Introduction

Webcast archive: Belgium vs. Oregon

This week, we're looking at differences in statistics and legal requirements for assisted suicide in Belgium and Oregon.

Webcast archive: Belgium vs. Oregon

In this episode of Euthanasia & Disability, Amy Hasbrouck and Christian Debray discuss:

  • Why are there more assisted deaths in Belgium than Oregon?
  • FAQ: Aren’t there safeguards to prevent problems and abuses?

Please note that this text is only a script and that our webcast contains additional commentary.

WHY ARE THERE MORE ASSISTED DEATHS IN BELGIUM THAN IN OREGON?

  • Though Belgium has only three times the population of the U.S. state of Oregon, it has nearly 20 times more assisted deaths per year.
  • According to Wikipedia, the population in Oregon in 2014 was 3.97 million.  The population of Belgium in 2013 was 11.2 million.  The number of assisted suicides in Oregon in 2015 was 132 (verified deaths, with 218 prescriptions written). The number of reported euthanasias in Belgium in the same year was 2022.
  • This discrepancy cannot be explained by the incidence of suicide.  The overall suicide rate for 2012 in Oregon was 17.7 per 100,000 people, while in Belgium it was actually lower, at 14.2 per 100,000.
  • The next place to look would be the differences between the laws in Oregon and Belgium.
  • Perhaps the most important difference is that in Oregon, the person must perform the final act by ingesting the drugs, while in Belgium, the drug is injected by a doctor.  This shifts more of the responsibility from the person who is dying onto the doctor.
  • Another difference is in who is eligible.  In Oregon, the assisted suicide (“Death with Dignity”) law has the following eligibility requirements:
    • The person must be an adult – age 18 years or older
    • They must be a resident of Oregon
    • They must be capable of making and expressing health care decisions, as determined by the attending physician.
    • They must have a terminal disease (will cause death within six months)
    • They must express a voluntarily and informed wish to die.
  • The Belgium euthanasia statute protects a doctor against a charge of a criminal offence as long as the following eligibility criteria are met:
    • The person must be an adult or an emancipated minor (or a child who is terminally ill, with the permission of the parents).
    • The person must be legally competent and conscious when making the request.
    • The request must be voluntary, well-considered, repeated and not the result of external pressure.
    • The person is in a “medically futile” condition.
    • The person has constant and unbearable physical or mental suffering that cannot be alleviated.
    • Their suffering results from a serious and incurable disorder.
  • One important difference here is the fact that in Oregon, eligibility is tied only to the terminal nature of the illness.  This is a (somewhat) objective criterion, though doctors are not very good at making end-of-life prognoses.  In Belgium eligibility is linked to a series of subjective criteria; “medically futile” condition and the person’s own perception of his/her suffering.
  • Another possible explanation for the discrepancy may be cultural.  Nearly 60% of Belgians belong to the Flemish Community, 40% to the French community and 1% to the German-speaking Community.  Yet the vast majority of euthanasias in 2015 were performed on Dutch-speaking people (1629 of 2022) as opposed to 393 on French people.  This indicates that there may be a bias in the Flemish population toward euthanasia as an acceptable option.
  • It would be important for Canada to better understand these factors in order to reduce the number of Canadians who request “Medical Aid in Dying” in the future.

FAQ:  AREN’T THERE SAFEGUARDS TO PREVENT PROBLEMS AND ABUSES?
Many safeguards have been suggested and tried.  Both the Council of Canadians with disabilities and the National Council on disabilities in the U.S. studied the possibility of safeguards in detail and determined that prohibition was the only truly effective solution.  In general, there is not enough oversight before the person dies, and almost no oversight after the person dies.  Typical safeguards include:

  • Voluntary request – Requests for assisted suicide should be voluntary and free of external influence.
  • Discrimination and barriers, rather than the person’s disability, create the conditions that lead to most requests for aid in dying.  People with disabilities often lack the health and rehabilitative care, supports and accessibility necessary to be integrated members of their communities.  People who are dying may lack necessary palliative care to ease physical and existential pain.
  • The person may face pressure because of economic hardship or family stress.
  • Comments from family, friends or medical staff may make someone feel like a burden, that they’re are less valuable, that their life is a tragedy or that they’d be “better off dead.”
  • Disputes over an inheritance can lead to family members putting direct or indirect pressure on someone to choose death.
  • People with disabilities and elders suffer very high rates of abuse both at home and in institutions.
  • Undue influence and coercion usually happen behind closed doors and are hard to detect.  Most people are too embarrassed to report abuse, or the abuser is the only caregiver, so reporting abuse would risk worse consequences, such as institutionalization or retaliation.