quinta-feira, 28 de abril de 2016

“Euthanasia is bad medicine”

Robert Clarke
This is a full transcript, in the original English, of an interview with Robert Clarke, of ADF International, about euthanasia in Belgium. The news report, in Portuguese, can be read here.

Esta é uma transcrição completa, no inglês original, de uma entrevista a Robert Clarke, da ADF International, sobre a eutanásia na Bélgica. A reportagem pode ser lida aqui.

Could you briefly explain what ADF is and its mission?
ADF International is a legal alliance building organization, which advocates for the right of people to freely live out their faith. We are headquartered in Vienna, but with offices in Geneva, Strasbourg, Brussels within Europe, and other offices outside of Europe, including in the United Nations, New York, Washington DC; we have positioned ourselves at the international institutions across the world in order to advocate for that right of people to freely live out their faith.

And you help people of any faith?
That's right. Freedom of religion is a fundamental right and one which we support and uphold.

I understand ADF represents Mr. Tom Mortier in his case in the European Court of Human Rights. Could you explain the basics of the case?
Tom's mother was euthanized at the hands of a Belgian doctor in 2012. He didn't know about it until the following day, when the hospital phoned his home number and asked him to come and make the necessary arrangements. 

This changed his world, changed his family, his children's understanding and we say, fundamentally, that Euthanasia is bad medicine. It was offered to a woman, his mother in this case, who was diagnosed with depression, an illness which is episodic in nature and yet she was able to go to a doctor and obtain a prescription for death. 

What exactly is he asking the ECHR?
He is challenging the position of Belgium, at the ECHR, on essentially three grounds: 
He says that the country didn't uphold his mother's right to life, that is to say that a government has the responsibility to protect its citizens right to life, guaranteed under the convention but, more particularly it has the obligation to protect vulnerable citizens and we say that someone who is diagnosed as suffering with depression is a particularly vulnerable person, and that the government has an obligation to protect. Moreover we say that Belgium has violated Tom's right to his family life and that Belgium has failed to provide an adequate remedy to these violations. 

The difficulty in this case is that the same person has essentially acted as judge, jury and executioner. The doctor in question, the doctor who euthanized Tom's mother, sits as the co-chair of the federal commission which is responsible for regulating Euthanasia in the country, so we have the same person who is not only a prominent advocate for Euthanasia in the country, but is carrying out euthanasia and is then sitting on the panel which revues all the euthanasia deaths in the country to decide whether they complied with the law, so we say that the safeguards that the government suggests were built into the law are not adequate and that they cannot be adequate and certainly the context of this case shows everything that can and does go wrong where euthanasia is legalized. 

If the case goes your way, is this something that could make euthanasia illegal in Belgium?
The ECHR is considering a specific case here and at the current time the emphasis has shifted back to Belgium. The public prosecutor is in receipt of a file and is looking into it and the decision rests with them at the moment, as to whether or not they continue with the investigation. Of course the ECHR will be very interested to hear the outcome of that, and we'll continue to push things there if the prosecutor decides not to take any action or causes an undue delay in carrying out their investigation and any possible remedy for Tom.

The position of the ECHR is that it will look into the case and we hope, yes, that it will challenge the legislation that Belgium has put in place, which fails to protect the vulnerable in society, which fail's to protect people like Tom's mother, and fails to protect people like Tom.

Mr. Mortier has said that before this issue struck so close to home he didn’t really bother about Euthanasia, considering that it was an individual decision which didn’t concern him or others. We keep hearing that vast majorities in Belgium, Holland and Switzerland support Euthanasia, is this why?
Certainly our experience is that there is a huge level of ambivalence, a huge level of people not really engaging with it, because it doesn't strike close to home. And that is absolutely right. Tom shared with us that before this happened it wasn't an issue which he thought was particularly relevant for him, it wasn't one he'd given a great deal of thought too. 

And now, without wanting to be the centre of this, without wanting to be the face of this - in fact he want's quite the opposite of that - he's felt compelled to speak on behalf of others who haven't had the confidence to speak out but have felt the same way.

