Proposition 51K1832

Projet de loi complétant la loi du 28 mai 2002 relative à l'euthanasie par des dispositions concernant le rôle du pharmacien et l'utilisation et la disponibilité des substances euthanasiantes.

General information ¶

Submitted by

The Senate

Submission date

July 1, 2004

Official page

Visit

Status

Adopted

Requirement

Simple

Subjects

pharmacist euthanasia medicine

Voting ¶

Voted to adopt

Vooruit Ecolo PS | SP Open Vld MR

Voted to reject

CD&V N-VA FN VB

Abstained from voting

LE

Party dissidents ¶

• Josy Arens (LE) voted to reject.
• Carl Devlies (CD&V) abstained from voting.

Contact form ¶

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Discussion ¶

Oct. 20, 2005 | Plenary session (Chamber of representatives)

Full source

Mr. Minister, it is interesting that I begin because I would like you to call Mr. Minister. Demonte to ask him a precise question.

by Mr. Demotte has been replaced by the Minister of Employment, Mr. by Vanvelthoven.

I do not know where he is right now. Madame Laruelle, tell me, replace yourself Mr. and Demot?

I am replacing everyone.

But Mr. Demotte is not everybody.

This is not what I wanted to say. by Mr. Demotte is in London.

The reason for the absence of Mr. Demote is valid.

I do not want Mr. Demotte returns from London but maybe you will understand, listening to my speech, that one question is ⁇ concerned with my heart. If you can answer it directly, it will be very well so.

One of the collaborators could possibly help Mrs. Laruelle. We will see well.

As part of parliamentary work on the law of 28 May 2002 on euthanasia, the CDH had already pointed out the need to provide for specific provisions for pharmacists. At the time, this was rejected by the majority. Today, we finally realize that these provisions are necessary.

Article 14 of the Law of 22 May 2002 provides that no other person is required to participate in euthanasia. For us, the pharmacist must be able to express an objection of conscience. The amendment filed in this sense in the Senate, by Ms Nyssens and De Schamphelaere, was rejected on the grounds that Article 14 of the law would already allow pharmacists to refuse to issue euthanasizing substances.

To ensure that there is no doubt in this regard at the end of the parliamentary work, which will be completed within a few minutes, let us insist that you expressly express your opinion on this subject before the vote. This could influence our own. In other words, can you confirm the fact that the pharmacist has the right to express an objection of conscience? When reading the parliamentary work, it appears that this was clear to the deputies and senators but, apparently, the minister did not confirm this possibility.

For the rest, the draft law undoubtedly contains clarifications and useful modalities. However, we will not be able to vote in favour, since we remain in principle opposed to the law of 28 May 2002 on euthanasia.

Mr. Speaker, Mrs. Minister, colleagues, I think that the present draft will ⁇ receive the support of our group, and this for several reasons. Their

Collega Drèze has already mentioned this: there was indeed a gap in the previous legislation. This was not only discussed in the Senate, but was then also transmitted by the Public Health Committee in the recommendations delivered to the Justice Committee in exactly this sense. It is therefore a welcome initiative for the VLD – it was also taken by the colleagues in the Senate – that in them the situation of the pharmacists and the delivery of euthanatics were regulated. We have already had the evaluation committee and the evaluation report, which, among other things, also questioned a number of such uses. Their

There is more. I think this, Mrs. Minister — you will pass it on to the Minister concerned — still responds to the need for adequate and expertly composed euthanasia kits, so that patients who request euthanasia do not have to search through various pharmacies. Not less than 41% of cases of euthanasia are still performed at home, so by definition the euthanasia kit should be ordered from the home pharmacist. Therefore, it is also a plea to respect the quality criteria in this regard and to apply them adequately. The fact that this law can be passed today will be a good contribution to that. Anyway, the pharmacist signaled a number of problems that were included. Among other things, deconditioning is a need of the pharmacist, as hospital packaging is obviously not suitable for outpatient trade. Furthermore, it is necessary to be able to carefully avoid any surplus, waste, or careless handling of the surplus at the patient’s home where euthanasia was requested. Therefore, these careful requirements are included in the draft law. It is up to the King, thus to the Minister, to determine in what manner they will be completed. The return of the remaining euthanatics will therefore become possible and the registration will only be improved. Their

