case of application of euthanasia with the Prosecutor’s Office, the Prosecutor’s Office shall retain the possibility to conduct an investigation on its own initiative or after reporting a alleged crime or not. The general rules of the Code of Criminal Procedure and the general legal principle of the opportunity of the criminal proceedings apply, according to the Minister, unabated. Their

There are concerns with the Statute of the Committee. Questions are also raised regarding Parliament’s control rights. The Senate has, according to the colleagues, opted for the inclusion of various actors of different philosophical and philosophical backgrounds in the committee, and the special majority was, according to the applicants, necessary for the attachment and aims to ⁇ the widest possible consensus.

Following this general discussion, several experts were heard at the request of several parties. There has been an extensive exchange of views with them on the topics that have been addressed here and which will also be cited by the colleagues in the discussion of the articles of this draft law further extended.

Mr. Speaker, Mr. Minister, Ladies and Gentlemen, I would like to thank the Secretariat of the Committee on Justice and Public Health for the excellent report. It is my task to give you a brief report on the article-by-article discussion of the draft law on euthanasia. The Justice Committee spent three days on the article-by-article discussion. Article 2 sets out the definition of euthanasia. On Article 2, three amendments were submitted. These amendments are mainly related to whether or not to include the crime of euthanasia in the criminal code. Another amendment aimed at refining the definition of euthanasia so that it would not be subject to any interpretation and also intends to make the bill in accordance with Article 2 of the European Convention on Human Rights. A third amendment also wanted to define the concept of aid in suicide. None of these three amendments were held. The article itself was adopted with 10 votes in favor and 6 votes against. Another amendment to introduce a new article 2bis that would include palliative care as a basic right in the law was rejected with 11 votes against and 2 votes in favour.

Article 3 then specifies the conditions under which euthanasia can be applied. There were 29 amendments to this article. The scope of the various amendments can be summarized as follows: one amendment was intended to define the aid in suicide, another amendment was intended to include the state of emergency in the law and to include euthanasia itself in the criminal code to emphasize the exceptional nature of euthanasia.

Other amendments aimed to introduce additional conditions such as ‘terminally sick’, ‘perspective situation’ and ‘no other way to relieve pain’.

In addition, the amendments provide that the patient should be able to judge with full knowledge of matters. It was also proposed to remove the concept of "psychological suffering". There was also the possibility that the doctor would be assisted. Subsequently, an amendment was submitted to include an additional condition in the law that the patient must be informed about the possibilities of palliative care. Another amendment concerns the role of the general physician, which should be made very important. All 29 amendments were rejected. The entire article 3 was adopted in the committee with 10 votes for and 6 votes against.

Article 4 deals with the declaration of will, the conditions which it must meet and also the duration of its validity. 20 amendments were submitted to that article, including the removal of the article. Following this, there was a discussion in the Justice Committee on how to work in the committee. There was criticism of the fact that so few answers were given to questions that were asked. One member responded that the texts could no longer be amended because the law would otherwise have to be returned to the Senate, wasting too much time. The discussion of the amendments continued. Amendments were submitted with the following objectives: an amendment providing for a ban on euthanasia for disabled persons, a ban on euthanasia for pregnant women, an amendment to respond to the comments of the State Council, an amendment providing for the King a not too extensive authority to draw up the specific modalities of the declaration of will. Other amendments provide guarantees for the correctness of the declaration of will. Other amendments also respond to the comments of the State Council and explicitly stipulate in the law that the physician cannot be obliged to set conditions for passing to euthanasia, and to the comments made during the hearings. None of these amendments are accepted. Article 4 is finally adopted in the committee with 10 votes for and 6 votes against.

Article 5 relates to the declaration. There are two amendments to this article. First and foremost, there is an amendment aimed at involving a doctor who specializes in forensic medicine. The question was also asked in the committee which sanction will be attached to non-compliance with the declaration obligation by the doctor. No response was given. An amendment to provide for a specific sanction is subsequently submitted. Article 5 was also adopted with 10 votes for and 6 votes against.

Article 6 relates to the Audit and Evaluation Committee. Six amendments were submitted. An amendment aims to require members of the committee to meet certain competencies. The Commission is also clearly defined. It is stipulated that the members of the committee must be independent. The procedure is further defined and the manner of discussion is also outlined in other amendments. Those 6 amendments were also rejected and the article relating to the Audit and Evaluation Committee was adopted by 10 votes in favour and 6 votes against.

Article 7 relates to the registration document. A total of 12 amendments were submitted. Some amendments provide for transitional provisions, while others provide for additional safety requirements for people who are unconscious. It is also requested to include in the opinion an additional mention of all persons who were consulted. No amendments were adopted and the article was approved.

Article 8 relates to the discussion of the committee. Eight amendments were submitted, including to adopt the unanimous opinion of the Committee on Public Health. This is about the fact that the treating physician should have the opportunity to be heard in the committee in relation to a matter that concerns him. In addition, the submitted amendments aim to retrieve the two-thirds majority to be achieved in the committee. On the other hand, it is also proposed that the file is automatically sent to the parket. Article 8 was adopted with 10 votes for and 6 votes against.

Article 9 relates to the annual report to be submitted annually by the committee to the legislative chambers. Three amendments were submitted, including that the annual report should also include proposals and recommendations on how to prevent preventive euthanasia. Article 9 was also approved by 10 votes for and 6 votes against. Their

Article 10 relates to administrative support. No amendments were submitted. Their

Article 11 relates to the means of operation. Their

Article 12 relates to the professional secrecy and the deontology of the committee members. Many questions were raised regarding the scope of this article and the limitation of the jurisdiction of the criminal judge. There were no amendments. Article 12 was subsequently approved with 10 votes for and 6 votes against. Their

Article 13 relates to the discussion of the annual report in Parliament. An amendment was submitted to link measures to the discussion. This amendment was rejected and the article was adopted. Their

Article 14 states that no doctor can be compelled to commit euthanasia. An amendment was submitted to provide that euthanasia is not a right. The article was adopted, the amendments rejected.

An amendment was submitted to introduce Articles 14bis and 15bis concerning the inclusion in the Criminal Code of the specific crime of euthanasia.

Article 15 of the bill stipulates that a person who dies by euthanasia is considered to have died a natural death. Amendments relating to life insurance and a number of technical legislative amendments to meet the comments of the State Council were not accepted. The article was approved.

