So to Live, that One has also at the Right Time One’s Will to Death.
Humanist euthanasia advocacy in Flanders between the 1970s and the 1990s, a story of personal choice and therapeutic tenacity
Niels De Nutte
History Department, Vrije Universiteit Brussel
Abstract: Research on euthanasia advocacy outside of the Anglo-American sphere is rather scarce. Belgium, originally a Catholic country with now liberal laws concerning bioethical issues, has never been properly researched in this regard. Based on my work on euthanasia advocacy within Flemish humanist organisations, this article describes the emergence of end-of-life advocacy based on freedom of choice from the 1970s to the 1990s. Although tentatively present before this time, I argue that euthanasia advocacy in Belgium was only successful due to the lack of a eugenics connotation and the collaboration of humanist and liberal Catholic factions in the law-making process.
Keywords: euthanasia, end-of-life, humanism, medical ethics, Belgium, mercy-killing, eugenics, therapeutic tenacity
On May 28th 2002, Belgium attracted international media attention when it became the second country in the world to partially decriminalise voluntary euthanasia. Since then, an impressive amount of literature has been published on the matter. However, most of it has been in the fields of law, medicine, and ethics.1 In addition, some studies have focused on the incidence and characteristics of the laws’ application in the past 17 years.2 Scarcely any publications exist, however, on the history of end-of-life practices and their advocacy in Belgium.3 This apparent dearth of publications is striking, since this country might hold the key to finding an answer to the question of how euthanasia advocacy groups might successfully translate their desires to the political level. Humanist groups in Belgium, and more specifically those in Flanders – the Dutch-speaking region – have always been vocal about their support for the legalisation of euthanasia and see its decriminalisation as one of their most prominent achievements.
Not only has the Flemish humanist sphere4 played a decisive role in euthanasia advocacy and awareness-raising but, according to historian Ian Dowbiggin, in the United States, too, a durable link can be found between freethinkers and subsequent secular humanists on the one hand, and euthanasia advocacy on the other.5 The current paper thus contributes to the debate on the history of voluntary euthanasia advocacy. By examining the source material of the two largest humanist organisations in Flanders, the Humanistisch Verbond (Humanist Association, HV) and the Unie Vrijzinnige Verenigingen6 (Union of Freethinkers’ Associations, UVV), I paint a picture of the place euthanasia advocacy occupied in the humanist sphere in the 1970s, 1980s, and early 1990s.7
By combining this research with interviews conducted with individual euthanasia advocates and articles on the law-making process, my goal is to propose an answer to the question of why Belgium has partially decriminalised euthanasia as opposed to other countries with a history of euthanasia advocacy, notably Great Britain and the United States. In attempting to answer this question, I build on the work of Dowbiggin and Kennedy.8 Furthermore, my results refute bioethicist Ezekiel Emanuel’s claim that “historical review suggests that there is no inherent or causal link between actual advances in biomedical technology and interest in euthanasia.”9
At least as far as Belgium is concerned, this statement is untrue. Belgian euthanasia advocacy was primarily developed in response to the rapid medical evolutions of the decades following the 1960s. Campaigns and publications focused on personal freedom of choice, opposing the paternalism and therapeutic tenacity of physicians – that is, the utilisation of any medical means necessary to prolong a patient’s life, independent of that person’s quality of life.