Mr. Drèze, I think it is very clear - there is no discussion about it - that the pharmacist can refuse and that it is precisely thanks to this law that this is also arranged with so many words. The euthanasia law was regulated only by the doctors. I think that this extension of the euthanasia law shows very clearly that also a pharmacist in that sense has the right to refuse and that this is only a supplement, in accordance with the recommendations made at the time. Their

We as the VLD will ⁇ support this law and we will of course approve this law because it is a clear improvement of the euthanasia law.

Mr. Speaker, Mrs. Minister, dear colleagues, it is fun to hear that the CDH has actively collaborated with the drafting of the law on euthanasia. Let’s say that the CDH has actively blocked us for two and a half years! Giving us lessons now on the drawing of the law is unwelcome; Mr. Drèze, it is ⁇ not on the CDH that we could count on to move forward in this debate that fortunately ended in the way you know.

I will reassure you immediately: the freedom of the doctor is inscribed, the freedom of the pharmacist as well. I do not invent anything. I will read you the report on the project we are currently talking about where the minister says that “the bill” – this one – “maintains the freedom of choice for pharmacists”. The Minister adds: "As for the pill" — you know what it is? “They can choose whether or not to deliver a particular medicinal product.”

The problem therefore does not arise. When you ask Mr. Demotte, through Mrs. Minister of the Middle Class, Sabine Laruelle, the answer is clear. The minister said there was no problem, that they could do it.

But this project did not say that. In fact, no pharmacist has ever worried about whether to say yes or no to a prescription request. On the other hand, pharmacists said they were not protected if, by adventure, they agreed to deliver according to the prescription. This is the answer to this bill. For now, the law simply stipulates that the doctor is not prosecuted when he does not commit any offence, when he decides on euthanasia on the basis of the provided conditions; you know the legal system. But there was no provision saying that the pharmacist does not commit any offence when he responds positively to the prescriptions. This did not happen in the facts, but therefore one could have imagined a substitute or an investigative judge, filed with a complaint, declaring that he does not have a clear answer from the law and deciding to inculcate the pharmacist.

That is why a provision was needed that clearly stipulates that the pharmacist who issues an euthanasant substance does not commit any offence when he does so on the basis of a prescription in which the doctor explicitly states that he acts in accordance with this Act.

One, the pharmacist’s freedom to say yes or no, the answer is clear. It results not only from the law, the preparatory work, but above all from the Minister’s response. Second, the pharmacist is protected by the new provision.

We find this extremely positive; it clarifies the ambiguity regarding the provision of euthanasia products, which is made by prescription of the doctor, issued for euthanasia.

It was discussed the precautionary measures established by royal decree: overdose, return of unused substances, etc. The Minister revealed that three working groups were established in this regard: one board on euthanasia kits (I will return to it), the other on advice and criteria of caution and the third on the issue of the decomposition of products by wholesalers.

For the third, it is very easy. Currently, there are no available products that doctors would like, not necessarily everywhere. Then, the packaging is not always well done; it must be achieved to condition on a case-by-case basis and not in bulk. Precautionary advice will apply on the subject.

Regarding the provision of euthanasia kits, you know that the National Council of the Order of Pharmacists, like that of the Order of Doctors, was moved by this announcement. I will not condemn those who did so in so far as these boxes responded to the finding that was made of the impossibility of making euthanasia products available as appropriate. A number of pharmacies have launched this euthanasia kit and the Orders of Doctors and Pharmacists have blunted themselves according to the individual nature of euthanasia decisions. The French-speaking Vice-President of the National Council of the Order said that if a general physician is faced with a patient who meets the requirements of the law, it is up to him to choose the euthanasia substances and how to administer them. He also said that the choices of doctors and pharmacists constitute an important part of the patient’s therapeutic freedom.