Article 16 relates to the entry into force. An amendment was submitted to link the entry into force of the law to the operationality of the Act on Palliative Care and the Law on Patient Rights. This was rejected. The article was adopted.

In the statement before the vote as a whole, the CD&V group regrets that the majority parties will accept the text from the Senate unchanged to the absurd extent. However, the CD&V group has attempted to constructively adjust and improve the articles. The PSC also stated in the declaration before the vote that, provided that certain conditions are met, it is not against euthanasia. The PSC faction has tried to adjust the faulty law, but without success. She therefore declared to vote against. The Flemish Bloc group also regrets the law on euthanasia. This law is inhumane and involves great risks. The speaker stresses that pertinent was refused to work in a joint committee with Justice and Public Health out of fear of criticism from the majority. Also Mrs Van de Casteele considers the law a missed opportunity. The SP.Afractie emphasizes that every text is subject to improvement. Ethical problems are so evolutionary that they cannot be contained in legal texts. The debate will not be done after the vote. Finally, there is a vote on the whole. The whole law is adopted in the Committee for Justice by 10 votes for and 6 votes against.

Mr. Speaker, in my turn, I would like to thank the services of the Justice Committee for the very important work they have provided and which today allows us to make these oral reports.

As agreed in the organization of the work, this report deals with the discussion of the articles of the bill on palliative care submitted by the Senate.

From the beginning of the discussion of the articles, the chairman of the committee recalls two important elements, namely that: - the Senate, contrary to what it had proposed, has decided not to include the issue of palliative care in the draft law on euthanasia but rather to make it the subject of a special law; - the regulation in the draft will only partially regulate the matter since the Committee of Public Health is brought to consider this problem in a more comprehensive way, with other draft and proposals of law as well as proposals of resolutions being submitted.

In particular, I would like to refer to Article 2, which has brought about a number of remarks. In fact, this article 2 of the bill is essential because it establishes the right of every patient to receive palliative care as part of the accompanying end of life. It guarantees equal access to such care through social security mechanisms. It defines palliative care as a multidisciplinary set of care to be provided to the patient once his illness no longer responds to curative therapies and risks resulting in death, in order to guarantee the quality of life of the patient and his family.

As I said, the reactions about this article have been numerous but they all have one thing in common: they consider, for various reasons, that it is not going far enough.

Ms Colen considers that it must be made a fundamental right arising from Article 23, §2 of the Constitution. He submitted an amendment in this regard.

by Mr. Goutry believes that this text, in the form of a law, looks more like a resolution, that it does not provide for actions to be undertaken to improve the supply of palliative care, that it is limited to patients at the end of life and that finally, the text does not address the problem of the lack of access to highly expensive techniques for patients left at home. This last point is also the subject of an amendment.

The chairman of the committee responds to these various arguments, in particular with regard to the usefulness of the text. He recalls that this is probably a transitional one since a project on the rights of the patient is to be presented soon and that a debate on palliative care is still to take place in the public health committee.

As regards the definition of the limitation of access to palliative care, it should be clarified that while the first subparagraph of Article 2 provides that every patient must be able to receive palliative care as part of the accompanying end of life, it does not exclude that these can also be provided to other patients. Palliative care does not only target patients at the end of life.

Finally, with regard to the right to palliative care that the bill recognizes to patients, the usefulness of this recognition is obvious, says the president. Even if the draft would be interpreted as a set of directives without immediate normative scope, it will allow parliamentarians to put each minister before his responsibilities and, when discussing the budget, to demand that it allocates sufficient funds for compliance with the provisions of the law.

The debate on end-of-life and palliative care is far from over. The law does not provide a definitive solution to the problem, but rather a first response that may be improved later.

Some, however, believe that the definition of palliative care should be revised. by Mr. Erdman repeats that Article 2 must be understood as allowing end-of-life patients to benefit from palliative care without, however, being limited to these people.

The opinion of the Public Health Committee explains and clarifies these articles by confirming that they are obviously not limited to end-of-life patients. In other words, care may be provided to anyone who needs it, but end-of-life patients are entitled to it anyway.

Following this discussion, the Vlaams Blok submits an amendment proposing a new article 2bis. CD&V, on the other hand, proposes a new definition consistent with that of the WHO.

Article 3 does not give rise to any discussion. In accordance with Article 4, Mr. Arens proposes an amendment that specifies the elements to be included in the progress report that must be presented to Parliament by the ministers who have Social Affairs and Public Health in their duties.

Article 7 consists of the right of the patient to be informed about palliative care and his health status. This article gives rise to a discussion about patient rights. For CD&V, patient rights must be defined as part of a comprehensive and coordinated approach that will result in a law on patient rights. He regrets that this law is still lacking. It would have been more logical if the debate on patient rights had preceded the debate on euthanasia and palliative care. The Chairman then notes that the regulation developed in the framework of the bill under consideration contains a series of principles that will be specified in the bill on the rights of the patient. These two bills have a specific purpose, there is no need to link the vote of the bill at the examination to that of the bill on the rights of patients. by

During this discussion on information, the Vlaams Blok presents an amendment aimed at explicitly providing in the law the necessity and obligation to inform patients. The President then points out that the bill on the rights of the patient goes even further than the amendment that is being considered. by Mr. Laeremans once again pleads for the examination of this problem as a whole but the President ⁇ ins that it is better to give priority to the general regulation since it can be adopted in a short time. Otherwise, it would have to wait for the vote of the bill on the rights of the patient, which examination is only in its first phase. by

Finally, the review of the articles was followed by a debate on the financing of palliative care. Several colleagues believe that limiting the home palliative care package to thirty days, renewable once, is too restrictive. by Mr. Goutry and consorts, in particular, propose the possibility of repeating this intervention six times. Another amendment by the same authors proposes to give the patient’s relatives the opportunity to request an intervention, limited to one month, after the patient’s death. by

Other colleagues reject that the funding cannot be settled until the costs have been estimated and that, even if the twice-thirty days are exceeded, the ordinary home nursing scheme is applied without restriction. They add that in the future, it is not excluded to switch to a three-month intervention. Finally, the president considers that it is unusual that the compensation granted to the patient is transferred to relatives after his death.

At the end of these discussions, all submitted amendments were rejected and the bill was voted without amendments by 10 votes and 6 abstentions. by

I have tried, Mr. Speaker, to account for the major issues that were raised during the discussion of these articles. The fullness of the exchanges is evidently found in the written report, which I invite all my colleagues to consult.

