DR DEATH who proudly ad­mits he’s killed 140 pa­tients – and t wo were his friends. . .

A dis­turb­ing dis­patch from the EU state that’s helped 15,000 – in­clud­ing three chil­dren – take their own life. Do we RE­ALLY want as­sisted dy­ing in the UK?

The Mail on Sunday - - Tina Weaver - From IAN BIRRELL IN AN­TWERP

WITH his ge­nial man­ner, check shirt and care­ful choice of words, Marc Van Hoey seems like any other gen­eral prac­ti­tioner. But then he tells me about the death of one of his pa­tients af­ter she suf­fered a stroke. ‘She was a good friend as well as a pa­tient whom I had known more than 15 years,’ he says. ‘She was a beau­ti­ful old lady. The day of her death, she did her hair at the hair­dressers, put on her make-up and drank cham­pagne with us – then we gave her the in­jec­tion and she died.’

Van Hoey talks about an­other friend, rid­dled with pan­cre­atic can­cer, whom he despatched with an­other strong dose of bar­bi­tu­rates. ‘He was re­ally suf­fer­ing badly.’

Oth­ers who have died at his hands in­clude the el­derly mother of a fel­low doc­tor who had de­men­tia and ate her favourite meal of eel in herbs washed down with fine wine for her last sup­per, and a 34-year-old woman with chronic de­pres­sion.

As we sit in his cosy first-floor surgery in An­twerp, sur­rounded by books and me­men­tos of his life in medicine, I ask this mu­sic-lov­ing 57-year-old physi­cian and pres­i­dent of Right To Die Flan­ders how many peo­ple he has per­son­ally killed since Bel­gium made eu­thana­sia le­gal in 2002.

‘Maybe 140,’ he con­cludes af­ter a quick cal­cu­la­tion, adding that he has ad­vised per­haps an­other 500 on eu­thana­sia pro­ce­dures. ‘But they did not all go through with it and die, of course.’

This as­ton­ish­ing toll is even higher than at­trib­uted to Jack Kevorkian, the in­fa­mous Amer­i­can right-todie ad­vo­cate who be­came known as ‘Dr Death’ af­ter he claimed to have helped 129 ail­ing peo­ple end their lives be­fore be­ing con­victed of sec­ond de­gree mur­der for his 130th.

‘It’s never easy,’ in­sists Von Hoey, who be­came an ad­vo­cate of eu­thana­sia through his work in pal­lia­tive care. ‘That would make me sound like a ter­ri­ble sadist. It is an act of pity. An act of em­pa­thy.’

Yet the Flem­ish doc­tor could – like Kevorkian – end up in prison. He can­not carry out any more mercy killings as he is be­ing in­ves­ti­gated by po­lice over the eu­thani­sa­tion of an el­derly woman in 2015 who was threat­en­ing to com­mit sui­cide af­ter the sud­den death of her daugh­ter.

If the case goes to court, he could be charged with poi­son­ing his pa­tient. ‘ It is like the Sword of Damo­cles hang­ing over me,’ he said. ‘It’s very wor­ry­ing but my con­science is clear.’

The case high­lights the del­i­cate dilem­mas on this dif­fi­cult is­sue, even in the world’s most per­mis­sive so­ci­eties such as Bel­gium, the sec­ond coun­try in the world to le­galise eu­thana­sia af­ter Hol­land and the first to au­tho­rise it for chil­dren of any age.

It co­in­cides with a for­mal crim­i­nal in­ves­ti­ga­tion into three Bel­gian doc­tors over the death of a 38-yearold woman called Tine Nys that made head­lines around the world last week.

She was di­ag­nosed with a mild form of autism just two months be­fore she was killed, and her sis­ters al­lege there were ‘ir­reg­u­lar­i­ties’ lead­ing up to her death, while ques­tion­ing the va­lid­ity of the sud­den di­ag­no­sis.

Last week, Noel Con­way, a Bri­tish man with mo­tor neu­rone dis­ease, lost a le­gal bat­tle at the Supreme Court in the lat­est chal­lenge by cam­paign­ers to over­turn Bri­tish re­stric­tions on as­sisted death.