It must therefore be avoided that one comes to a kind of monopoly of such a pharmacy sector over another, which would impose on the doctor this or that kit of euthanasia. No, every doctor must be able to decide, in conscience, freely, which product he wants to administer. The doctor must be able to request the products from the pharmacist and the pharmacist must, depending on the measures to be taken, be able to respond positively to his request.

In this regard, I saw that the Minister would set up three working groups that would give their opinions in July. We are in October, I think that, in a next parliamentary committee, it will be good to ask the minister if the three working groups have already presented their conclusions because it is on the basis of these conclusions that the royal decree of enforcement of the law will be presented that, I hope, we will vote.

I think things are going normally and that this is a happy clarification of the euthanasia law. There will be a need to put some order in the provision of medicines.

It seems to me that all this is going in the right direction and it is with satisfaction that our group will vote on the bill as it is presented.

Mr. Speaker, Mrs. Minister, Colleagues, it is almost a horrible coincidence that we are talking about that bill today in the Chamber, at the moment that in a newspaper a page-wide interview is printed with Mrs. Leduc of the VLD faction from the Senate, who rightly advocates to immediately extend the yet so young law on euthanasia to all minors. This was once a major battle point in the discussion of the law on euthanasia. If I remember correctly, then it was about the bodies of all colleagues at the time, with a few exceptions, that there would ever be an euthanasia law in which also minors could be euthanized. Not so long as this morning there is a large interview in the newspaper, in which for the second time — it is not the first time — that case is brought to the fore and announced. That is to say that our liberal colleagues have already reconciled with this and will support all steps and attempts to immediately strengthen the yet so young law in a direction that we think is even more delicate than originally intended.

Nevertheless — we have always done so during the discussion of the euthanasia law — we always take an active part in all those discussions because we have a great interest in it. We also have a lot to gain from a good ethical debate. We have done so because of this bill. In the committee, we have made comments and have actively participated.

We have not even kept hidden at all that what is now present here, if one separates it from that for which it must serve, is actually an improvement. No one can deny that the scheme that is now being proposed provides greater legal certainty, is clearer to the pharmacist and just mention it.

But actually it is not for us to do that. Therefore, we absolutely do not want to make a ruling on an instrument that serves to enforce, to improve a law that we have combated and at the time with conviction rejected by voting against it.

We cannot, therefore, otherwise, consistent with our former attitude, than now reject the design. Our group will not approve this bill. We also did not approve it in the committee. We have outlined our reasons for this. Even then, we stressed that it makes no sense to help improve projects that we then rejected and did not support, now.

By the way, we have already emphasized at that time — it will not be the first improvement to be submitted to Parliament — that the draft law did not fit well and that the text was the minimum minimorum, so that no discussion would break out among the then fragile majority who wanted to support it. We have predicted that there were so many hooks and eyes and shortcomings in the law that it could not be otherwise or there would be changes to be made soon. The evidence is there today, because there is therefore a draft that should improve the legislation.

Ladies and gentlemen, I would like to say the following. The competent minister, Mr Demotte, is not present here.

Minister Demotte is in London at a meeting of the Ministers of Public Health.

Mr. Speaker, all the understanding for that.

Nevertheless, there is a draft on the agenda on a matter that belongs to the competence of Minister Demotte and of course of the government.

I therefore assume that the Minister, on behalf of Mr Demotte and the Government, will want to answer the questions that we have to formulate here regarding the draft.

Our major question is the following. During the preparation of the legislative work, the Minister, as colleague Monfils has already done here, has set up three working groups. These working groups operated in parallel with parliamentary work and would normally end their work by the end of June. They would then report, so that Parliament could take note of it, and then vote on the draft based on it. This has been noted in the Senate and Minister Demotte has, by the way, said in the Senate that he would never submit the draft to Parliament for approval before he would have the report of those working groups in his possession.

