Report of Intercalated Project by Toni Saad, MA in Bioethics and Medical Law, St Mary's University, Twickenham

I am grateful to the IME for their awarding me the intercalated degree grant for my research project into euthanasia in Belgium. Below is a summary of my dissertation, which, I am pleased to report, received the highest mark ever awarded a dissertation on the MA programme at St Mary's (91%).



Following the Netherlands by a few months, Belgium is the second nation worldwide to decriminalise voluntary euthanasia. It did so in 2002 with the passing of the Act on Euthanasia, though euthanasia was relatively widely practiced in Belgium beforehand. Moreover, the Act did not put an end to illegal practices in regard to euthanasia: much euthanasia remains unreported, and non-voluntary euthanasia and physician-assisted suicide, both of which are illegal, continue to occur. Chapter One of this dissertation considers the state of affairs concerning euthanasia prior to and after the 2002 Act, and traces its development and influences. It shows that the process which preceded the decriminalisation of euthanasia was expedited by political motive, and that the Act itself suffers from conceptual flaws. Chapter Two places this Belgian euthanasia experience in its historical-philosophical and political context. It begins by outlining one influential ethical tradition, Aristotelian-Thomism, and describing how departure from it has radically changed the nature of moral philosophy, and, consequently, the fabric of moral debate. Furthermore, it argues that in the social context of political liberalism, the Belgian euthanasia experience and similar phenomena are somewhat inevitable developments. Analysis of the changing nature of moral debate confirms that, though it is very difficult to achieve moral consensus today, trends in moral philosophical thought nevertheless run in definite directions. It is concluded, therefore, that the Belgian euthanasia experience is a single symptom of broad and powerful changes in moral and political philosophy.

Chapter One: The Belgian Euthanasia Experience: Historical and Political Review of a Law unto Itself

In this first chapter I considered the historical and political development of the Belgian law on euthanasia, beginning with the practice of euthanasia before the 2002 law was passed. I examined this law in detail, and traced its evolution, and compared euthanasia practiced before and after its passing into law. Here is a quote from my conclusion of chapter one:  "The 2002 Act on Euthanasia was a rushed and deficient piece of legislation which served to justify a pre-existent practice. In a sense, it was a mere formality, though one strongly influenced by the political climate, rather than interested parties. The Act suffers from conceptual and practical shortcomings and remains significantly under-enforced—only half of all cases of euthanasia are reported. The later amendments it has undergone, particularly that of 2014 concerning the repeal of an age restriction on access to euthanasia, reflect the existence of a strong political will to liberalise euthanasia. And, as in 2002, calls to amend the law did not come from interested parties. At present, euthanasia in Belgium remains a concern because physicians do not abide by the law in terms of reporting euthanasia, continue to practise physician-assisted suicide and, most worryingly, non-voluntary euthanasia."

Chapter Two: The Moral and Political Context of the Metamorphosis of Bioethics

The second chapter takes a broader look at the phenomenon of the Belgian euthanasia experience (BEE), and sets it in its philosophical context. I consider one significant ethical tradition (that embodied by Aristotle, Thomas Aquinas and John Finnis) and describe how departure from it leads almost inevitably to the multiplication of phenomena like the BEE. I consider thin theories of good in the light of this, and explain them in the context of a concurrent evolution in political theory. These changes are then considered in terms of how they bear on contemporary bioethical discourse and debate.

Here is the conclusion to which I come: "the BEE is not an isolated or even a surprising phenomenon. It is the product of an anaemic moral philosophy which has abandoned a substantive notion of human goods. Into the resulting vacuum has entered a conceptually-thin formally rational debate, coupled with shifts in political ideology which seek to place morality in the hands of individuals rather than the State. Ethical discourse is changed unrecognisably as a result...The fact that euthanasia was relatively widely practised before it became legal, and before any significant public debate occurred on the subject, is evidence of the psychological influence of this moral evolution. It is only a society with a very narrowly redefined axiology which can tolerate such widespread transgression of the basic good of life. And it is only a formally rational terrain of debate which can allow such actions to be rationalised in law in order to maximise individual autonomy. That euthanasia continues to go unreported in Belgium, and that there was such a strong political will for its passing into law, is additional evidence of Belgian society's desire for something which was once unthinkable. And the decision to extend the scope of euthanasia to include children is due to the projection of paper-thin axiological values onto the youngest and most vulnerable members of society..."