In most places where it is al­ready le­gal, in­clud­ing Canada, Colom­bia and parts of the United States, such ac­tions are re­stricted to adults with ter­mi­nal ill­ness. But boundaries are be­ing pushed wider in Europe’s pi­o­neer­ing na­tions.

Bel­gium, along with Hol­land, is unique in al­low­ing peo­ple to re­quest death when suf­fer­ing from psy­chi­atric con­di­tions if they can prove their men­tal pain is un­bear­able, un­treat­able and their de­ci­sion is backed by psy­chi­a­trists.

Yet many doc­tors and ethi­cists fear their coun­try is slid­ing down a slip­pery slope to­wards death on de­mand rather than only un­der tight med­i­cal reg­u­la­tion.

Al­most 15,000 peo­ple have been of­fi­cially eu­thanised since laws changed in this coun­try of 11 mil­lion peo­ple. Lat­est data dis­closed 2,309 in­ci­dents in 2017, more than dou­ble the num­ber seven years ear­lier and al­most ten times the first-year fig­ures.

Con­tro­ver­sial cases to have hit the head­lines in­clude a per­son with botched gen­der re­as­sign­ment surgery, deaf twins who feared go­ing blind and a jailed mur­derer. There has also been a sharp rise in older peo­ple with non- ter­mi­nal con­di­tions seek­ing eu­thana­sia.

Three chil­dren are known to have died since the law was changed to per­mit mi­nors in 2014.

A nine- year- old with a brain tu­mour and an 11- year- old with cys­tic fi­bro­sis be­came the first peo­ple un­der 12 legally eu­thanised in the world.

‘It’s im­pos­si­ble to keep the door open just a bit – you end up with hardly any con­trol,’ Tienen psy­chi­a­trist An Haekens told me. ‘I am against it for psy­chi­atric suf­fer­ing since it is sub­jec­tive to say some­one is un­treat­able, that there is no hope left for them.’

Haekens told me of a re­cent case she came across in a nurs­ing home of a woman in her 80s who said she was tired of life and wanted to die – which is per­mit­ted if there is griev­ous and ir­re­me­di­a­ble ill­ness. Her de­mand was sup­ported by her son. ‘Then it be­came clear the son was vis­it­ing weekly to ask for money, so he was prob­a­bly be­ing sup­port­ive be­cause he wanted her money,’ she said.

A sim­i­lar sharp rise has been seen in neigh­bour­ing Hol­land, where as­sisted dy­ing now ac­counts for one in 25 deaths. ‘Sup­ply has cre­ated de­mand,’ com­plained one prom­i­nent aca­demic af­ter re­sign­ing from the reg­u­la­tory board.

Some medics in both coun­tries refuse to par­tic­i­pate in eu­thana­sia. Now, right-to-die cam­paign­ers in the Nether­lands are push­ing for ‘tired of life leg­is­la­tion’ that would per­mit any per­son over 85 to ob­tain a fa­tal drug dose on re­quest.

Co­in­ci­den­tally, it has also emerged that a Dutch doc­tor faces pros­e­cu­tion af­ter al­legedly putting sleep­ing drugs in the cof­fee of a con­fused woman aged 74 with de­men­tia, then ask­ing her fam­ily to hold her down when she strug­gled dur­ing the in­jec­tion of a lethal dose.

Mean­while, Bel­gium has be­come a mag­net for some des­per­ate peo­ple. Von Hoey told me of a gay Hun­gar­ian artist who turned up at his door, say­ing his part­ner had died so he had sold his house and pos­ses­sions since he did not want to live alone. ‘ I said it was ridicu­lous com­ing here with your prob­lems. We have le­gal pro­ce­dures.’

The more pro­found legacy of re­form is a pal­lia­tive care sys­tem en­twined with eu­thana­sia and a ris­ing tide of re­quests – but the key con­tro­ver­sies, sym­bol­ised by the po­lice probes, sur­round lonely or jaded old peo­ple and pa­tients with men­tal health is­sues.