Dear colleagues, we have thus concluded with the reading of the reports on these different projects and proposals, and I thank the rapporteurs for their work. Twenty-eight speakers are included in the general discussion.

I suggest listening at least to Mrs. Schauvliege and Mr. Arens this morning. Per ⁇ another speaker will speak this morning. I will ask Mr. Henry to replace me later, during the Conference of Presidents, and to allow the meeting to continue until 13 o’clock. Then, we reprendrons our works at 14.15 hours.

Mrs Schauvliege, Mr Arens and ⁇ another third colleague will speak this morning.

We will see where we are about. Ms. Schauvliege has the word.

Mr. Speaker, let it be clear to everyone: also CD&V considers unnecessary suffering inhuman, also CD&V considers that there should be a legal arrangement for euthanasia. However, we disagree with the way this law was created and with the conditions included in the draft. With this design, the majority parties do "crocket policy": put money into a machine and a croquet comes out. Make an euthanasia request and there will be euthanasia.

We have always been willing to work with an arrangement and consensus. In the majority, however, there was a manifest unwillingness: this law had to become a political purple-green pamphlet and this at the expense of sound legislation based on a broad social consensus. The result is disgusting and opens the door to abuse. The debate completely ignores the medical reality. Euthanasia does not stand by itself and does not stand apart from the rights of patients. To date, there is no legal regulation for these rights. The majority would like to play the piano, but the keys are missing; they have not even provided the keys.

A global regulation of medical operations at the end of life also did not occur. The disagreement within the majority had to be covered up.

For CD&V, there are five major obstacles in the bill, which make the draft unacceptable. First, it is unacceptable that euthanasia is possible in a non-terminal phase. Second, euthanasia, according to the design, is possible in the case of pure psychological suffering. Third, euthanasia is possible in will-bearing patients. Fourth, we believe that in the design there are too few careful conditions. Finally, there is no separate criminal provision for euthanasia.

Allow me to go back in time first. The initiative for this parliamentary debate was already given in 1996 when the Presidents of the House and Senate asked the Bioethics Advisory Committee for an opinion on the desirability of a legal regime of termination of life at the request of an incurable sick person, i.e. euthanasia. The Advisory Committee issued two opinions. The first concerned the deliberate end-of-life act by a physician, at the request of a patient who is in a prospective situation. The committee presented four possible solutions; the members of the committee could find themselves mainly in the third solution, which shows many similarities with the proposal that CD&V submitted at the time. In 1999, the Advisory Committee issued its second opinion on the termination of life in patients who are no longer able to express their will, the so-called will-being.

On the basis of the first opinion, a parliamentary exchange of views took place in 1997 as a preparation for possible legislative work. This exchange of ideas was serene and remained largely out of the political waters. Since 1999, the political maps have been different. The Christian Democratic parties are on the opposition banks. However, that did not prevent CD&V from wanting to participate in a constructive way in the euthanasia debate. From the beginning of the ruling period, we have stated that we do not want to fulfill our mission as an opposition party in a purely negative way.

While the majority parties wanted to quickly pass an euthanasia law — initially it was even intended to finish everything in 2000 — CD&V always urged a calm approach to the problem. Legislation on a matter which is literally of vital importance should not be adopted for CD&V as a result of an accidental political majority. As a contribution to this debate, CD&V originally submitted its own bill. Moreover, CD&V advocated for hearings with people from the field, such as doctors, nurses, patients, ethics, lawyers and others, not as a delaying manoeuvre as the majority always anticipated, but as a basis for reaching a social consensus.

For CD&V, the regulation on euthanasia is not a private matter. It is not a simplistic choice of being for or against euthanasia. The society and the government as a representative of the community have a very important task in this regard. Their

You do not live alone, you do not die alone. Our pluralist society has rightly led to the fact that even on the most essential principles such as life, death and death, there are sometimes different opinions. The government is the guardian of law and order, but the government must also ensure the organization of solidarity between citizens. The State and the rule of law are a roof on the house of the community. It is therefore a primary task for politics to develop a common framework of civilization in which many recognize themselves and which can serve as a social guidance.

Political decision-making is ⁇ not a neutral scientific activity, but relies on choosing between ethical principles that may be in conflict with each other. One can give priority to the patient’s right to self-determination, one can also give priority to human dignity or respect for human life. The legislation should try to reconcile this with each other.

The fact that the debate on this issue was first held in the Senate had a special significance. It expected that the discussions, without denying the contradictions, would be conducted in a business and serene manner, where everyone could present their arguments and where these arguments were also listened to. In other words, it held the expectation that the conversation would not be conducted on a party-political basis.

It is normal that the legislator, when he has to make decisions in the ethical domain, is confronted with different views. However, it does not testify to a good policy when, in the decision-making process, one of these views is undoubtedly chosen and the other one is undoubtedly dismissed. Indeed, it is his responsibility that in such matters a maximum loyalty of the public to the regime in question is sought. This means that the different views that live with the population are integrated as much as possible into the arrangement.

The response from the various civil society groups to the debate held in 1997 was very positive, partly because many had the impression that a comparison across the various groups was among the possibilities. Within the political world, there was also the will to reach such an agreement. Ultimately, a consensus arrangement was not chosen because a part of the current government majority did not see the development of an euthanasia arrangement in concert with CD&V.

The question, however, is whether the public opinion wants the debate to be conducted in such a way. On the contrary, the signals from the various layers of society indicate the desire to conduct the discussions in the broadest possible context. Organizations and associations that give meaning to life are marginalized and thrown into the corner. A significant portion of the population is no longer taken into account, which can have negative consequences for social cohesion.

Also in the House of Representatives, no effort was made to reach a consensus.

First and foremost, there was the ⁇ peculiar option to address the draft on euthanasia and palliative care in the Justice Committee. The opposition from the majority itself to address these draft projects in a joint committee for Public Health and Justice — which is the logic itself — was remarkable. It may be unique in the history of this Parliament that the Justice Committee has to discuss a draft on palliative care. The reason for this is that members of the majority who, from their own experience, are critical of this draft, happen to be part of the Public Health Committee. The majority was afraid of surprising votes.

The Public Health Committee should give an opinion. The discussions in this committee were constructive. The opinion was unanimous in certain points and apart from the drafts presented here for discussion. These unanimous opinions were wiped out under the mat in the Justice Committee. No amendment that meets those unanimous opinions was accepted. These amendments, however, were correct and correct translations of what had been accomplished in the Committee on Public Health — across party boundaries, majority and minority. There is even more. Some members of the Public Health Committee were put under pressure and later in the Justice Committee even returned to previously held positions.

