The Nameless Horror

Figures: The Belgian Death Industry

Over the last couple of days I’ve seen links to Fox (and quoting a different study (I’ve not read) on slightly different matters, IIRC by the same authors, the Fail) and elsewhere talking about a lack of consent in euthanasia carried out in Belgium, where it’s legal, citing this study (of which the full text is freely available). Most quote “66 out of 208” cases or “30%” carried out without consent.

Since I’ve gone to the effort to type this up for a friend on Facebook, let’s reprint this here in case it interests any of you. Maths time.

In this particular case, media spin is heavy on the numbers. The study’s authors make it clear they’re talking from the point of view only of what constitutes legal consent (strictly defined as written instruction from the patient and the opinion of 2-3 doctors that their condition meets the standard set), as opposed to a reasonable understanding of the patient’s wishes and wellbeing. In actual fact, in the figures, the decision was discussed with the patient in 22% of those 30% “non-consensual” cases, or else the patient had previously expressed a wish to die (in 40%), leaving only 38% of that original 30% still unaccounted for (or ~10% of the overall figure) in terms of never broaching the subject.

Of that remaining chunk, the decision wasn’t discussed with the patient in 70% of those cases (the 38% of the 30% overall; with me so far?) because the patient was in a coma and therefore couldn’t give their written consent to anything. The thornier side comes in in the 21% (of that chunk; 21% of 38% of 30%, or ~2% of overall cases) where it wasn’t discussed with the patient due to dementia, or the 8.5% where talking about it was thought to be harmful to them (for unstated reasons).

Dementia is one of the things people fear most - and believe you me, I’d be happy to be quietly killed if I’d totally lost my marbles - and it’s that, IIRC, that Terry Pratchett is facing with the form of Alzheimer’s he’s suffering. But it also makes it impossible to get a reliable after-the-onset consent, which is bound to complicate things (and yes, I’m aware of the concept of ‘living wills’, but there’s always a ‘what if there were second thoughts’ argument to those cases).

So that’s one thing. But in 80% of all cases, relatives were consulted, as well as in almost all cases, other caregivers and other medical professionals. Only in (a slightly worrying) 6.5% of the 30% who didn’t give express consent was there no consultation at all, although for all we know these might well have been in the worst-affected of the comatose patients (there’s no cross-referencing of that sort in the figures).

And don’t forget that’s 6.5% of 30%, or ~2% of the overall total. I would suspect - at least, I’d like to believe - that these are people with no family, comatose and with such failed health that there’s no chance of them ever recovering. With cross-referencing of figures it’d be clear to see, of course. There’s no suggestion in the study that doctors might be going death-crazy, indeed that’s 208 cases total out of nearly 7,000 responding doctors so it’s hardly commonplace in any event, and response to the survey was entirely voluntary, so I doubt there’s much there that’d be too unreasonable.

It’s a difficult thing to balance, but I don’t know that it’s too hard to legislate for: the Belgian standard actually seems pretty good, it’s just enforcement of that standard that maybe needs tightening.

The study is, to say the least, rather more nuanced than recent reports on Fox and elsewhere, and paints a very different picture of the Terrible Belgian Death Industry and all its delicious organ harvesting. The second study, in the Fail, would I suspect show a similar pattern; in terms of the strict Belgian legal definition of consent the figure is higher, but there’s a world of difference between failure to meet that definition and murdering the elderly and the ill.

Edumacashunal, that’s me.