Euthanasia and its Connotations
As is often stated, the word euthanasia has its origin in ancient Greek, with the word euthanatos translating to a good (eu) death (thanatos).10 Equating the practice of euthanasia to mercy killing, however, is an idea that only emerged in the late nineteenth century. It is commonly accepted that this approach originated with an essay written by non-physician Samuel D. Williams for the Birmingham Speculative Club.11 In this essay, he defends his view that a “patient’s consciousness should be promptly and irrevocably extinguished in order to secure a quick and painless death”.12 In doing so, Williams was instrumental in moving euthanasia away from associations, through what we know today as palliative sedation i.e. a passive act where the pain is mitigated by increasing doses until an individual meets his or her end.13 This was, until the early 20th century, a role for which a physician was summoned to the patient’s house at the end of his or her life. It was then considered a normal part of medical practice. The text by Williams soon spread and made way for terms such as ‘voluntary euthanasia’ and ‘physician-assisted suicide’. The fact that a school teacher – and not a medical professional – lit the fuse, adds to the growing understanding that the acceptance of end-of-life practices is linked to changes in public attitudes, rather than alterations in the medical-scientific world. The emergence of the medical euthanasia debate approximately 150 years ago is not surprising, given the enormous rise in efficiency henceforth. At the end of the nineteenth century, mortality rates in United States hospitals stood at 25% for patients and 10% for staff, primarily due to infections.14
Until the outbreak of the Second World War, an association between euthanasia and eugenics would be a part of euthanasia advocacy in the United States, as well as Great Britain.15 No euthanasia advocacy existed in Belgium during that period, nor did any substantial eugenics movement emerge.16 Television broadcasts made by Belgian humanists in the early 1960s do link euthanasia to eugenics, somewhat emulating the Anglo-American approach. A booklet in the series of ‘Humanistische Perspectieven’ in 1962 makes explicit reference only to Anglophone literature when explaining what it considers ‘modern euthanasia’.17
Throughout the 1920s and 1930s, popular support for euthanasia grew in the United States, while leaders of advocacy groups believed in their eventual legislative success. In 1935, the Voluntary Euthanasia Legalisation Society (VELS) was founded in London, and one year later the Voluntary Euthanasia (Legalisation) Bill was introduced in the House of Lords and rejected 35 votes to 14.18 The conflation between mass murder and euthanasia created by Nazi Germany between 1939 and 1945,19 however, severely hindered its advocacy and public support in the post-war period. In Belgium, the subject would only tentatively (re)surface in the early 1970s, some earlier examples notwithstanding, as – by that point – the Nazi association would be less present. Even in the mid-1980s, opponents would continue to equate euthanasia to Nazi war crimes.20
Emergence of Euthanasia Advocacy in Belgium
Although Anglo-American countries have had advocacy groups for euthanasia since the last quarter of the nineteenth century, be it voluntary euthanasia or other forms, this was not the case for Belgium, where its advocacy only emerged a century later, most likely with the Flemish Humanist Association in the late 1970s21. The humanist movement itself was only established in 1951.22 Already by 1959, HV chapters in Bruges and Antwerp held two debates on euthanasia, followed by a nationwide television broadcast on the Nationaal Instituut voor Radio-omroep (National Institute for Radio Broadcasting – NIR) by Flemish freethinkers on February 18th, 1959.23 Another early example was the book “Euthanasie” written by M.D. Weytjens in the series of Humanistische Perspectieven, published by the HV in 1962.24 Apart from humanist action, the Softenon (Thalidomide) trial in Liege in that same year also brought euthanasia into the public eye, although this case seems to have attracted more widespread attention outside of Belgium than it did within the country itself.25
This does not mean that euthanasia was not mentioned before this time. Despite its highly polarised newspaper landscape, issues related to the concept were sporadically mentioned in both catholic journals like De Standaard, as well as freethinker (socialist and liberal) journals like Vooruit and Le journal de Charleroi.26 Most prominently, these include the 1936 Euthanasia Bill introduced in the British House of Lords, the euthanasia trial of Dr Sander in the United States,27 and the release of the picture Meurtres in 1950.28 The affiliation of newspapers is quite obvious, seeing as De Standaard describes the 1936 proposal as being in violation of the Fifth Commandment, whereas Le Journal The Charleroi calmly describes the modalities of the proposal, titling the article “Euthanasie: a-t-on le droit de recevoir la mort?” [Euthanasia: can one be entitled to die?].29 These examples, however interesting, do not equate to the presence of an actual societal debate. Even by 1970, no such debate existed. Janine De Rop, author and journalist of Vooruit, published a novel on euthanasia, set in Nazi Germany, but had a hard time finding a publisher and the issue itself was carefully omitted in almost every review.30 When, one year later, the socialist mayor of Antwerp, Lode Craeybeckx, defended the right to voluntary euthanasia in an interview, the issue received some attention in media, but even at that point in time, the journalist in question felt the need to add a section referring to a societal debate on euthanasia only in the future tense.31
Thus, the question of why formalised advocacy groups only seem to have emerged from the 1970s onwards remains. Perhaps Catholic post-war Belgium was not ready to tackle the subject before that time? It is true that, in the post-war era, Christian Democrats were present in every legislature passed between 1949 and 1995 (with the exception of the 1954–1958 legislation led by Achille Van Acker in the middle of the Second School War), thus creating a country dominated by Catholic structures – Flemish humanists would go so far as to dub Belgium the CVP-state (CVP being the Flemish Christian Democratic Party). Nonetheless, it would be a mistake to assume that the populace was equally religiously observant.32 Apart from the Christian pillar, smaller, socialist and liberal ones had emerged in Belgian society as well.