I have another second evidence that in the House of Representatives and the Committee on Justice was not sought to reach the widest possible basis and consensus. There was no serious debate in the Justice Committee. Many questions were not answered. We were just talking against a wall. The majority did not even want to make the effort to remove some legal uncertainties, even if it was just by giving a clear answer that can be included in the report. The search for consensus was obviously not in question. The text should be adopted as soon as possible, unchanged. Collega Valkeniers said during the discussion without shame, as we know him, that there were instructions to no longer accept any amendment because otherwise the drafts would have to be returned to the Senate. Otherwise, too much time would be lost. It is clear that the majority of the euthanasia scheme has created a symbolic file. This is bad for the law. Even the purely technical-legal amendments — for example to respond to comments from the State Council, to ensure that the law is consistent with the principles of treaty law or with the Constitution, or to correct an error when referring to a no longer existing law — were all voted against. Is this the new political culture? The government is constantly talking about a style break with the past. I am convinced that this was a piece of a style break. There was a clear reluctance to conduct a good debate and to seek consensus.

The proposers of the draft often laugh at the possibility of consensus because the ethical contradictions would be too big. They do this wrongly. Ethical contradictions are transcended by a well-balanced system. From the very beginning, the CD&V group has sought such consensus. We are not the party of suffering. We are also in favour of an euthanasia scheme, but there are too many legal imperfections in the draft. With more legal certainty, a consensus would ⁇ have been possible.

After the Senate vote, we had false hopes. We thought that something else could be addressed. After the vote in the Senate, supporters, who had previously voted in the Senate, cracked back. Members of the Green Group approved the draft in the Senate, but later also saw the need for a palliative filter.

President: Jean-Pol Henry, Prime Minister and Vice-President. President: Jean-Pol Henry, First Vice-President Similarly, Senator Vankrunkelsven: earlier he had voted in favour, but not a week later he had a particular difficulty with the fact that the law also applies to non-terminal patients. Consequently, one would think that by leaving some time on it, certain insights would have grown. However, the discussion in the Justice Committee quickly caused a ⁇ cold shower. A law is now seen as a political pamphlet and does not think about its consequences. Let it be clear that we were open to a consensus, for a legal arrangement of euthanasia.

Mr. Speaker, Mr. Minister, Ladies and Gentlemen, I would like to talk about the missing framework. I think the debate was too tight. It should have been much wider. In fact, there is still no regulation on patient rights and there is still no regulation for all medical decisions of the end of life. You cannot play the piano without a partition. Well, the partition is not present; a partition is not even thought of.

First and foremost, we still do not have a regulation of patient rights in Belgium. The debate here was too limited. The present draft was to be preceded by a parliamentary discussion on the legal establishment of patient rights. A global law on the rights of patients provides an excellent framework for the further development of rules, both for specific situations as for example for medical-guided conception, medical experiments, as well as for specific categories such as minors, mental illnesses, prisoners and patients in a medical-impaired situation. That patients’ rights are now being discussed in the Public Health Committee, the world is on its head. The regulation on patient rights now comes after the law on euthanasia. In this way, the laws are not aligned. They are even completely contradictory on certain points. The euthanasia law thus enters a legal vacuum.

Can anyone tell me what a medical record is? What is a Will Decision? What is meant by a trust person? It will later be included in the Patient Rights Act. These are matters these are now not regulated and which, however, are often used in the present design.

The second proof that for us the debate was conducted far too limited, that it should be seen in a wider framework, is the fact that there is still no regulation for all medical decisions at the end of life. Euthanasia is just one of the possible medical decisions at the end of life. Acts, such as assistance in suicide and other medical acts with life-cutting consequences, fall outside the scope of the draft law and thus remain in a shimmer zone. Also in the opinion of the Council of State it is pointed out that there is a criminal law ambiguity by regulating certain acts and simply not regulating others. This creates the possibility that there is still a sliding path and that another alternative will be used.

Many witnesses pointed out that the euthanasia issue is in fact only the tip of the iceberg. The hearings and the sometimes Babylonian speech confusion about the concept of euthanasia show that euthanasia, death accompaniment and palliative care are not clearly defined legal concepts. In actual medical practice, they are not always distinguishable from each other. It is precisely for this reason that the euthanasia legislation must primarily pay attention to the decision-making that precedes the aforementioned actual medical acts, the so-called MBL, medical decisions regarding the end of life. For example, it is about pain control with life-shortening consequences; it is about stopping or omitting a medical action. This global framework, which was an important contribution of the Bioethics Advisory Committee, has completely disappeared in the majority proposal. Also, the results of the Deliens study show that a large proportion, 40% of deaths, is preceded by a medical decision. In Flanders, about 4.3% of people die after the administration of lethal drugs, compared with 2.9% in the Netherlands. It is also clear that in Flanders more people than in the Netherlands themselves request the administration of lethal drugs.

From these findings, it can be inferred that there is an urgent need to regulate euthanasia, to give people the opportunity to officially request the administration of those lethal drugs.

In addition, the study also raised the question of the improper use of medicines that ultimately lead to death. It involves the administration of overdoses of morphine or pain relievers without a request from the patient. The results of that study illustrate that this happens more often in the Netherlands than in Flanders: 16% in the Netherlands versus 5.3% in Flanders. Despite the legislation on euthanasia and the drug policy in the Netherlands, this makes a difference of 11%. These figures clearly prove that, when one only regulates one aspect of the end of life, the other should also be regulated otherwise the problem simply shifts. The notification obligation is simply bypassed by driving on a parallel road. This is not discussed in the draft law. Therefore, there is a clear link between euthanasia decisions and other medical decisions. Despite the arguments and statistics, the CD&V amendments were simply rejected.

Is such control consistent with the determination of the decision-making between doctor and patient? That is what some people ask. Confidentiality is indeed an important principle in our medicine. Nor can it function without society having confidence in the medical corps. We agree, but that trust cannot be unlimited. It is noted that, for example, the government has developed a comprehensive device and is now further developing to control the prescription behavior of doctors within the framework of health insurance. In such an important area as the decision-making at the approaching end of life, monitoring of medical operations is therefore necessary. The principle of self-determination requires that the patient knows what is happening to him, that he participates in it, and that the medical decision-making is much more transparent. Ensuring that transparency in medical practice is therefore also another important objective of a legislative initiative. The current bill is ⁇ fraud sensitive. The protection of human rights against medical action in the final stages of life.

