From care to the act through the emotional load, five practitioners deliver on their practice of euthanasia, which was decriminalized twenty years ago in Belgium.
There, the debate no longer really exists. While France has launched a citizens’ convention on the end of life, with the objective of a change of law before the end of 2023, Belgium has legislated on euthanasia since a long time. It has been legal there since 2002, under certain conditions and within a very strict legal and legal framework. The request must be written, anticipated and consented to and it must be formulated by the patient who suffers from an incurable disease, causing physical and psychological suffering.
In 2021, 2,699 euthanasias were performed in Belgium. In the hospital, in nursing homes or at home in half of the cases. Five Belgian doctors have agreed to tell franceinfo how this process takes place, from care to action, through the emotional aspect and the relationship with the family.
Yves de Locht: “The decision is up to the patient”
Yves de Locht defines himself as a “humanist”. This 77-year-old general practitioner, who has been consulting for half a century in Brussels, has been practicing euthanasia since 2010. An experience, or rather a “last care”, that he refuses to trivialize and that he realizes about “once a month”.
The management of. “The patient appeals to his attending physician who can accept or not since there is a conscience clause. If all the conditions are met, the law imposes a second, or even a third opinion if euthanasia is not planned. in the short term. The first question I am often asked is: ‘Will my file be accepted?’ Many do not complete the process, but they know that one day they will have a way out, and this relief is soothing. I listen to them, explain to themIt’s a long process and I see them for as long as possible, at my office or at their home. But our role is neither to influence them nor to judge them. In Belgium, the decision is up to the patient. The choice to die is the most serious of their lives.”
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The act. “There are two ways to perform euthanasia in Belgium. With the lethal intravenous injection of a product, often a barbiturate, which causes death in less than a minute or orally when the patient ingests a product. Relatives are crying, others are impassive, and some ask afterwards if he is really dead. My first euthanasia dates back to 2010, I was very scared. He was a priest, he had taken the time to shave and to shower before and I think that image will always stay with me.”
The emotional charge. “You never get used to euthanasia, it would be awful to say that it becomes a habit. There is nothing harder than killing, and there is always an emotional shock. I am moved, I need to talk to my wife, to walk in the forest. I never had the feeling of killing. To kill is to kill voluntarily. Me, I give the last care to someone who kills me. Requirement.”
Marc Decroly: “There is a transfer between the doctor and the patient”
While still a student, Marc Decroly, settled in the suburbs of Brussels, saw doctors “practicing care stoppages when it was illegal”. This general practitioner saw with a good eye the decriminalization of euthanasia, convinced that the “almighty medicine does not exist”.
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The patients. “There are two types of patients who come to my practice: those who want to write an advance request and those who suffer from incurable illnesses, often cancers and degenerative pathologies such as Charcot’s disease or multiple sclerosis. Paradoxically, they are relieved and soothed when given the green light I accompanied an 18 year old [l’euthanasie est autorisée pour les mineurs depuis 2014 en Belgique] who dreamed of becoming a sports teacher. He had lost the use of his legs and was in danger of losing his arms. He didn’t want to leave life, his parents, his brothers, but his future looked terrible.”
“When we are in good health, we don’t want to die, we feel like we haven’t seen everything, haven’t told our loved ones that we love them. But when your future is made up of suffering and of decay…”
Marc Decroly, general practitionerat franceinfo
The act. “I always perform euthanasia in the evening. The evening is a moment of calm. I often tell my patients not to be in pajamas or an operating gown but rather to dress in a cardigan, a shirt, a tie if they wish. Before setting up the infusion, I always take a quarter of an hour with the patient and I ask him again if he agrees, which we can postpone if he no longer feels it. I ask him to tell me about the most beautiful place he’s been to. Then, a pre-anesthesia is performed before the injection of drugs. And there it goes fast. There are several products. VSach doctor uses the cocktail of drugs he knows.”