And we do see that, we see more and more voices speaking out and challenging this. In relation to discussions in Belgium to extend Euthanasia not only to children, which has now been passed into law, but a discussion in relation to patients suffering from dementia, patients who don't have the capacity essentially.

The discussion going on there has prompted a number of prominent academics, people in the public eye, to right an open letter criticizing that proposal. So we are seeing, increasingly, people recognizing these laws for the dangerous precedents that they set and the very real danger that they put society's most week and society's most vulnerable, the elderly, the sick, the very real danger that it places these people under.

Tom Mortier's mother
You mentioned some aspects of the current debate... Could you describe the current law about Euthanasia in Belgium?
The law in Belgium allows someone who is suffering from a condition - and its not necessary for that condition to be physical, it can be mental, which is a significant difficulty - to approach a doctor, there is no requirement for that doctor to be their treating physician, and indeed in Mrs Mortier's case, the person consulted was not her treating physician, she had a treating psychiatrist of many years, who had on her initial request suggested that she wouldn't be a candidate for euthanasia, that it wasn't an appropriate option for her, and so she approached Dr. Distelmans someone who is very well known in the media, someone who has a high public profile, and asked if he would do it. 

As I say, there is no requirement any longer that the patient be an adult, or that they have obtained the age of majority. The request has to be made, it has to be repeated, and the law says that it cannot be the result of any external pressure. Well how do you assess that?

This is a difficulty which we see throughout the law, because it asks that the patient in a medically futile condition of constant and unbearable physical or mental suffering, which cannot be alleviated... These are difficult judgements, and essentially when you ask questions like “is the request voluntary?” and “is it well considered?” That is not a medical judgement, that is not the sort of judgement that a doctor has been trained for and, in our experience, it is a decision many doctors don't feel comfortable with it and it is not something that they are trained to do or want to do, and in a lot of cases it is not something that they feel is right, to assess whether or not a patient is in a state of constant and unbearable physical or mental suffering that cannot be alleviated and has made a well-considered and repeated request.

In short there are just no safeguards within this law that would put anyone's mind at rest that this is a practice which is safe, that it should be encouraged, or should be promoted. We see it time and time again, the cases come up which raise very serious questions. 

In fact the first time in the history of the federal Euthanasia commission's reviews of these cases, they referred a case for criminal investigation, in relation to a physically healthy elderly lady who had simply become "tired of living" and despite what some people would say are the safeguards in the law, she was able to go through the process and be euthanized at the hands of, again, another well-known doctor who is an outspoken advocate for euthanasia. 

Euthanasia is also legal for children, under the age of consent. How does it work in those situations?
In relation to children this is a new law and as far as I am aware there have not been any cases yet coming out of Belgium where children have accessed this. It requires a consultation, a discussion with parents, but ultimately if the child has obtained a sufficient understanding, and again, this is something which I suggest is not a medical diagnosis or procedure, but if the child has obtained an understanding, such that they understand the nature of what is being discussed, then the decision is handed over to them. 

Again, we are looking at weak and vulnerable members of society. We are looking at children, who in many of these cases would have years to live, in respect of whom there are different treatment options, but instead are being offered which we say is in fact no treatment at all. 

I have also heard about concerns for freedom of Conscience…
Absolutely. There is a recent case, ongoing at the moment, against a Catholic Care Home which wanted to be a care home in which Euthanasia was not provided as an option, that was its conscientious conviction, and the decision of that care home is being challenged in the courts. 

That is what we see. We see an assault on the Freedom of Conscience of medical professionals, many of whom actually say because of the atmosphere in Belgium, which can be very hostile when people have spoken out. Tom has spoken about this. The reaction to the Church when they spoke out about it, is not atypical. When people speak out against Euthanasia the Belgian media is incredibly critical of those people. Tom gave an interview and spoke with a journalist from the New Yorker, for an extended piece, and they quoted and referred to the very hostile approach of the national media in Belgium, and the following day there was negative coverage of the New Yorker article in Belgium. It just seems that there is an unwillingness in Belgium to scrutinize this practice, to really ask what is going on. When you have soaring rates, when you have the numbers of people who are being euthanized going up every year, so that in one region of Belgium you now have a 2% chance of being killed by your doctor; an expansion in the categories and types of people being invited to consider this as an option.

