Euthanasia for non-terminally ill mental patients, those with dementia, and other disabling conditions: an open window towards eugenics and economic savings
Joaquín Díaz Atienza
INTRODUCTION
The decision by a Catholic institution to apply euthanasia to non-terminal psychiatric patients and those with other causes (age, dementia, etc.) at the patient's request has been widely reported in the press.
The fears of a slippery slope are being realized with the enactment of the Belgian Euthanasia Law. Its extension to non-terminally mentally ill patients in Catholic care institutions and to minors is a further step down this slippery slope.
Not only the Provincial General of the Brothers of Charity, René Stockman, has spoken out against his order's decision regarding the recognition of euthanasia for non-terminally mentally ill patients, but also the AAmerican Psychiatric Association (APA).
The reaction of the Belgian health minister, Maggie De Block, The strategy has consisted of attempting to discredit the APA with irony and unfounded accusations, and accusing it of being reactionary compared to the "courageous, enviable, and democratic Belgian progressivism" on matters of euthanasia and assisted suicide. According to the minister, all those who criticize the aforementioned Euthanasia Act of 2002 They are reactionaries, regardless of their level of technical expertise in the matter, like the APA, or moral expertise, like some Belgian bioethics associations or even the Vatican.
The freedom to apply euthanasia to terminally or non-terminally ill patients, including minors, has taken such deep root in Belgian society that not even the Belgian Episcopal Conference, nor some Catholic orders, such as the Brothers of Charity, They are free from this pro-euthanasia movement.
In this post we will present the document of the Brothers of Charity called «Texte d'orientation du groupe des Frères de la Charité en Belgique sur l'euthanasie en cas de souffrances psychiques en phase non terminal». A document that applies the 2002 Euthanasia Act to psychiatric institutions managed by them.
We will divide it into four parts: The first section addresses the ethical values involved and their tensions; the second, the support provided in response to the request for euthanasia; the third develops the prudential requirements to be taken into account in response to the request for euthanasia; and finally, the process in decision-making and ex-ante control.
A) Ethical approach
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Core values
The document considers three fundamental values to take into account with regard to euthanasia: The protection of life, the autonomy of the patient and the care relationship between caregivers and the patient.
The protection of lifeAccording to the document, life is the fundamental value par excellence, the foundation of all other values. It is a value in itself, independent of the quality of life. Furthermore, the value of life is protected by Human Rights. The nuance introduced by the document to justify euthanasia is the question of whether the value of life is absolute or whether it should be weighed against other values. Of course, for the authors of the document, life It is not an absolute value.even though it is fundamental.
Patient autonomy It is considered a fundamental value. It signifies the overcoming of traditional medical paternalism. It must be respected as long as it does not infringe upon the rights of others and is protected by patient rights legislation. Some consider it an absolute value (human beings can freely dispose of both their life and their death), while others see it as a fundamental value that must be evaluated in relation to other values also considered fundamental.
The care relationship It is equally fundamental and rests on the necessary trust that must always exist between caregivers and the patient in order to ensure the best possible care. Those who consider this relationship an absolute value maintain that care should always be provided, while others believe that this relationship should be reevaluated in specific situations. This latter position is the one defended in the document we are presenting.
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Tensions between values
They tell us that they wish to maintain their position from the paradigm of the relational ethics Based on personalist principles, although without considering any of the values as absolute, but rather from the perspective that they are constructed in relation to the other (relational). They say they evaluate fundamental values in order to find a reasonable compromise, the most humane possible for specific situations. To seek the best possible integration between different values and directly involving the patient in the dialogue.
Respecto a the protection of life The document states: “However fundamental the protection of life may be, it is not absolute, in the sense that it should take precedence over other values, no matter the situation.” They say they always prioritize the value of life over euthanasia, without forgetting other values. To this end, they propose “accompaniment from a life-centered perspective” as the first approach (approaches that will be discussed in the next post).
With regards to patient autonomy, They position themselves “in full respect” for the request for euthanasia, considering that the patient is the primary party involved. While they state that patient autonomy is not considered an absolute value, they also write: “A seriously decided and prudently supported request for euthanasia can prevent more violent forms of suicide.” Dialogue with the various stakeholders and support for the patient are necessary to clarify the underlying issues. According to the authors of the document, this leads to support regarding the second step: the request for euthanasia.
La care relationship It acts by integrating the protection of life and autonomy. "We will build a relationship of trust through which everything possible regarding support will be discussed in dialogue with the patient and their loved ones."
"Prudential requirements will be formulated and applied as a guide for accompaniment in the care relationship. These prudential requirements, according to the authors, will be made, both on content and form, and concern the two trajectories: life perspectives and the demand for euthanasia."
UltimatelyThe document, in its ethical analysis, clearly prioritizes patient autonomy over any other fundamental value. Although they repeatedly emphasize the supreme value of life, it is clear that one value predominates: patient autonomy.
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