Upon administering a lethal dose, the doctor left the room. But the patient was not dying. For Sophie Druenne, a palliative care nurse working under the Belgian physician who had approved the euthanasia request, this was a breaking point.
“The situation was so absurd that we were laughing,” Sophie told me at the start of our interview. “We had to call the practitioner back to tell him that the patient was still alive and that we had to give him an additional injection. And I caught myself laughing in the course of protecting myself from what was happening.”
Recounting the story to her friends and family outside the hospital, Sophie realized the horror of this situation and began to question Belgium’s so-called social experiment with euthanasia. Legalized in 2002, euthanasia was decriminalized under certain conditions. Its scope continues to widen, with the inclusion of minors in 2014, and now lawmakers debate broadening that scope to include psychiatric patients. It wasn’t these laws, however, that changed Sophie’s opinion toward her country’s euthanasia policies, but working in Belgium’s integrated palliative care system.
Palliative care is medical aid that treats symptoms of a typically serious disease rather than the disease itself, which sometimes cannot be treated or not easily. Integrated palliative care (IPC) subsumes traditional palliative care within Belgium’s 21st century euthanasia framework. In this new model of care for the dying, physicians and nurses are trained to discuss euthanasia as the last medical option with their patients. Proponents of IPC describe it as a “reconciliation.”
Historically, palliative care was defined by the anti-euthanasia beliefs of its founder, Cicely Saunders, a British nurse who developed a holistic method of caring for the dying in the 1940s. Witnessing the rise of effective pain management strategies and drugs during her lifetime, she believed that a patient’s request for euthanasia represented a failure to adequately care for the patient’s spiritual, emotional, and social needs.
This medical system failure prompted her to design a method of caring for the dying that attended to those needs alongside the physical ailment, as so often a patient’s euthanasia request actually represents a plea for reconciliation and companionship in the grip of their illness. Saunders also pushed back against the pro-euthanasia autonomy arguments marking her own day, saying, “If you make active euthanasia a right, it soon becomes a duty. The patient, knowing that he or she can die by choice, will soon feel it incumbent to relieve relatives of the ‘burden’ of looking after them. When that stage is reached you have removed the patient’s choice.”
Nonetheless, Belgium attempts to reconcile Saunders’ standard with their euthanasia laws, which made history again by granting death to three minors last year.
Doing No Harm vs. Allowing No Suffering
Sophie can understand her Belgian colleagues’ motivations for this integration, since the patients who most commonly request euthanasia are terminally ill and receive treatment from palliative care physicians. Yet she observed that in IPC, the physician’s altruistic intention to relieve suffering morphed under the legal euthanasia framework. Physicians replaced “first, do no harm” with “first, relieve suffering,” which justified a blind eye turned toward patient consent, despite their avowed commitment to patient autonomy.
Sophie remembers first remarking on this shift in ethos when attending to a patient with strong breathing difficulties. At the time, she was working with another nurse, and they called the attending physician in for help.
“The first reaction of the doctor was to prescribe a triple dose of morphine with the obvious consequence that death would occur,” Sophie said. “Our reaction was to ask the practitioner if he really thought it was a good solution because it didn’t actually look like [death] was the will of the patient, but that this was a strong person fighting for life.”
Hearing their suggestions, the physician decreased his initial prescription of morphine. The patient died a few hours later, probably as a consequence of her disease. The fact that the practitioner changed his mind so easily indicated to Sophie that his initial prescription wasn’t medically justified. This experience emboldened her to question decisions of practitioners and appeal to the consciences of her colleagues in ethically challenging cases.
“This was not in the case of all physicians, but in him especially, there was sense of desperation regarding the capability of medicine. When confronted with the pain of the patient, he suffered from the feeling of being unable to relieve the pain of some patients, and that’s why he saw euthanasia as the only solution,” Sophie said.
As she continued to work in this particular oncology unit, Sophie noticed that the ethical shades of grey were disturbing the medical team as they reacted to the unilateral decisions of the physician to prescribe euthanasia. They expressed their disapproval by pronouncing the phrase “We’re helping people,” in a sarcastic tone, Sophie said.
Euthanasia Is the ‘Easy’ Solution, Not Right One
It was not the euthanasia cases per se, however, that moved Sophie to uproot from Belgium and leave behind family and friends. She left in search of an institution where practitioners and medical teams were better equipped to treat suffering. Effective treatment of suffering excludes euthanasia—the “easy solution”—and defies the vision of integrated palliative care.
Sophie believes that this vision fails because of the contradictory premises of palliative care and euthanasia. The replacement of “first, do no harm” with “first, relieve suffering” reveals IPC as a dominating framework instead of an authentic integration.
When physicians are given unilateral power to void “first, do no harm” under certain conditions, altruism can lead to involuntary killing. Likewise, the guiding principle of “first, relieve suffering” does not bar death itself as a solution. The advent of IPC tells the latest lesson from Belgium: the normalization of euthanasia installs a new guiding principle for physicians and effectively nullifies the “autonomy at all costs” argument of proponents, by the sheer number of involuntary euthanasia cases.
“I had mixed feelings leaving, because I knew that euthanasia was taking place and medical care workers were needed to provide other options to patients. While getting away, I didn’t want to flee from this mission or task,” Sophie said, articulating a personal struggle many medical professionals face.
Sophie now works in Paris at a hospital where terminally ill patients are treated with traditional palliative care. She says her experience with cancer treatment in Belgium revealed to her the limits of medicine’s power over suffering, especially mental and existential.
Sometimes there are no medical solutions, but palliative care offers holistic answers to evaluating the patient’s needs beyond the physical. Speaking as an insider to Europe’s pro-euthanasia fever, Sophie beseeches medical professionals to defend their maxim of “first, do no harm,” lest medical care conflate itself with murder.
This interview was conducted during a three-month research partnership with the World Youth Alliance.