One example of letters to the editor in Vooruit implies that, even in the 1950s, some tolerance for the concept of voluntary euthanasia was already present among the secular populace. Following the Sander trial in the United States, readers were asked to send letters explaining their position on the legitimacy of mercy killing for cancer patients. Readers’ opinions were published over a period spanning three weeks. Their answers lead the editor to conclude that the majority of the Vooruit’s readership is receptive to the idea of voluntary euthanasia.33
Although one source alludes to advocacy groups having been established prior to the 1970s, it seems unlikely that any such groups existed formally. Humanist groups may have existed in Belgium since 1951, but the fact remains that, notwithstanding some media attention and publications on the subject, they only started their advocacy work on the matter tentatively since the late 1970s, as I intend to show below. Firstly, following its conception, the HV was primarily occupied with establishing local chapters and strengthening its financial situation, since it was almost exclusively dependent on volunteers. Secondly, the newly established humanist association did not strive for internal consensus over societal issues and would not take any formal position on them.34
Thirdly, due to the Nazi connotation implicit in any subject related to the bioethical sphere, organisations had to be cautious in how they were perceived. Humanist organisations deemed it safer to first advocate for the right to abortion, before tackling voluntary euthanasia. The start of the 1970s also meant the establishment of the UVV which, henceforth, took over as the umbrella organisation for Flemish humanism. This allowed the HV to reposition itself, aiming to become a leading force in paving the way in ethical debates based on scientific insights.35 Furthermore, the emergence of euthanasia advocacy in the late 1970s stands to reason, seeing that legislative proposals on the matter in Belgium exist only as of 1984.36
Euthanasia Advocacy in the Humanistisch Verbond and Unie Vrijzinnige Verenigingen
Already since the 1950s, post-war Belgian humanists looked at a multitude of societal issues that had been previously deemed (quasi) taboo. One prominent example was the airing of a programme in 1962 on the book Jeugd voor de muur, written by sexologist Jos Van Ussel at the start of his academic career. He was inspired by the American Kinsey Reports on sexual behaviour among younger generations.37 The ensuing media outrage was quite substantial. The right to an abortion was another societal issue which concerned Belgian humanists, and in which they played a substantial role.38 Their advocacy for euthanasia and subsequent influence on its legalisation, however, remained uncharted territory.
