By Hilary White

ROME, May 19, 2010 ( – In one region of Belgium, over 30 percent of reported euthanasia cases were carried out without the consent of the patient, a study has found. At the same time, the overall number of official reported deaths by euthanasia are dramatically increasing in the country since the practice was legalized in 2002, with 40 per cent more cases reported for 2009 than the previous year.

A team of Belgian and Dutch end-of-life researchers circulated a questionnaire to physicians who signed death certificates of patients who died in the Belgian region of Flanders between June and November 2007. The study showed that of the 208 reported Flemish deaths involving the use of “life-ending drugs,” 142 were killed with “an explicit patient request,” and 66 “were without an explicit request.”

The study, published in the Canadian Medical Association Journal this week, showed that in the majority of cases of euthanasia without a patient’s consent, the euthanasia “option” was not discussed with them before they were killed, and that most were undergoing medical treatment with the hope of a cure for their illness.

The researchers noted that euthanasia and assisted suicide “mostly involved patients less than 80 years of age, those with cancer and those dying at home.” Euthanasia without a “specific request” from the patient was “mostly” carried out on patients over 80 years, “those with a disease other than cancer and those in hospital.”

In most cases of patients killed without “an explicit request” (77.9%), “the decision was not discussed with the patient.”

Many cases in which patients were killed without requesting euthanasia, the researchers said, “involved patients whose diseases had unpredictable end-of-life trajectories,” with death not being an inevitable result.

The Belgian government’s statistics show that the number of euthanasia cases is rising dramatically, with 700 cases in 2009 compared to 500 in 2008. It is likely, moreover, that the actual numbers of people being euthanized with or without their consent is likely much higher than the official statistics. Belgian media reports that physicians are “hesitating” to report euthanasia for fear of “judicial problems,” with an estimated 1 in 4 actually making formal reports of euthanasia.

In countries, such as the U.S., Canada and the UK, where the possibility of legalizing assisted suicide or euthanasia continues to be debated in legislatures, advocates of the practice routinely cite the “safeguards” that are ostensibly built into the law to protect vulnerable patients. In Belgium, while the law allows euthanasia for people without terminal illnesses and who are suffering from “constant and unbearable physical or psychological pain,” it also technically requires a patient’s written consent, the opinion of a third physician in cases where an illness is not terminal and a one-month waiting period for patients suffering from depression.

However, a study of cases of euthanasia in patients’ homes that was conducted by researchers from the End-of-Life Care Research Group, and Belgian Department of Public Health and found that, “Procedural requirements such as consultation of a second physician were sometimes ignored.”

“Euthanasia cases were least often reported when the physician did not regard the decision as euthanasia, when only opioids were used to perform euthanasia, or when no second physician was consulted.”

Anti-euthanasia campaigners have long warned that legal “safeguards” in practice do little to guard the safety of vulnerable patients. It has been widely reported, and admitted by euthanasia campaigners, that euthanasia was legalized in the Netherlands after years of physicians killing patients without a law and simply not reporting the cause of death.

Bioethics writer and lawyer Wesley J. Smith, writing on his blog at First Things magazine, said that it is likely that in countries that have legalized euthanasia by this backdoor means physicians are killing patients on their own cognizance without regard to legal restraints.

In reference to the recent study, Smith wrote, “We could say Flemish doctors murdered their patients since explicit request is required under the supposedly ‘protective’ euthanasia “guidelines.”

Smith also points to the next logical step in the euthanasia business, the linking of euthanasia and organ “harvesting.”

He cites a letter to the editor of the journal “Transplantation,” dated 2008, that recorded a case of a legal euthanasia, and subsequent “harvesting” of organs, of a patient with “locked-in” syndrome, in which she was fully conscious but completely paralyzed, and who requested that she be killed. But before she died, she also decided to donate her organs.

The letter, from the physicians presiding over the case, said, “This case of two separate requests, first euthanasia and second, organ donation after death, demonstrates that organ harvesting after euthanasia may be considered and accepted from ethical, legal and practical viewpoints in countries where euthanasia is legally accepted.

“The ethical and legal possibility of combination of the two separate processes, physician-assisted suicide and after-death organ donation was then considered and agreed by the institutional ethical committee president.”

Smith writes, “If this doesn’t set off alarm bells about how the sick and disabled are increasingly being looked upon not only as burdens (to themselves, families, and society), but potential objects for exploitation, what will?”

The killing of patients, even with consent, he wrote, validates “the ideas that dead is better than disabled and that living patients can, essentially, be viewed as a natural resource to be killed and mined.”