‘It is very dif­fer­ent when it is a ter­mi­nal pa­tient with just a few weeks to live,’ said Joris Van­den­berghe, pro­fes­sor of psy­chi­a­try at KU Leu­ven uni­ver­sity and a psy­chi­a­trist at Leu­ven uni­ver­sity hos­pi­tals. ‘The dif­fi­cul­ties are much greater if they could have life ex­pectancy of sev­eral decades.’

He has been ac­tively in­volved in sev­eral such cases, in­clud­ing a woman in her 50s who en­dured anorexia for 30 years.

Death comes quickly, said Van­den­berghe, but he ad­mit­ted: ‘It is weird when you are watch­ing some­one with a healthy body.’

His hos­pi­tal, among the big­gest in Bel­gium, sees about ten deaths from eu­thana­sia each year, al­though it re­ceives many more re­quests and some pa­tients opt to die at home.

‘ I have wit­nessed many cases when I feel peo­ple have thought it through and the is­sues are clearcut,’ said the pro­fes­sor.

But in one case it turned out a mid­dle-aged man with mo­tor neu­rone dis­ease was sim­ply scared of be­com­ing a bur­den on his fam­ily

Son prob­a­bly sup­ported eu­thana­sia to get her money

as his con­di­tion de­te­ri­o­rated – and he with­drew his re­quest when he was given re­as­sur­ances by his wife and chil­dren.

Van­den­berghe also told me of a young par­ent with com­plex med­i­cal prob­lems that led to a failed or­gan trans­plant who de­manded eu­thana­sia rather than go through the de­bil­i­tat­ing and drawn- out process a sec­ond time with low sur­vival odds.

‘It was a rea­son­able, eth­i­cal de­ci­sion and they knew what they were talk­ing about,’ he said.

‘But from my point of view as a father, I think I would have over­come my fear and taken any chance to give my chil­dren just a few more years of par­ent­ing.’

Van­den­berghe, who fears some doc­tors lack suf­fi­cient cau­tion and t hat pa­tients have died when op­tions were avail­able for treat­ment, has helped draft tighter rules for the Flem­ish Psy­chi­atric As­so­ci­a­tion. ‘It is stricter to get con­sent for deep brain stim­u­la­tion, an ex­per­i­men­tal treat­ment, than it is for eu­thana­sia,’ he said.

‘This is in­com­pre­hen­si­ble when noth­ing can be more in­va­sive or ir­re­versible than death.’

But oth­ers ar­gue that if eu­thana­sia is seen as play­ing a role in re­lief of suf­fer­ing, there should be no dis­tinc­tion be­tween phys­i­cal and psy­cho­log­i­cal pain, even if men­tal agony is harder to de­tect and more re­liant on the word of pa­tients.

I learned of one woman, just 21 years old, who is un­der­go­ing eu­thana­sia eval­u­a­tion on psy­chi­atric grounds. ‘Here in Bel­gium, it hap­pens that young peo­ple die like this – but it is very dif­fi­cult when they are so young,’ said a doc­tor in­volved with the case. These is­sues will be tested in the loom­ing le­gal cases. ‘It is not a trial of eu­thana­sia law but of the ap­pli­ca­tion of the law,’ said Fer­nand Keu­le­neer, the lawyer for So­phie Nys, sis­ter of Tine Nys.

‘The case will trig­ger de­bate on the boundaries of eu­thana­sia leg­is­la­tion.’ And the stakes are high.

‘Eu­thana­sia in­volves a toxic sub­stance that causes death,’ said Keu­le­neer. ‘It is poi­son­ing, so that is man­slaugh­ter if il­le­gal. The max­i­mum sen­tence for that is life.’

So­phie Nys said last year that while her sis­ter had long-term men­tal health is­sues, it was un­think­able they war­ranted her death.

She claimed the doc­tor per­form­ing the eu­thana­sia asked her par­ents to hold the nee­dle in place dur­ing the pro­ce­dure.