In looking at archival material dating from 1977 until 1994, I have found an overarching pattern supporting a classification into four periods. The first two, 1977–1980 and 1980–1984, see the humanist sphere searching for an official position on euthanasia advocacy and informing itself about existing initiatives. Taking into consideration the fact that dedicated advocacy organisations in Belgium were only established in the early 1980s, their endeavour seems a logical one. The third period, spanning 1984–1989, is characterised by research and centralisation of its initiatives. Over these four years, the humanist sphere – and more specifically the HV – makes euthanasia advocacy one of their focal points, and organises task forces and living will storage options. I have named the fourth period, leading up to the establishment of the Belgisch Raadgevend Comité voor Bio-ethiek (Belgian Advisory Comity on Bioethics), the “specialisation and bioethics” period. In the early 1990s, humanist actions and debates involve a broader panel of specialists and academics, and effectively treat euthanasia as part of a broader bioethical debate concerning patient rights, end-of-life care, and freedom of choice. In my opinion, the HV and UVV at that point become more vocal about their opinion in regard to voluntary euthanasia than before. I have evaluated each of these periods by looking at the place euthanasia occupied on the national humanist agenda, the dimensions and broader context (palliative care, patient rights, etc.) in which euthanasia is placed, the interaction of the humanist sphere with other euthanasia advocacy groups, and the scope of action of humanist initiatives. Determining the scope and influence of these initiatives, however, proved a difficult task, since for most of the publications, flyers, and activities, no circulation or attendance details are provided in the archival sources.
Although I treat the humanist sphere here as seemingly one collective, different organisations often had vastly divergent interests and responsibilities. This is especially true in the case of the UVV. While it had been established in 1971, as of 1975 it begins to mainly occupy itself with securing financing by arguing for a recognition similar to that already granted to religions in Belgium.39 In 1980 the “vrijzinnigheid/laïcité” was granted a preliminary subsidy, followed by an annual grant.40 In subsequent years, the UVV took up the mantle of hiring staff and disseminating a humanist infrastructure as a non-confessional life stance throughout Flanders. Their Walloon counterpart, the Centre d’Action Laïque (Center for Secular Action – CAL), undertook similar actions, albeit with different emphases.41 Apart from the practical workload, this also meant quasi-inventing the profession of ‘professional moral counsellor’.42 Not much room was left for advocacy work on ethical issues in the 1980s and early 1990s. That role was mainly handled by the HV.43 One marked exception is a media campaign by the UVV for their 25th anniversary celebration in 1996. Of the five themes chosen, the right to die with dignity was one of them.44
HV’s Euthanasia Advocacy: Good Contacts, Slow Progress
The Humanistisch Verbond, for its part, was much more involved in advocating for bioethical issues. In their actions, they were more dependent on international input than on any sort of national collaboration. As a starting point, a member survey of 1981 demanded that action be taken to advocate an individual’s right to voluntary euthanasia. HV members at that time described their own point of view, in support of that same right, as socially deviant.45 In the early 1980s, contact was established with both Recht op Waardig Sterven (Right to Die with Dignity – RWS) and the Nederlandse Vereniging voor Vrijwillige Euthanasie (Dutch Association for Voluntary Euthanasia -NVVE).46 For reasons beyond my understanding, a mutually advantageous collaboration with the RWS, a Flemish organisation, did not get established. Contact with the NVVE, however, proved very fruitful.47 It provided the HV with vital definitions on the then-called ‘active’ and ‘passive’ euthanasia, and with examples of living wills.48 By 1984 euthanasia had become one of the top twelve issues for the association, with its own dedicated board member. The HV’s position on the subject is very clearly stated in a memorandum from 1985, sent to all political parties following the most recent federal elections:
“The HV, which prioritises the right to self-determination [zelfbeschikkingsrecht], demands for this right to also apply to people in distress who have made an informed, unambiguous and repeated request concerning the passive or active termination of their life. Those people who find themselves in a physical or mental state with no hope for a reasonable and decent existence, are entitled to humane guidance, devoid of any therapeutic tenacity [therapeutische hardnekkigheid/acharnement therapeutique].”49