Mrs. Schauvliege, I apologize, but Mr. Decroly asks for the word.

Our discussion began at about 1 hour 30 minutes ago and I listened attentively to all the remarks that have been held since the beginning. For about twenty minutes, I have heard Mrs. Schauvliege give us a series of elements that seem extremely precise about the debates that took place during the review of the projects in committee.

However, what annoys me about how I work today is that Ms. Schauvliege may not have a response because the ministers concerned – Justice and Public Health – are not there. Such a matter demands parliamentary dignity. Therefore, the least thing would be that these ministers attend the debate, listen to the questions posed by parliamentarians, whose work has been the most serious, and give them an answer. Government accountability before a parliament also involves listening, being present and responding.

You have closely followed Ms. Schauvliege’s speech. On the other hand, I see that the government is present. He will therefore have the opportunity to respond in due time.

Mr. Speaker, I wish once again to fully join Mr. Decroly’s remarks. I would like to ask if the presence of one of the two ministers has been announced. A lot of concrete questions are being asked here today. What is happening here now is an illustration of what has taken place in the committee, namely that we have spoken against walls. With all respect to Minister Daems...

Minister Picqué is also present.

Mr. Speaker, Mr. Daems has nothing to do with this whole matter and he cannot be expected to answer.

I assume that the government is present.

This is formal.

Mrs. Schauvliege, I give you back the word.

Mr. President, I ask for the word.

Mr Leterme, do you have the same question?

I ask for the word in relation to the arrangement of the work. You will have to miss your truck box.

Mr. Leterme, I want (...) That is ⁇ not my intention.

I ask for the word for the rules of procedure. You must give me the word.

I give you the word.

Mr. Speaker, Minister Daems was fleeing to the Conference of Presidents. We are waiting for Minister Picqué to come in. It would indeed testify to some decency if the functionally competent ministers of Public Health and Justice came to the House and also answered the questions for clarification and took a position from the government.

I therefore formally ask that the Ministers of Justice and Health, as colleague Decroly correctly noted, be asked to come to the House and do their job here.

They will definitely be present later. I would like to say that the government is present.

I can understand your point of view, but one cannot require a minister to be constantly present.

Two ministers are present today.

Mr. Speaker, I asked a year ago — Minister Daems will remember — when discussing a program law on a small provision in the telecommunications sector, for the sake of economic importance a very clear answer in the plenary session on unanswered in the committee. Mr. Daems then came to the Chamber in all kinds — he was in Paris. He gave us an answer here. That answer contained all the information we had asked for. What could be for the telecommunications sector, apparently cannot be in a matter of life and death.

They may report to the competent minister and the competent ministers will respond to it. At least I hope that. I think it is normal that the competent ministers will respond to this. Two ministers are present today. You can talk further. I am still the master of the work, if you allow me to do so. Two ministers are present today and the competent ministers will respond.

I respect the sensitivity of my colleagues. It is not always practically possible for the competent minister to be present at any given moment. The example that Mr. Leterme gives is a right example. I actually came to the Room to answer the questions. I have understood that in this debate questions are asked and concerns are made for a certain period of time.

for two days.

These questions are submitted to the competent Minister. We are here to send the concerns to the competent minister. He will of course answer them.

I think we have received a response from the government and that we can continue the discussion. If you do not wish to speak, I give the word to the next speaker. For me, this issue has been solved.

The debate is too important to be treated in this way. I thank the two ministers present and especially Minister Daems, who is a great friend, but it is not he who manages this matter.

The Minister of Justice, Mr. Speaker, in the Justice Committee has himself asked a series of questions. That is why his presence here is essential.

It is an opinion. The opinion is not shared, I regret it and the relevant ministers will respond. We won’t talk about this for half an hour. Please continue on!

Mr. Speaker, I am going on. As I said earlier, the bill is ⁇ fraud sensitive. Protecting the patient’s rights to medical treatment in the final stages of life is entirely impossible if this problem is reduced to a regulation.

( ... ...

Mr Decroly, you are on the list of speakers. You will have the opportunity to express yourself soon. We must not prevent people from speaking. Everyone can have their own opinion on the government’s attitude.

Mr. Speaker, I have just asked a number of punctual questions. I asked, among other things, what is understood under the trust person and under the medical record and what is a will-of-will decision. I hope that the competent ministers will come today to answer this question. I have never received an answer to this. (Rumeurs dans la salle) (Rumeurs dans la salle) The protection of the patient’s rights with regard to medical intervention in the final stages of life is entirely impossible if this problem is confined to the system of euthanasia. With the approaching end of life, many medical decisions are made that are beyond euthanasia and are not controllable without a solid legal framework. The current bill floats in a legal vacuum. It was removed from a context from which it could not be removed. It is the logic itself that the more general is arranged first before the work of the specific is made. Here they do exactly the opposite. You want to regulate euthanasia, but there is no framework, there are no foundations. Without patient rights and without a global regulation for all medical decisions at the end of life, there is no legal guarantee for recurrence.

As I said in my introduction, the bill for the CD&V group is inherently unacceptable on five major points. First, it is impossible for us that euthanasia is applied in a non-terminal phase. Second, it cannot be that euthanasia can be applied to purely psychological suffering. Third, euthanasia cannot be applied to will-bearers. Fourth, there are insufficient precautionary measures in the design. Fifth, the fact that there is no provision for euthanasia in a separate crime is also a big obstacle for us.

First, euthanasia can also be applied in a non-terminal phase. CD&V has great objections to the extension of the regulation to persons who are not in a death stage. Unlike palliative care, which must be accessible to everyone and which is not limited to the end of life, euthanasia can only be discussed in the terminal phase. If not, we transcend the limits of medical necessity and reaffirm the right of anyone who is no longer sick to give an order to end his life. The draft law extends euthanasia to patients who are not in a death stage, while euthanasia in the meaning that society has always given to it and still indicates it is only about the suffering patient facing the approaching end of life.

The draft law extends euthanasia to patients who are not in a death stage, while euthanasia in the meaning that society has always given it, only and only concerns the suffering patient who is faced with the approaching end of life and the conclusion that the doctor with the medical resources he has at his disposal can no longer act sufficiently to ease the physical pain of the patient. The draft law thus goes beyond the limits of medical necessity. It is actually a legal regulation of the right to assistance in case of suicide.