But his attitude suddenly changed. When we discussed in the committee at the beginning of July, the Minister proposed that the text, although he did not have the reports of the three working groups, still be approved in the committee. We then violently protested, referring to his statement in the Senate and the inconsistency. The Minister responded that we have some time left and that the reports would ⁇ be completed in July. They would then be ready to use time – with this he meant after the resumption of the parliamentary working year, now therefore – to be ready.

My question to the Government by Monde of Minister Laruelle is, whether we could get before the vote the reports of the working groups hic et nunc, at the meeting — it is a little late, but we have no other option — reports of which — I repeat it — the completion was promised by the end of June.

Mr. Bultinck, I had just closed the list when you entered. You asked if you could take the word briefly. I will give you the word immediately, Mr. Bultinck. Ms. Detiège will then be the last speaker.

I have closely followed the committee’s work. by

by Mr. Goutry says that the vote of the law was subordinated to the taking of royal arrests. This is completely false. I have the report in mind. I said that the law had to be approved before the royal decrees. Imagine what we would look like if we took a royal decree and the law was not voted! by

The minister simply said that he would accelerate things. He talked about July. It is true that we are in October, but this is not the first time that a report is not delivered within the prescribed deadline. However, no decision has been made — I invite you to read the report again — according to which the arrested should be awaited. It was said that the law should be voted first. And the Minister said that he was preparing the decision on the basis of the opinions of the three working groups. We hope to reach a consensus on the whole. by

For my part, I would rather waste two months and have a consensus between pharmacists, doctors and other participants in the working group rather than having a royal order "badly made". by

We will vote the law. It will enter into force. The royal arrests will be taken later. This is a parliamentary logic. But I repeat that I have rarely seen that the vote of a law is conditioned to the adoption of a royal decree on the basis of a law that has not yet been voted. This would seem really strange to me!

In addition, the Senator speaking to Mr. Goutry belongs to the VLD group. They are them! We are us! by

You could not read anywhere that I wanted to extend euthanasia to minors! I have always opposed such a possibility. I think this opinion is shared by many, if not all, members of my group.

Mr. President, Mr. Monfils, for the sake of clarity, I would like to say something about those reports and those working groups. It is clear, that is also stated in the report of the Senate, that the minister said at the time in the Senate that he would not submit the draft to vote before he had the reports of those working groups. Their

He removed that a little in the Chamber Committee. However, he then said that those reports would be ready by the end of June. It came in a few weeks. He said there was no problem and that they would definitely be ready during the summer. It is now 20 October. Today we will vote on the draft. Of course, we will get the royal decisions afterwards. However, the working groups have to deal not only with the royal decrees, but also with the legislation itself. We assume that what was promised in this regard will not be kept. That is the only thing we have explained here.

Since I was a rapporteur in the committee, I would like to speak very briefly. I have the report here. Indeed, it states that Mr Goutry proposed to postpone the vote on the draft. Mrs Avontroodt then said that she did not agree with the proposal and requested to hold a vote. We voted on this, Mr. Goutry’s proposal was rejected and the draft was passed to the vote. I have the result here. The entire bill was adopted with 8 votes against.

I would like to point out a little thing to Mrs. Detiège who is young and new. At the time, the rapporteur was sitting next to the minister.

The reporter could take the word from time to time when there was a discussion. We have now lost that habit. Per ⁇ we need to think about reintroducing that.

We can argue against Mr. President’s position. The Goutry!