It is precisely the use of the terms “zelfbeschikkingsrecht” and “therapeutische harnekkigheid” that, in my opinion, make euthanasia advocacy groups in Belgium and the Netherlands different from their counterparts in Great Britain and the United States in the pre-war and immediate post-war period. Since Belgium had no advocacy groups before the 1980s, its advocates – although unconventional for their time – remained untainted by any eugenics connotation.50 Granted, their view did not find any common ground with the personalist ethics of their Christian peers, but that was another issue entirely. The timing of the second half of the 1980s further coincides with the arrival of bioethics on the European mainland and in Belgium more specifically.51
The decade spanning 1985–1995 was a productive one for humanist advocacy on the matter. By 1987, two task forces were established in Ostend and Antwerp.52 Not much can be said about the activities of the Ostend taskforce, since no source material can be found in the CAVA archive. The Antwerp one, however, had some success. They established a decent contact with the NVVE and helped create the first living will in 1986. During that same year, the HV opened up a storage facility for living wills in Antwerp. These wills were filled out and deposited annually. Since doctors were not legally obliged to accept a request for euthanasia, claimants hoped that the repeated nature of their request would help in the matter.53 The storage facility was undoubtedly a good initiative and quite possibly the first of its kind in Flanders (the RWS might have had one sooner, but this is unclear), but some remarks need to be made. The first three years after its conception, the storage facilities were only open to HV-members, even being discontinued when an individual ceased to be a part of the HV. This was no doubt a consequence of the then dire financial situation of the organisation.54
Apart from a now generalised storage facility for living wills, the HV also established an international euthanasia taskforce together with the NVVE. This initiative lasted for two years and resulted in some jointly organised conferences and presentations. Those were attended by many voluntary counsellors, as well as some professional UVV counsellors. As of 1989, thus, I argue that euthanasia advocacy within the humanist sphere had gained sufficient traction. Besides its functioning living will storage facility and the existence of a BeNe (Belgium/Netherlands) taskforce, euthanasia steadily became a part of the broader bioethical debate. Euthanasia, patient rights, and palliative care, the three subjects of the 2002 bioethical liberal laws passed in 2002, were no longer treated as separate subjects, but often became the shared object of conferences or policy documents. At such conferences, euthanasia specialists such as Wim Distelmans – the renowned oncologist and euthanasia advocate – became increasingly sought after during this period. Outside of the HV, the professional counsellors on UVV payroll by this time invested more time in getting acquainted with bioethical questions, and euthanasia in particular. By 1991, the subject had become a repeat issue at their training sessions (alongside issues such as sexuality, addiction, depression, death, and mourning.)55
It would, however, be a mistake to ascribe intentionality to these successive developments. It might seem to some that local taskforces, followed by the establishment of a living will storage, an international task force, and a lasting interest shown by professional counsellors towards the subject of euthanasia and broader bioethical concerns is the result of some kind of careful planning. This idea, however, was conclusively disproven by Lydia Blontrock.56 As an HV-board member focused on ethical issues since 1977, and HV-president until 1989, she makes clear that the board and local chapters had a long-standing interest in euthanasia and end-of-life problems. Poor communication and financial problems, however, made any sort of long-term initiative improbable, if not impossible.
What was the Humanist Contribution?
While organisations belonging to the Flemish humanist sphere argue that they have played a substantial role in decriminalising euthanasia in Belgium, the lack of historical research on the subject does not allow us to clarify the scope of their efforts. As I have shown, the HV specifically has had a long-standing interest in the issue, going back to its formative years. I believe it is safe to conclude that the humanist sphere has played a substantial role in raising awareness, both among the general public and within the political sphere. By the 1990s, euthanasia had been a prominent issue for humanists for quite some time and, apart from the work done by the RWS, the HV was the first organisation to publish a living will and provide a storage option. Although no actual collaboration with the RWS was achieved, the humanist television broadcasts did provide a platform for both the NVVE and the RWS. Furthermore, euthanasia and end-of-life issues enjoyed considerable attention in several humanist books and journals. The similarities in the terminology used in relation to euthanasia between humanist organisations and later legal texts further support the idea that their contribution was substantial.