The draft law sends a completely wrong signal to society. People who find themselves in a difficult situation in their lives are affirmed in their self-image and have a right to euthanasia. That signal works self-enhancing and will give rise to very unwanted social consequences. The society should give the opposite signal and say that life is also very valuable and can be fulfilled meaningfully. Society must therefore provide the necessary means to give meaning to their lives to people who are no longer psychically seated and who are not terminal. The text will create a sloping plane, as demonstrated by the Dutch evolution that has systematically expanded the possibilities for euthanasia, for example, even to patients with untreated depression. After all, concepts are going to lead their own life, even though they are legally established.

The result of the bill is that the protection of life is linked to its quality. It begins with the individual’s belief that the quality of one’s life has been so weakened that it needs to be put to an end. When such reasoning becomes common and one becomes convinced that ending life is an acceptable solution for such situations, the next step is that policy takes indirect measures that are tailored to them. For example, we think of funding in healthcare. There is a difference between the value of a person and the subjective sense of value. People may feel worthless, but are these people therefore worthless for our society? I do not want to make polemical links, but everyone knows from the history of the twentieth century that a number of classes who were persecuted by certain systems have eventually found themselves worthless. Because of social indoctrination, they could no longer imagine being still valuable. Even today, there is a certain social indoctrination, even if it was only through the visual representation of what happiness is. This, of course, does not mean that we must address questions concerning the listening of the person. We must give an adequate and human response.

The proposers of the draft say that more procedural guarantees are provided for the non-deathing patient. Thus, a mandatory one-month consideration period is provided between the request and the effective execution of the euthanasia. The bill applies the laws of market analysis to solve an ethical issue. The application for killing is equated to the purchase of a vacuum cleaner. If one has ordered impulsively at home, one gets a short reflection time. Therefore, it remains there. For both categories of patients, terminal and non-terminal, there is a difference in the procedure but the material criteria for depenalization are the same. Can one seriously say that being sick in a terminal phase and being sick in a non-terminal phase mean the same? It is not excluded that a disease that is at one point out of sight is perfectly curable a few years later.

What is the difference between terminal and non-terminal? Based on what criteria will this be decided? The proposal of the group leaders of the majority parties does not provide any support in this regard. It should also be noted that there is a lack of intellectual logic. The majority asserts that the term terminal cannot be defined or that it is irrelevant, but on the other hand they provide for a different procedure for who is terminal and who is non-terminal. As far as our comments relate to the unacceptable fact for us that non-terminal patients are also eligible for euthanasia.

Another important point for us is that euthanasia can also occur in the case of pure psychological suffering.

The bill states that mental suffering is sufficient as a prerequisite for allowing euthanasia. This cannot be for us. The subjective dimension of mental suffering is far too broad, and one opens the door to abuse. For the doctor, it is almost impossible to estimate the severity of mental suffering. In addition, the will of mentally ill people is often not unambiguous, and depends heavily on the moment.

There is also a lack of any medical context. Depressed and psychiatric patients, dementia, Alzheimer's patients, can not be counted into the scope for us. Everybody comes into a situation where they believe that psychological suffering cannot be alleviated. However, it is completely unacceptable that such a situation could give rise to euthanasia. Therefore, the CD&V group has submitted several amendments to remove mental suffering from the text to ensure that depressed and psychiatric patients, dementia and Alzheimer’s patients are kept out of the scope. The Committee on Public Health has also given a unanimous opinion on this issue, across the boundary between majority and opposition. In the Committee on Justice, however, the majority refused to accept the amendments in question.

The implications of this bill are truly frightening. This is especially the case since the bill also allows for non-deathing euthanasia. Then we come to the thought track in which disabled persons who are mentally suffering will also fall within the scope of the law.

A third major obstacle for us is that the bill lacks the most essential condition for euthanasia: the free will of the person concerned. After all, euthanasia can, according to the design, also be used in people who are willing. People who are unable to form a request for euthanasia can still be euthanized according to the draft. It is sufficient that they have drawn up a declaration of will earlier, up to five years earlier. We are positive about the possibilities offered by drawing up a preliminary declaration of will, but we consider that the request for active termination of life does not belong to that. Such a request presupposes a free will at the time of acceptance and not only at the time of formulation of the request.

The draft law makes it clear that a patient, when he is still healthy, can express his desire for euthanasia in a declaration of will in case he can no longer express that desire later. It is true that the decision a doctor must make from his medical assignment at the end of life is complex. In some cases, the patient is no longer able to express his will. For example, someone who is unconscious. The medical practice has a large arsenal of possibilities to adequately respond to these problem situations. However, almost all witnesses during the hearings agreed that a declaration of will may be an important element in making medical decisions, for example in palliative care or intensive care. For patients, such will-of-will also offers greater psychological comfort, greater transparency and protection certainty.

Therefore, the decision of will can also be understood positively. A patient can just as well register in his will that even when there is only 1 chance out of 100 that he will survive a certain procedure, the doctors who do the procedure should do it. However, we do not agree with a declaration of will that is about euthanasia. The declaration of will is often confused in the discussion with the declaration of euthanasia. It would have been better to develop a general legal framework for the declaration of will. That framework is currently not available, in part because there is still no global regime on patient rights. Such declarations of will also exist in other countries, even in countries where euthanasia is prohibited.

However, there is no euthanasia declaration in the present draft law, since it is not a medical act at all. A declaration of will for euthanasia is based on the free will of the person concerned. However, one is never certain that, at the moment when one can no longer express his will, this free will is still the same. It is impossible to give consent to marriage without knowing with whom to marry. Those who said three years ago that they never wanted a mobile phone may already have one in their pocket today. The rule of inform consent is completely set aside here. The doctor is reduced here to a death officer, an execution master who comes into conscience distress. There is no longer a question of the doctor and the patient who together decide on euthanasia or any remaining solution. Professor Schotsmans rightly spoke of the declaration of will as the cold death on paper. The decision-making on the end of life is too important to be approached in a bureaucratic way based on a simple written piece of paper.

