Belgium is embroiled in a religious freedom controversy after the new head of the country’s Roman Catholic Church demanded that faith-run hospitals and nursing homes have the right to refuse euthanasia to patients. A 2002 law decriminalized euthanasia for terminally ill adults and it has the support of a large majority of public opinion and politicians. But opposition in this historically Catholic country has grown as lawmakers extended the practice to including terminally ill children and people with severe psychological problems.
At the end of a long interview with the daily Het Belang van Limburg the day after Christmas, the new primate of Belgium, Jozef De Kesel, acknowledged that many secular-minded Belgians had no problem with abortion or euthanasia. “But it is not obvious from my faith,” said De Kesel, who is the archbishop of Mechelen-Brussels. “I think that we have the right, on an institutional level, to decide not to do it. I am thinking, for example, of our hospitals.”
The statement surprised many because De Kesel’s reputation as a moderate made him a popular choice when the pope appointed him to succeed his arch-conservative predecessor Andre-Joseph Leonard last month. “We were happy when he arrived, he seemed like an open man and I had great hopes for him,” said Jacqueline Herremans, head of the Association for the Right to Die with Dignity. “I didn’t expect comments like this.”
Several politicians and right-to-die advocates promptly came out against the idea, saying religious heath care centers could not opt out of providing a legal medical service because they are financed by taxpayers through state subsidies they receive. Senate President Christine Defraigne, from the liberal Reformist Movement party, said the euthanasia law was clear. “Freedom of conscience does not apply to hospitals,” she said.
Defending the Catholic position, lawyer Fernand Keuleneer—a former member of the federal euthanasia commission that reviews death requests—said the law foresaw a conscience clause for doctors but did not mention institutions. “The law does not create … a fundamental right to euthanasia,” he argued.
The 2002 decriminalization law was originally only for terminally ill patients with diseases like cancer. Religious leaders and some conservative politicians have long opposed euthanasia, but public acceptance has grown over the years—especially in Flanders, the Dutch-speaking northern region with about 60 percent of the population—and voluntary deaths have risen steadily. From 235 deaths in 2003, the total climbed to 953 by 2010 and then jumped to 1,432 in 2012 and 1,924 in 2014. About 80 percent of the cases are in Flanders, where people may be influenced by the neighboring Netherlands, which also passed a law in 2002 after turning an official blind eye to the practice since the 1970s.
As public acceptance grew in Belgium, the criteria for accepting requests for euthanasia were loosened to the point that unusual cases began to appear in the news. In 2013, identical 45-year-old twin brothers, deaf since birth, got lethal injections after they began to go blind and told doctors they could not bear not seeing each other. That same year, a 44-year-old man born female was euthanized because he suffered “unbearable psychological suffering” after several botched sex-change operations.
A serial murderer and rapist was granted permission for medically assisted suicide in 2014 due to the mental anguish he suffered since he had no prospect of release because he could not overcome his violent sexual impulses. This decision was reversed a week before he was to die, possibly because about 15 other convicts also applied for euthanasia after his request was granted.
While cases like these stiffened the resolve of euthanasia opponents, public acceptance was so widespread that newspapers expressed surprise at the negative comments made abroad when the Parliament voted in 2014 to allow terminally ill children to opt—with parental consent—to die.
“I’m annoyed at hearing ‘you kill children’ in the foreign media. We don’t use that kind of language anymore. It’s a very different debate on a different level,” said Bart Sturtewagen, editor-in-chief of the center-right newspaper De Standaard. The left-wing daily De Morgen said Belgians should be proud to be “ethically progressive leaders.”
Public opinion and politicians agreed. An opinion poll in 2013 before the vote on allowing euthanasia for children showed that 74 percent of those surveyed supported the reform. When it came to the legislative vote, large majorities backed it in both houses of Parliament. With such widespread support for euthanasia, and the once-powerful Catholic Church reduced to an average 5 percent attendance at Sunday Mass, De Kesel’s comments could seem to be background noise that politicians could ignore.
But the church still plays an important role in Belgium’s mixed private and public health care system. Private Catholic institutions provide about three-quarters of the hospital beds in Flanders and 42 percent in French-speaking south Belgium, or Wallonia. They also run roughly a third of the nursing homes in the country.
The Catholic hospitals, which receive state subsidies, officially offer only palliative care for end-of-life patients, but not all of them have an outright ban on euthanasia in their guidelines.
The debate over De Kesel’s comments has brought to light that, in the first such case, a Catholic nursing home outside Brussels has been sued for refusing to euthanize a 74-year-old patient. A court is due to rule on the case in April.