At the heart of this land­mark case i s Lieve Thien­pont, who was ac­cused by nine fel­low psy­chi­a­trists in a let­ter to the Bri­tish Medi cal Jour­nal i n 2015 of be­ing re­spon­si­ble for ‘prob­a­bly close to 50 per cent… of eu­thana­sia cases for psy­chi­atric dis­or­ders’.

In one leaked email, she com­plained to a col­league about the Nys fam­ily.

‘We must try to stop these peo­ple,’ she wrote. ‘It is a se­ri­ously dys­func­tional, wounded, trau­ma­tised fam­ily with very lit­tle em­pa­thy and re­spect for oth­ers…

‘ I am start­ing to bet­ter un­der­stand Tine’s suf­fer­ing.’

Thien­pont de­clined to dis­cuss the case with me. But she de­nied claims there was any ‘slip­pery slope’, say­ing eu­thana­sia for psy­chi­atric pa­tients in­volved just one in 50 cases and claim­ing this fig­ure had re­mained sta­ble.

She op­er­ates Vonkel, a walk-in clinic in Ghent that has seen 450 pa­tients – mostly el­derly or with men­tal health prob­lems – dis­cussing eu­thana­sia since 2015, of whom about 50 have died. ‘Many come to us with­out hope,’ she said.

‘We of­fer some­thing hu­mane. If pos­si­ble, a hu­mane per­spec­tive for ways for­ward in their lives, and only if this is not pos­si­ble do we pre­pare them for a hu­mane farewell – and al­most al­ways sur­rounded by their fam­ily, which is im­pos­si­ble with sui­cide.’

Among the strangest as­pects of Bel­gium’s eu­thana­sia lib­er­al­i­sa­tion is how it has ended up sav­ing some lives by giv­ing pa­tients con­trol of their death, some­thing I heard from sev­eral ex­perts in the field as well as Amy de Schut­ter, a 32-year-old sci­en­tific re­searcher and pa­tient of Thien­pont.

She s uff ered men­tal healt h an­guish from the age of 12, which was in­ten­si­fied by five bru­tal years locked in a se­cure adult hos­pi­tal, dur­ing which she was forcibly se­dated and of­ten se­cluded. Only re­cently was she di­ag­nosed with pos­si­ble autism.

De Schut­ter care­fully planned sui­cide meth­ods dur­ing her years of tor­ment, us­ing her skills to cal­cu­late the best bridge for jump­ing and over­dose meth­ods.

‘Peo­ple can think about sui­cide for years, plan­ning it – and I did this,’ she said.

Yet she felt re­lieved when her re­quest for eu­thana­sia was granted two years ago.

‘It of­fers an­other way. I know I can just call my GP and we can make an ap­point­ment for my death – and from that mo­ment, I have never talked about sui­cide.’

So, I ask ner­vously, will she ever make that fate­ful call? ‘ At this mo­ment, I am do­ing ev­ery­thing I can to live,’ she replies. ‘But it is re­ally dif­fi­cult to know the fu­ture.’ To die with your fam­ily all around is bet­ter than sui­cide

CRU­CIAL CASE: Tine Nys, cen­tre, with her sis­ters, Lotte, left and So­phie, who ar­gue that her men­tal health is­sues did not war­rant her death

GE­NIAL: But gen­eral prac­ti­tioner Marc van Hoey says he has legally killed about 140 pa­tients since 2002 THE DROP-IN AS­SISTED DEATH CLINIC THE PA­TIENT DIS­CUSSING HER DEATH Vonkel, a walk-in clinic for pa­tients want­ing to dis­cuss dy­ing, sits down a bustling shop­ping street in the Flem­ish city of Ghent. It has seen about 450 pa­tients since 2015, of whom about 50 have died. Amy de Schut­ter, left, is only 32 but af­ter fight­ing men­tal health is­sues for two decades has been granted eu­thana­sia. Her psy­chi­a­trist is Lieve Thien­pont, right, a lead­ing ad­vo­cate of eu­thana­sia who runs the walk-in clinic above and now faces crim­i­nal charges in an­other case.

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