Good intentions aside, the actual scope of the humanist influence on the matter is unclear, as the source material contains barely any numerical data. The circulations of publications, conference attendance figures, number of living wills kept in storage – none of this data survives, making the actual scope of their impact unknown. Apart from issues related to the source material, the humanist movement itself suffered from several structural problems. Firstly, its historically low membership (around 1% of the populace in the early 1990s) did not help the humanist cause. Second, the UVV in the 1980s and early 1990s was primarily occupied with organisational issues, following the yearly subsidy started in 1980. Since the subsidies prior to the financing law of 200257 were not all that substantial, organised humanism lacked any form of serious local embedding, compared, e.g. with that enjoyed by the Catholic church. As such, the humanist sphere had no actual ‘pillar’ to fall back on and exerted only a limited influence on Belgian society. Thirdly, no actual strategy was created in the period until the late 1990s. Initiatives, or even taskforces, often acted on an individual basis and attendance to meetings was problematic, which severely hindered the possibility for any real progress to be made through such initiatives. Tendencies that accelerated the emergence of public and political debates on the issue ought probably to be sought elsewhere.
Humanist organisations in Flanders can, however, be credited with delivering content on the issue and enabling a more in-depth understanding of the issue of euthanasia in Flanders, as they did with the issue of abortion in earlier decades. Flemish humanists were at the forefront of progressive rights activism. Some examples of such activists include Jos Van Ussel, Hugo van den Enden, Lydia Blontrock, Marijke Van Hemeldonck, and Willy Peers. As they were only a small group, it is certainly true that well-placed individuals (medical professionals, politicians, etc.) were of vital importance, allowing Flemish and Belgian humanist organisations to get their point across to a wider audience.
Why Belgium and not the UK?
As a final part of this article, I want to present my thoughts on the reasons why euthanasia was decriminalised in Belgium, as opposed to the failed efforts to achieve the same goal (the 1935 and 1969 proposals) in Britain.
In contrasting the underlying mechanisms in both cases, by using the work done by N.D.A. Kemp in the British case, I recognise three reasons for the implementation of the euthanasia law in Belgium, as opposed to Great Britain. Firstly, it seems that pluralism was of vital importance in the Belgian case. In using the term pluralism, I refer to both the concomitant developments of euthanasia advocacy and palliative care in the early 1980s, and to the composition of the Belgian Advisory Comity on Bioethics, in which all political, religious, and philosophical viewpoints are equally represented.58 The simultaneous evolution of euthanasia advocacy and palliative care led to Belgian debates on the subject being intense, but never scathing. As is stated in Bernheim e.a. “Advocates of legalisation always supported palliative care and never presented euthanasia as an alternative.”59 The lack of antithesis was no doubt supported by the fact that the movements developed with shared workers. The Advisory Committee in Belgium, as opposed to its French counterpart, the Comité Consultatif Nationale d’Ethique, was not obliged to reach a consensus when presenting an opinion. As such, a variety of viewpoints would be added to position papers. Prominent euthanasia advocate Etienne Vermeersch was surprised to find, when he first became a member, that some Catholic representatives on the committee condoned euthanasia in extreme cases.60 As the law of 2002 contained some concessions to opponents, including a restriction to adults with incurable diseases, pluralism in this case was helpful and markedly present.61
Secondly, since euthanasia advocacy only gained traction in the post-1960s period, social Darwinism and eugenics were never a part of its agenda. Although the link between eugenics and euthanasia advocacy had been, on the whole, greatly weakened by the 1969 British proposal, social Darwinism and eugenics had always been “strong themes of the euthanasia debate”62 in Britain. Initiatives in Belgium, on the other hand, were rooted in notions of freedom of choice and sought to combat the therapeutic tenacity of physicians in a world becoming increasingly more capable of extending life. The perception within society of a degree of paternalism among physicians, disregarding the quality of life of patients, spurred many to civilian action.
Thirdly, the unique political constellation at the turn of the century greatly aided in the legalisation of euthanasia, favouring the passing of laws on palliative care and patient rights. The exceptional absence of the Catholic political family resulted in the implementation of an impressive list of progressive laws.63
Finally, I think there are two final aspects that must not be overlooked. The 2002 Belgian law was not a strong departure from the views the general public, and the checks and balances contained within the law made it widely acceptable. As such, unlike its British 1969 counterpart, it did not concede on technicalities.64 The slippery slope argument – a common argument opposing euthanasia practices, which claims that normalising them will cause such practices to rise exponentially, and eventually include involuntary usage – was not very present, since laws on patient rights and palliative care were coupled with euthanasia-related law-making. It remained a Catholic argument, but was not supported by the public opinion.