In fact, it can be read in the report: "The working groups should finish their work by the end of July. The aim is to develop a protocol that will be transmitted to all categories of persons concerned. If the draft is adopted, the decisions contained in the protocol may be incorporated into a royal decree." by

We cannot be clearer! It means: “Vote the bill, vote the law!” On the day that there will be a law, there will be a royal decree of application. No law, no royal arrest! by

In what language should I say it? This seems to be an obvious logic! In addition, as my honourable colleague said, this bill was voted by an overwhelming majority. And those who didn’t vote for it, it’s not because of the project itself, it’s those who didn’t vote for the euthanasia law. I understand and respect them. They did not want to vote a supplement to the law, which may also seem logical. by

Otherwise, there has never been a problem in this regard. So don’t come to invent, what, maybe, you read in watermark through these four pages of report!

I know about how it is with the reports and with the working groups. Therefore, I do not ask this question here by chance, but I do not have to answer them. I just ask the Minister. That was my question and the whole discussion that follows is a protection that our respectable colleague Monfils undertakes in front of his party mate. My question to the Government and to the Minister is simply the following. What about the working groups? How far is it? When will the reports be ready? I think this is a legitimate question when voting on a law.

I don’t invent it, unlike you.

That is enthusiasm! Mijnheer Bultinck, then Mrs. Detiège and then the minister for a few answers if possible.

Mr. Speaker, the symbolism we experience today through the media leads to this draft being discussed today a little more extensively than would normally be the case.

I would like to remind you of the creation of this law. In the hearing in the Public Health Committee, we talked about both the euthanasia law and the opposite pole on palliative care. Even then, the whole problem of the specific role of the pharmacist has already been addressed. We must then conclude that no consensus could be reached in the committee.

Our faction — in which we follow Mr. Goutry — can perfectly gain in the problems of the pharmacists. We can understand that pharmacists will end up in unpleasant conditions if this is not regulated. In a weak constructive moment, we could say that this bill could be a technical improvement.

Mr. Minister, I will try again. I hope that your answers during the discussion of legislative proposals are a little better than during the questionnaire. I hope you can tell us what the state of affairs is in the three working groups. In a weak moment, I have respect for Mr. Monfils’ tenacity with which he tries to protect a weak minister and party fellow. That will not happen this time, Mr. Monfils. The Minister will have to be able to tell us sharply what the state of affairs is in these working groups. From time to time, you flatter into the Public Health Commission if you feel good. However, the permanent members of the committee are assured that they will receive correct answers. This time it will not succeed with non-spoken answers, let that be clear.

If there is a member who has been here for 25 years, it’s me. Not everyone can say the same, especially people in your group.

I do not allow my colleague Monfils to hunt on the stake. I feel a little too good in my skin, colleague Monfils.

It is very clear that we have never been in favour of the existing euthanasia law. We have always very explicitly chosen the path of palliative care. I will return to one of the questions still pending in the Public Health Committee. I must note that there is still great uncertainty as to whether the day centers for palliative care will be removed by Minister Demotte in a blind saving drive. If this is the case, it will appear that the entire dossier of palliative care was therefore only an excuse to hunt something else through it. Either one must begin to build out palliative care and then we are allies, or one must stop hypocrisy if one goes blindly to save on palliative centers.

Professor Distelmans has clearly requested additional budgets following a number of debates. It would be good, Mrs. Minister, if you could reassure us today as a demonstration of benevolence and inform us that additional resources will be allocated. If you look closely at the 2006 budget, there is no increase in resources in this file.

Ladies and gentlemen, I want to address you for a moment. The current circumstances force me to do so. In the previous legislature, you were one of the attentive, very constructively collaborating colleagues in the hearings following the establishment of the euthanasia legislation and the law on palliative care. If I now hear your colleague in the Senate, Mrs. Leduc, in all the media say that one wants a very rapid and drastic extension to children and to people with dementia, then I must honestly admit that I then freeze my eyebrows and that my irritation rises. What we see here today is, in my opinion, only a step forward to do much worse. You must contradict me colleague Avontroodt if this is not the case, but you were one of the few liberal colleagues who in the previous legislature in the Public Health Committee had the courage to defend the consensus that existed to not extend the euthanasia law to dementors and children. I have a very concrete question, colleague Avontroodt. Are you still confirming the consensus that existed when the law was made, or are you going to serve again as a lubricant for your colleague Leduc in the Senate who wants to go much further?

