In Belgium, palliative care at the time of euthanasia

” That works, my love ? » Muriel the nurse enters the room of the “pink lady”. The bubbly banter, this one is quietly seated in her medical chair, and waits the fires of lovehis favorite soap opera. I am very happy ! exclaims the woman in the fuchsia t-shirt, suffering from lung cancer. “I am well cared for, the pain disappears. And above all, I feel at home! » The proof: she brought her sewing machine!

We are at the CHC-Hermalle clinic, in the province of Liège, near the Dutch border. The institution hosts a six-bed hospitalization unit and a mobile team. Patients have access to a library, a dining room, a smoking room and a terrace overlooking the Meuse and the Albert Canal.

The testimony of a fear transformed into gratitude

The service also calls on a psychologist, a social worker, a spiritual guide, beauticians, a physiotherapist and a team of volunteers. “We started in 1993 with a mobile team”explains Françoise Beckers, one of the four doctors in the service, who recalls the philosophy of palliative care: “Accompanying the sick person in respect of the rhythm and maximum comfort, until their death or when they leave the service, as well as their loved ones, who often believe they are arriving in a place of death. »

The guestbook made available to families testifies to a fear transformed into gratitude: “Given the illness of my godmother, I could not have imagined a better start for my dear and beloved aunt” ; “Here, it is angels, not nurses, who come to the aid of patients” ; “I never imagined that so much humanity could exist… Thank you. »

In front of all these compliments, Muriel the nurse has the astonishment of the humble: “It’s a gift for me, to receive all these bits of life from people! » Crossed in the corridor, an anonymous patient takes the time to slip us: “There is no hope for me. But here… We are fine. »

The palliative care department has living rooms, and the team stays close to the patients to soothe them.


Belgium, a pioneer in palliative care

Historically, Belgium is a pioneer in the field of palliative care. The first units were born in the 1980s, with the Continuing Care organization, the Saint-Jean clinic in Brussels, directed by the mythical sister Léontine, who devoted her life to the sick after her father’s cancer, and the Foyer Saint- Francois of Namur.

In 1991, the Socialist Minister of Health Philippe Busquin encouraged the development of services on a human scale and at home. In 1994, the Belgian Federation for Palliative Care adopted a charter rejecting therapeutic relentlessness, adding that “euthanasia is foreign to palliative care. »

However, the decriminalization of euthanasia will shortly precede the law which makes palliative care a right accessible to all, voted on June 14, 2002. A concomitance assumed by its promoters, who do not see any incompatibility with palliative therapy.

A mastery incompatible with “letting go”

Euthanasia lawyer Wim Distelmans is the former president of the Flemish Federation for Palliative Care. “Euthanasia is however the pebble in the shoe of the philosophy of palliative carelaments Françoise Beckers. We want to ensure control of his end of life by deciding the day of his death. We are no longer in the “letting go” that characterizes palliative care. »

Most medical institutions have agreed to perform euthanasia within their walls. The few who opposed it were finally forced to do so by the last revision of the law, in 2020: if the caregiver can always refrain from taking part, it is no longer possible for an institution to refuse euthanasia, even if it means bringing in an outside doctor.

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Euthanasia, expression of a “loss of meaning”

In Hermalle, euthanasia has been practiced since the beginning of the law, with respect for the conscience of caregivers. “Patients who ask for it rarely suffer physicallytestifies Françoise Beckers. Above all, they express a loss of meaning, saying that they are no longer of any use… There are also people who talk about euthanasia, and who don’t go all the way. We are all deeply ambivalent: the desire for life and death is intertwined within us. »

But contrary to what happens in some hospitals, the palliative care unit does not accept patients who come for the sole purpose of being euthanized. “I no longer experience this act as a failure, except perhaps in my subconscious… But I feel it as something very violent. I find it difficult to say goodbye to a patient who I know will be euthanized the next day. I feel a special atmosphere in the department when euthanasia is going to be performed. »

A certain discomfort among caregivers

Because a certain unease remains on this subject. Contacted by Life, no less than four palliative care units did not wish to speak. In covert words, we evoke a pressure that does not say its name on caregivers to practice euthanasia, volunteers dismissed for their opposition to the law…

“There is a shift within the staff. Some leave, others stay accepting a “mix” between palliative care and euthanasia”believes François Trufin, emergency nurse, former secretary of the palliative care platform of the Belgian German-speaking community.

“From my point of view, the two practices have a diametrically opposed spirit. With euthanasia, I will seek death before it comes to find me. Like throwing a person off a cliff into the sea, rather than guiding them down a path to the water”he laments, without overwhelming the doctors who practice it.

“Caregivers are more often confronted with this request. For the patient, it became a step in the personal acceptance of death. Do not be afraid to hear it, and to offer better. » He evokes this woman, crushed by a neurodegenerative disease, and having made several suicide attempts, who demanded euthanasia. By combining painkillers and controlled sedation, she finally calmed down. She died in her husband’s arms, listening to their wedding music. “It was a beauty! »

The need to be extra vigilant

François Trufin sees in this the need for a redoubled requirement. We must abandon this form of fatalism which leads some to ask themselves: do we still believe in palliative care? » Part of the answer to this question can be found in Hermalle.

Arrived yesterday, a “lady in white”, almost a century old and overwhelmed by anguish, is agitated. Her gestures have too many wrinkles, as Jacques Brel sang, but she speaks, and not just out of her eyes. “Leave me! », she screams, calling her daughter and attacking the caregivers. Muriel makes her sit on her bed, and gradually manages to reassure her. Curled up against the nurse, the lady seems to come to her senses. “I’m wasting your time”she breathes. “No, not a single second”replies Muriel.

To read
Take my hands in yoursby Attilio Stajano, Editions Mols, 2014. The moving testimony of a former European civil servant residing in Belgium, who was a volunteer for a long time in the palliative care unit of a Brussels hospital.

We want to thank the author of this write-up for this remarkable material

In Belgium, palliative care at the time of euthanasia

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