Secretariaat, Nancy Denyn
Wetenschappelijke Vereniging van Vlaamse Huisartsen
St.-Hubertusstraat 58,
2600 Berchem,
Belgium

Dear Madam:

I enclose a copy of the Standpunt over medische beslissingen rond het levenseinde en euthanasie issued on 4 December, 2003, with the English translation we have used in reviewing it. The document is of great interest because the Protection of Conscience Project supports freedom of conscience for health care workers who do not wish to participate in procedures to which they object for reasons of conscience. However, the translation is incomplete in some places and only approximates the meaning of the original, so I am writing to ensure that we correctly understand the statement and explore some of the issues it raises.

We are pleased to see that the statement acknowledges that physicians who do not want to participate in euthanasia may decline to do so. We also agree that physicians should give timely notice to patients of their views, and that they should be assisted in developing strategies that will allow them to deal with requests for euthanasia in a manner that is respectful of the patient, and consistent with their own principles. Recording end-of-life discussions in the patients' medical file is very important, especially when there is a conflict between the views of the patient and the views of the physician. The suggestion that an "information and communication contract" could be used in this process is interesting.

However, we have concerns about some parts of the statement, which we now put forward for your consideration. It is possible that some of these reservations are based upon a misunderstanding caused by a mistranslation of the text. If so, correction and clarification would be most welcome.

The first concern is the requirement that a physician who objects to euthanasia is, nonetheless, expected to facilitate the procedure by assisting the patient to find a willing physician. The experience of the Project is that most conscientious objectors would refuse to do so, on the grounds that such collaboration would incur moral responsibility for the act.

The second concern is the stated intention to make euthanasia one of the 'treatment options' in a continuum of palliative care. Outside Belgium and the Netherlands, palliative care is understood to mean relieving the burden of pain and suffering caused by disease, so that patients live comfortably until they die. 'Palliation' specifically excludes euthanasia or assisted suicide. One commonly hears, for example, statements like, "We don't need euthanasia; we need better palliative care." The approach suggested by the statement appears to be a significant departure from this understanding, and would have a great impact on anyone involved in the field.

The third concern is the recommendation that euthanasia should not be treated as a medical specialty, requiring specialist 'teams' and facilities, but should become part of the regular health care system. This would, potentially, require the involvement of anyone involved in health care delivery and support, thus setting the stage for widespread conflicts of conscience. This problem would be exacerbated by the expectation that conscientious objectors must facilitate patient requests for euthanasia.

Finally, the expectation that physicians must ensure that patients are aware of and able to choose euthanasia is likely to present some problems. We would like to clarify whether or not the signatories to the statement expect or require that physicians communicating this information do so in a manner that portrays euthanasia as a morally neutral or morally legitimate choice.

Sincerely,

(Sean Murphy)
Administrator