We have also demonstrated that the arrangement of the declaration of will to euthanasia does not imply supervision, openness and controllability, among other things because a second doctor should only check whether the unconsciousness is irreversible. Furthermore, the risks of social and economic pressure continue to exist, both from the witness in the declaration of will and from the trust person who is allegedly voluntarily designated. It is also possible that, for example, the hospital itself is indicated as a trust person for the execution of the declaration of will. Here is the picture of the death clinics. Their

Finally, it is not clear why for patients who are no longer conscious there are less stringent conditions than for patients who are conscious. After all, judgment here is based on a piece of paper and not on a real expression of the patient’s will. The testimony of Mrs. Henri of the Alzheimer's League apparently convinced none of the majority parties. Can one imagine the social consequences of the option of removing euthanasia from the criminal code and legalizing the declaration of will so that one can determine that one does not want to go through, for example, Alzheimer’s disease? A will that cannot be confirmed so many years later? Can one imagine what social pressure arises to end the lives of a number of sick people indirectly by euthanasia? Or what pressure arises from society and the environment to make an explanation? After all, Mrs. Henri has very well described how someone who is confronted with the diagnosis of Alzheimer’s is destabilized, is not entirely free to judge normally and objectively and is therefore also very vulnerable and influenced. This is a law to be scared of.

A fourth major obstacle for us is the fact that in this design, insufficient care conditions are provided. The State Council correctly stated in its opinion that an euthanasia law is only compatible with Article 2 of the ECHR, which protects the right to life provided that the law provides adequate safeguards and incorporates an adequate control system. We consider that the due diligence requirements in the draft law are insufficient and that both the procedure a priori and the control a posteriori fail to provide adequate protection to the right to life. Their

What is specifically lacking in the a priori procedure is a clear and full-fledged palliative filter. The bill subordinates palliative care to euthanasia. Instead of making palliative care the possible alternative, euthanasia appears to be more important. Palliation is not considered a real treatment alternative.

According to the design, it is sufficient to point out the possibilities of palliation in the margin. It is part of a whole package of information that will be delivered to the patient. This, in our opinion, constitutes a disregard of the current possibilities of palliative care and of the involvement of so many professional and voluntary forces in palliation. Anyone in Flanders who deals with palliative care from far or near understands nothing of a bill on euthanasia without a palliative filter. Therefore for us, in addition to the consultation of another doctor and the nursing team, the advice of a palliative expert should also be obtained.

The question of euthanasia is an exceptional but often ambiguous question. A patient who is in a situation of physically unbearable and untreatable pain often expresses something completely different in his question of life termination than what he really means. A number of CD&V amendments call for the inclusion of palliative care as a social signal in an euthanasia law. It belongs to it at home given the necessary connection between the two concepts. A separate law on euthanasia, in fact, underestimates the complexity and reality associated with the approaching end of life. Also the well-known judgment-Chabot of the Dutch High Council stated that the government is obliged to offer palliation and that if the patient refuses palliation, it does not create for itself the emergency state that answers the question of euthanasia.

Article 2 of the ECHR also states that palliative care should be developed in response to the question of euthanasia. The replica that palliative care is regulated in a separate law does not convince. This rejects the claim that palliation is an alternative to the demand for euthanasia. By arranging palliative care separately, one rejects this test and simply becomes a choice. Palliation is then regulated in a law in which nothing is stated at all. It’s one of the many boxes we’ve seen passing here in parliament over the past few years. The image of the autonomous patient, which decides with full strength and insight, is repeatedly misrepresented after an explanation is given to him.

Mr. Speaker, I would like to ask a question on the effect of the judgment of the Court of Human Rights regarding the authorisation of termination of life in the United Kingdom. Per ⁇ the speaker can say something about it. What is the position of the Belgian government on this issue? I assume that Belgium considers itself bound by the European Convention for the Protection of Human Rights. The government should be able to formulate a position on this issue. Can the Minister give some clarification on this?

Mr. Speaker, I believe that Mr. Peter’s question was fully justified. In my argument, I will also refer to the judgment and the argumentation of the European Court of Justice.

I would like to comment on what colleague Schauvliege has formulated. I would like to ask the government for a position on the declaration of the Federation of Palliative Care. On Monday, they announced that they consider it absolutely necessary that a preliminary, mandatory palliative consultation should take place. Why is the Federation of Palliative Care of the opinion that this should happen? When one assumes the right of self-determination, one must, according to the Federation, be certain that that will is purified and authentic. What the patient wants must be really expressed. The Federation of Palliative Care believes that it is necessary that the doctor to whom the euthanasia request is made be obliged to consult a palliative expert, as colleague Schauvliege has said.

The Federation of Palliative Care is a pluralist organization. It is therefore important to be able to hear from the government whether it agrees to that mandatory, prior palliative consultation before one can switch to euthanasia.

I think this is a very crucial element in the discussion. I would very much like to hear the government’s position on this subject, on behalf of the CD&Vfractie and on the basis of the argument put forward by colleague Schauvliege, and now.

I don’t know if you will hear it now.

The Minister is present and is expected to be able to express the position of the Government.

I will do my best of my work, i.e. note what has been mentioned. I will then invite the competent minister to respond. The question of whether there would be a yes or no obligation of a prior consultation in the field of palliative care is a question that I cannot answer. And you know it well. But I will do my best to forward this question to the Minister.

Mr. Speaker, Mrs. Schauvliege has rightly brought into discussion a number of fundamental elements, including the fundamental problem of the need for a prior palliative consultation. It makes sense that the government is present to the extent that it can also answer the questions and discussion points raised here. I refuse to continue this discussion if we are confronted with a minister who has to say here that he will note the question and forward it to the competent minister. This is therefore not possible. Either the government is present and competent and competent to respond and take a position, or the competent ministers are present. I therefore ask for the suspension of the meeting, until someone from the government is present who is able to answer the questions raised here. Otherwise, this debate has no meaning.

You have the right to request a suspension. I would share your anger if the fundamental questions or remarks that were made this morning were not answered in time by the ministers. I would totally agree with your interpretation. by

The government is present. The Minister takes note of your questions. And I think the important thing is that the answers are delivered in time to the questions that are asked.

Let us reiterate once again that this was a parliamentary initiative. This is a bill that was sent from the Senate to the Chamber. Of course the government is present. She will take note where necessary, but this is a parliamentary debate, among parliamentarians, submitted by parliamentarians. Let us stop at that for a moment. The government is not involved here. In the polls, we will see what everyone will do. This is a parliamentary debate.

This issue may also be addressed by other speakers. Additional comments may be made or additional questions may be asked. I suggest that the government give a comprehensive answer at the end.