Mr Bultinck, I would like to bring your attention to the report containing the recommendations. Both items are included, though in two different orders. What is in the recommendations, which you also approved? There is a gap in the law regarding minors. This was then unanimously included as a recommendation in the report of the Public Health Committee. On the contrary, it is correct that the dementers were explicitly not included. These were the unanimous recommendations of the Public Health Committee. The gap concerning minors was very explicitly in place precisely because of the difference between the minors who were abducted and the minors who were not abducted. That discrimination was in the law. That was the point.

Mrs. Avontroodt, I fear — this does not happen too much to us — that this time we will have a profound disagreement.

I note that you once again emphasize the consensus with regard to the dementers. In the media today it was announced that they want to extend the euthanasia law to minors and children. The next step is that the issue with the dementers is being questioned again. I fear that what originally could be an innocent technical improvement, which I could even support in a weak constructive moment of opposition behavior – we must do something about the role of the pharmacist – but a step forward is for more. Your speech confirms that. Let it be clear: in that case, the Flemish Interest will no longer participate and the group will vote with conviction against the present draft.

I am one of those who have very strong doubts. I will review the recommendations concerning minors. The challenge lies in both hands. I notice that Mr. Goutry, who has followed the hearings very closely, shakes no. I cannot remember that the committee unanimously approved this. I suspect that you are quickly looking for a way of escape to be able to escape the difficult parquet in which you are located in a somewhat nice way.

Mr. Speaker, I am going around. The Flemish Interest will vote against with conviction — especially after what I have heard today. We do not want the present draft to be a step forward for more.

Mr. Speaker, colleagues, I feel that we are conducting the debate at this meeting in a different way than in the committee. That means that we had clearly stated at the time that we would not open the euthanasia debate around children, dementia or compacients.

It is very important to realize today that there is a gap in the law, relating to the role of the pharmacist. As Ms. Avontroodt said later, since 41% of euthanasia cases occur at home with the patient or in the home care, the role of the pharmacist, in the sense of who the euthanatics deliver and how the delivery takes place, is very important.

There was no legal framework for the pharmacist in the euthanasia law. I would like to briefly repeat some of the points already mentioned. Their

First, the right to refuse delivery could not until today. It was possible for the doctor. Therefore, it should also be possible for the pharmacist. He must be able, in honour and conscience, to deliver the delivery of an euthanatic or to refuse to deliver. For sp.a, however, there is a need for a reference obligation. I said this in the committee. After all, if a pharmacist would not want to deliver the euthanatics, the patient should not feel that he is at the end of counsel and he must then find another possibility.

The second point is the procedure with the regulation. At the moment, the pharmacist does not know whether it is an euthanatic. That is very important, because the delivery of an overdose by itself is prohibited for a pharmacist. So the law clearly showed that there was also a wrong school.

A third point is the delivery and surveillance of the euthanatic. At the moment, it is very unclear who can deliver the euthanatic, the pharmacist or the assistant. There is also uncertainty about who gets the product. Will it be the treating doctor or will the patient pass by himself? These ambiguities had to be clearly corrected, in order to avoid some clandestinity.

For all these reasons, the sp.a absolutely wants the bill to be approved today. After all, it is really important that the law comes in so that the pharmacist can do his job properly.

A few technical questions have been asked. by

Due to the technical questions that were asked, I understand that it is not easy for you that Minister Demotte is now validly apologized.

Two very concrete questions were asked. On the question of Mr. Drèze, I refer obviously to the Senate report and I confirm that the pharmacist will always have the choice, as Mr. Minister Demotte said it himself in the Senate. As regards questions regarding three working groups, reports thereof will normally be seen ready for the end of November.

Mr. Speaker, I would only like to point out that the pledge made at the end of June will be made at the end of November. We wait, in freedom and in joy.