The Portuguese manifesto for legalizing euthanasia defines it as “the reply to an informed, conscious and repeated request to hasten or abbreviate the death of patients in great pain and with no hope for a cure”. In your experience, does this fit the practice of Euthanasia in the Netherlands, Belgium and Switzerland, the only European countries where the practice is legal?
This sounds like very similar language to the legislation that we have seen elsewhere; the legislation which has led to A) An increase in the number of euthanasia deaths every year and B) A widening of categories of people who are able to access it. It is a pattern we have seen before, a pattern we have seen in Belgium, whereby the arguments made at the time the legislation is introduced is “this will be exception rather than the rule”, “only in truly exceptional cases will this be allowed” and “only under very tight safeguards will this be possible”. What we see in practice is, of course, the exact opposite and I would encourage any country which is considering this, be it Portugal or elsewhere, to look to the real life examples we have of what happens when euthanasia is legalised. 

You look to Belgium and you see the numbers go up, you see troubling cases in the media, you see the categories of people, whether children or dementia patients, expanded; and it is not a path that is very attractive anywhere.

Dr. Distelmans
Defenders of euthanasia often speak of a right to death with dignity. In your opinion has the legalization of Euthanasia brought more dignity to patients in Belgium?
I think we have to get away from this idea, this image of the velvet pillow death, in which somebody dies in a comfortable room, surrounded by their family. Because that is not what happened in this case and it is not what happened in cases we heard about. In this case a woman who was depressed, was able to go, after relatively few consultations, after a relatively short period of time, to be euthanised without the knowlege of her son. Despite this feeling of distance between her and her son being part of the reason for the occurence of the depression.

So we have to get away from this image. There are only a small number of countries in the World that have legalised euthanasia, and they have drawn criticism from UN monitoring bodies for their failure to safeguard vulnerable people, the ECHR has upheld laws which prohibit euthanasia in a number of countries because the ECHR and the UN bodies I have mentioned recognize that countries have an obligation to protect a right to life. There is no right to death under the European Convention of Human Rights, or under other International instruments. 

There are also stories of elderly people moving to Germany, where Euthanasia is illegal, out of fear of being euthanized against their will. Are these credible?
There are stories, and there are certainly people who have relayed fears to us. The UK, for instance, voted on this last year and the House of Commons rejected legalisation mainly out of these concerns. And if you look at the situation in the UK, every major disability rights group or advocacy group for the disabled, opposed the legalisation of Assisted Suicide, for that simple reason, because they recognized the sometimes explicit pressure that the disabled or elderly can come under, but if its not explicit, the implicit pressure. What does it say about the type of society that we want to live in? Because that's the real question here. What kind of society do we want to live in? Do we want to live in a society that responds to terrible suffering with death, or do we want to live in a society that responds to terrible suffering with treatment, care and compassion?

It sometimes seems that only Christians, and more specifically Catholics are campaigning against legal Euthanasia. Is this the case?
That is not our experience. We have seen a huge number of people, from across political, religious and areligious spectrum who have engaged in this. As I mentioned, in the UK in the run-up to the debate some of the loudest voices came from the disability rights groups who campaigned very strongly against the legalization of assisted suicide in the United Kingdom, because they have a very real fear that this kind of legislation leads to the slippery slope that we have seen Belgium fall down.

We have seen people with no religious belief recognize that this exposes vulnerable people to serious danger and Tom is a great example of that. Tom is not a Catholic, he is not a believer in that sense, but he recognizes that what has happened to his mother is wrong, but it also has much broader consequences for the countries he lives in and even beyond the borders, consequences for other countries. So I would encourage people to look to Tom's story, look to other stories from the countries that have gone down this path. They paint a unified picture and it is a very bleak future indeed.

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