I can share your opinion.

I would like to say to Mr. The Minister Picqué how much I appreciated his correction because he listened, humbly said that he would take notes and that he would be answered to questions.

In a second time, I would like to emphasize the indecency of the behavior of two ministers, the Minister of Health and the Minister of Justice who, for a debate that affects everyone regardless of their convictions, convictions that we otherwise respect, do not deny being present. I believe that at this level, all the boundaries are crossed.

I find that from the moment when one touches so much the heart of each and each, I repeat, in respect of the convictions of each and each, it is of the highest indecency for a Minister of Justice and a Minister of Health to shine in their absence.

I believe that it is not bad that one knows in the context of parliamentary debates, and that the public measures all the meaning, the contempt with which the Parliament is treated on a subject that has gathered for weeks and months, which has been debated in the Senate and which deserves the same attention in the House.

The President of the House and you, Mr. Vice-President, you acknowledge that the fundamental element of democracy is the Parliament.

Thank you for giving me the word, but I insist on this point: it is indecent.

The judgment of the European Court of Human Rights is an important fact. I therefore believe that an official position on the consequences of this judgment on this draft law is desirable. I think the Minister is the appropriate person to communicate this viewpoint, but ⁇ the applicants can also do so. However, we need to hear an objective position. After all, it makes no sense to make political readings of a judgment of the European Court of Justice and then a few months or years later to be confronted with a contradiction between the judgment and our law. Therefore, I do not ask for a political position of the minister, but for a legally correct analysis. Therefore, I do not think it is a good idea to have to hear this position at the end of this debate in the Minister’s response. I would rather find out now.

I would like to hear the arguments of all members.

Of course, I do not have to deal with the distribution of work in the government.

Subsequently, Mrs Schauvliege and Mr Van Parys know that the installation of a palliative filter was discussed extensively in the committee. The rapporteurs have also commented on this.

Furthermore, in the context of what I hoped would be a serene debate, it testifies, in my opinion, to a peculiar approach to reintroducing certain elements into the debate, to which an immediate response should be given. If that is what one wants, then I can now hold part of my argument and later the other part. In this way, everything can always be “saucisonsonated”.

Just then I apologized to Mrs. Schauvliege for being summoned to the committee and therefore missing part of her speech. However, if we are unable to listen to each other and thus draw conclusions, then I do not understand the meaning of this debate. Then we can also ask a series of questions, listen to the answers and then move on to a new series of questions.

You spoke wise words, Mr. Erdman.

Thank you a thousand times. I do not intervene on the background, on one position, to defend one point of view or to fight another. The only thing I would like to defend by asking that the two mainly competent ministers be among us and be able to answer certain questions at the time they arise, is a certain vision of the work of Parliament.

I think that by blocking you, in a way in my opinion somewhat blunt, on the idea of ⁇ asking the two ministers, not over-lechamp but in half an hour, to be present among us to answer arguments that seem precise and not polemical of some of us, you cut the bars of the perchoir on which you are, you do anti-parliamentarism and you accredit the thesis of some who believe that here nothing happens unless it is a succession of completely recurring rites without the possibility of real confrontations or real serene confrontations of arguments and points of view.

And finally, Mr. Speaker, we may have answers, because we agree that it is really not the habit of the government in a number of sensitive files to answer the questions that are asked to him here even in the plenary session and even at the tribune. I have a number of recent experiences to give you an example. by

A government that will therefore respond, ⁇ within ten hours, at a time when most of us may have forgotten a number of points, including the most precise points, the most technical points, the most legal but which engage our responsibility as well as the most general points.

I find that this is not a correct parliamentary work, at least on issues that are not in the order of the anecdotic; let’s recognize it anyway. For it is not anecdotal what we are doing today, neither for the opposition, nor for the majority, nor for Belgium, since we are working on a project that could make school internationally. So I find it frankly not responsible on your part, Mr. President, as the president of a parliamentary assembly, to throw you on a kind of formalism that consists of saying: "The government will answer in a few hours, tonight or tomorrow and therefore the tasks of the parliament and the responsibility that we are entitled to expect from a government are quite honored."

For me, etymologically, "being responsible" is to respond to what is done or not done in the context of a debate, of a discussion that includes exchanges, dialogue, of the eventually somewhat vigorous confrontation. There needs to be something of this kind of parliament that is not simply assimilable to a kind of purely formalist ritual without substance and, ultimately, without scope.

Have you finished, Mr. Decroly?

Yes, Mr President, I have finished. I believe that your behavior here, today, and your irony are quite displaced. I am not intervening to defend a position but to defend the institution that you are presiding over here, today, in a parliament that is a fundamental democratic instance.

Absolutely absolutely . However, I do not accept your comments, nor your pointing finger. I think it is necessary to stay calm in an assembly, Mr Decroly.

I am quite calm.

We should not reduce a public debate to what has happened for three years and make people believe that there has been no committee debate. These discussions, I think, have taken place in a very correct way. Everyone had the opportunity to express their arguments and the ministers were present. There was an enriching exchange. This project was submitted three years ago. Therefore, one cannot summarize a debate like this with the judgment that each of you can have on the presence of ministers. It is up to you to judge. I can share your opinion or not. Everyone will speak about their presence or not. The Government is present and undertakes to answer, after the general debate, on the fundamental questions expressed by one and the other. You judge the absence of the competent minister as being correct or not. by

I think you don’t have to ask my opinion. You are not running the debate yet. I ask you to be calm, Mr. Decroly.

Mr. Speaker, what Mr. Erdman just said was correct, but that is not the issue.

The question is whether the government is present and capable of answering the questions asked. The government is represented by Minister Picqué who, however, is unable to answer the question. Well, that does not testify to a proper organization of the work. This debate can only be conducted to the extent that the government is present in the midst of those who are able to answer the questions.

For this reason, I ask for the suspension of this meeting until the arrival of the relevant competent ministers.

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One speaks of a parliamentary initiative, but the bill has become a bill after it was approved by the Senate. However, the government will have to bear the political responsibility for signing and enforcing the law. This means that if there are fundamental questions being asked at the moment, the government must answer them.

I would have agreed with the presence of Minister Picqué if he had been able to answer the questions asked, but that is not the case. Therefore, I ask for the presence of the ministers who are able to answer the questions raised.

I repeat that I ask for the suspension of the meeting until the time the Ministers of Health and Justice are present.