The emotional charge. “Whether we like it or not, there is a transfer that takes place between the patient and the doctor. If the patient is old, I can project myself onto my grandmother; if she is my age, I will think to my wife; if it is a young person, we think of his child… And then, we perform an irreversible act. I feel great mental and physical fatigue every time.”
Michèle Morret-Rauis: “I was told I was an assassin”
The end of life is the fight of her existence, a fight that she compares to the fight for the right to abortion. Trained oncologist and vice-president of the Association for the right to die with dignity (ADMD), Michèle Morret-Rauis, retired practitioner, continues to provide end-of-life consultations.
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The management of. “The subject is sensitive, but there is lightness, joy and it is not rare that we can laugh in these consultations. I remember a lady who had opened the champagne when I had told her that his request would succeed. Sometimes patients cry, but most see the end of the tunnel. The people who come are not afraid of death, they long to be delivered from a life that has become unbearable for them. They are not really afraid. Those who are frightened by the fear of dying do not come to ask for euthanasia.”
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The relationship with the family. “There are families who accept. They are sad at the idea of losing their loved one, but they see him suffering, so they support him. And then there are the others… Some have already arrived in my office telling myself that I was an assassin. When you are in good health, it is not always easy to understand. There are still relentless people, often for denominational reasons.
Corinne Van Oost: “Death is not just a medical history”
It may seem paradoxical, but Corinne Van Oost is a doctor in palliative careCatholic and she practices euthanasia. “As a believer, I do not consider that God wants suffering”judges the one whose role is often to give a second opinion to validate the request for euthanasia.
The second opinion. “The doctor who gives the first opinion is responsible before the law, he has a therapeutic relationship with the patient. The other practitioner is independent and does not know the patient. My role, in addition to ensuring that the framework is respected , is to accompany the patient and help the first doctor on the emotional aspect, the procedure to follow, the choice of products or the last moments.”
The act. “I try to give meaning to this moment with rites. I ask loved ones to choose music that has meaning for them, I suggest that they express themselves before euthanasia. It allows them to get out of the act , of the doctor who pushes on the syringe, and to summon the memory so that death is not just a medical story.
“The injection is an extremely difficult moment: the person who was still speaking two minutes ago is now dead. When I perform the injection, it’s as if I had a gun. I kill him, but I don’t shorten not life, only agony.”
Corinne Van Oost, palliative care physicianat franceinfo
The following. “We write ‘natural death’ on the death certificate, since the patient died neither accidentally nor suspiciously. The doctor must fill out a ten-page document, recount the patient’s suffering, his care journey, his [intellectuel]. A control commission will then examine the document. These procedures frighten doctors, they know they could be called into question. Practitioners can review the family. The aftermath is not easy.”
François Damas: “We must not transfer the patient’s suffering to the family”
François Damas is a man who is listened to and respected. At the heart of Arte documentary The Words of the Endthis training resuscitator holds life consultations in Liège and was consulted by Olivier Véran ahead of the launch of the citizens’ convention on the end of life in France.
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The relationship with the family. “There are families who adhere to the patient’s approach, the last course is built. Others are more reluctant and express fear. The family suffering of losing a loved one can be expressed in opposition, while the patient will die.n 85% of cases, patients suffer from a disease that will quickly kill them. I then tell them that the patient does not choose to die rather than live, but chooses a way to die. We can work with the families if the disease leaves us a little time because we must not transfer the suffering of the patient to the family.
The emotional charge. “One day, a father asked me if I would agree to euthanize his 27-year-old daughter. I said yes and I cried. A year later, this father said to me: ‘Doctor, we have something in common, we are related.’ In reality, the more moving it is, the simpler it is. Euthanasia is not only a technical commitment, it is also an emotional commitment. We do not treat only one disease, there are lives , human stories.”
The French in Belgium. “It’s rare across Belgium, but frequent for me. I am identified, people see my name on the internet. They are often very willing people who travel a thousand kilometers to come and see me and suffer from cancer or of Charcot’s disease. Many do not feel heard or supported in France, and some are angry with their country.”