Belgium’s Dr Death admits he has killed 140 patients – including two of his friends
Published by The Mail on Sunday (2nd December, 2018)
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-to-die 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-year-old 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 clear-cut,’ 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 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 that 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 is Lieve Thienpont, who was accused by nine fellow psychiatrists in a letter to the British Medical Journal in 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 since 2015 has seen 450 patients – mostly elderly or with mental health problems – discussing euthanasia, of whom about 50 have died, mostly old people with polypathology. ‘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 suffered mental health anguish from the age of 13, which was intensified by five brutal years locked in a secure adult hospitals, 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.’