Belgium is an international outlier when it comes to end-of-life care, according to euthanasia expert Wim Distelmans. His comments to VRT follow the death by euthanasia of French actor Arnaud Denis in Namur this week.
According to Distelmans, Belgium stands out not only because of its euthanasia law but its laws on palliative care and patient rights.
“We are the only country in the world to have these three laws,” he told Radio 1. As a result, he believes Belgium is an ethical leader when it comes to euthanasia, pain management and end-of-life care.
Denis’s death by euthanasia at the age of 43 clearly illustrates the difference between Belgium and France, he says. A bill on medically assisted suicide was passed in Frane this summer, but that is not the same as euthanasia.
In assisted suicide, a doctor provides a lethal substance that the patient must take themselves. In euthanasia, the doctor administers the substance. The conditions in France are also much stricter.
The fact that Belgium has a more liberal euthanasia law does not mean that patients have easy access to euthanasia. Foreign patients, too, must meet all the conditions set out in Belgian law.
For instance, a doctor-patient relationship must be established with the doctor who is prepared to carry out the euthanasia, and a second medical opinion is required in every case. Where a person is terminally ill, a second doctor must give their opinion. In the case of a patient who is not terminally ill, as in the case of Denis, opinions from two additional doctors are required.
This means patients often have to travel to Belgium several times before a decision can be made.
A total of 110 French citizens underwent euthanasia in Belgium last year. Distelmans is reluctant to describe this as genuine “euthanasia tourism”. People who request euthanasia are often seriously ill and no longer able to travel long distances. “It is gradually increasing, but not to any great extent,” he says.
The group consists of patients with serious conditions such as ALS, advanced multiple sclerosis or cancer. These cause severe suffering without the patient necessarily being in a terminal phase.
Euthanasia for foreign nationals on psychological grounds is extremely rare. The reason is mainly practical. It must first be established that all treatment options have been exhausted, and that is particularly difficult to organise for someone who does not live in Belgium.
Distelmans argues that Belgium also has a well-developed system of palliative care, which is, moreover, enshrined in law. He singles out Flanders in particular as performing exceptionally well in this regard.
Although the end of life does not always unfold as people would wish, he believes Belgium remains one of the best places in which to spend the final stage of life. “If you compare this with other countries, it really is better to be in Belgium in that respect,” he says.
Arnaud Denis had an implant placed to treat an abdominal hernia at a clinic in Paris in 2023. Following numerous side effects, including an infection, the implant was removed in 2024 in the US. His condition continued to deteriorate and he was diagnosed with severe myalgic encephalomyelitis, a neurological and immune disease.
“I am done with medical abuse,” he wrote in a final message published on Facebook on Tuesday. He explained that he saw euthanasia as “a deliverance” after “three interminable years” of “degrading” suffering.