Declaration of interest statement
Much of this research was carried out under the employment of the Centre for Academic and Secular Humanist Archives. As of October 2019, I am also employed by the Union of Secular Associations (UVV-deMens.nu).
1. Vrije Universiteit Brussel. Annual Report 2010, 23. Since 2010, two Flemish universities, the Universiteit Gent and Vrije Universiteit Brussel, host the joint End-of-Life Care Research Group.
2. Federal Public Service for Public Health. Annual FCEE Euthanasia reports; Deliens, e.a., Palliatieve zorg en euthanasie in België (Brussels : ASP, 2011).
3. A few examples include: Franky Bussche and Wim Distelmans, eds., Een goede dood (Brussels : Vubpress, 2012); Yvon Englert, “Belgium – Evolution of the debate”, in Euthanasia, National and European Perspectives. Vol. 2, Council of Europe (Strasbourg: Council of Europe Publishing, 2004), pp. 13-24.; Etienne Vermeersch, “Le contexte historique et éthique de la législation Belge en matière d’euthanasie,” Gérontologie et société 27(108) (2004): 189-199; Stéphanie Wautier, “l’Ouverture du débat sur l’euthanasie au sénat. Cadre éthique, médical, juridique et politique,” Courrier hebdomadaire du CRISP 7(1672-1673) (2000): 1-67. These, however, omit societal and organisational advocacy before the 1990s. This period is usually glossed over or referred to only in a generalised manner.
4. Stefan Schröder, Freigeistige Organisationen in Deutschland. Weltanschauliche Entwicklungen und Strategische Spannungen nach der Humanistischen Wende (Berlin: De Gruyter, 2018). I use the word ‘sphere’ since Belgian post-war humanist organisations, although officially recognised as non-confessional in nature, never became a full-fledged movement. In this sphere, I include Stefan Schröder, who uses this term to denote the Freigeistig organisations in post-war Germany.
5. Ian Dowbiggin, A Merciful End. The Euthanasia Movement in Modern America (Oxford: University Press, 2003) 12-14; Stephen Weldon, “Organized Humanism in the United States,” in Looking Back to Look Forward. Organised Humanism in th World: Belgium, Great Britain, the Netherlands and the United States of America, 1945-2005, eds. Niels De Nutte and Bert Gasenbeek (Brussels: Vubpress, 2019), pp. 75-94. This was also the case for the Unitarian Church. The link between this church and American humanism is covered extensively by Weldon.
6. The archives of these organisations are kept at the Centrum voor Academische en Vrijzinnige Archieven (Centre for Academic and Secular Humanist Archives – CAVA) located on the Humanities, Sciences & Engineering Campus of the Vrije Universiteit Brussels (VUB).
7. This research excludes the Flemish organisation Recht op Waardig Sterven (Right to Die with Dignity, RWS), as well as its French-speaking counterpart l’Association pour le droit de mourir dans la dignité (ADMD). Although, needless to say, these groups played a part in Belgian euthanasia advocacy, my research originated in the study of the humanist movement and, as such, their pluralist counterparts are not treated here. I hope to take these organisations into account in the near future.
8. Ian Dowbiggin, A Concise History of Euthanasia: Life, Death, God, and Medicine (Lanham: Rowman and Littlefield, 2005). N.D.A. Kemp, Merciful Release: The History of the British Euthanasia Movement (Manchester: University Press, 2002).
9. Ezekiel J. Emanuel, The Ends of Human Life (Cambridge (MA): Harvard University Press, 1991), s.p.
10. For a history of euthanasia in ancient times, see: Anton J. L. Van Hooff, “Ancient euthanasia: ‘good death’ and the doctor in the Graeco-Roman world,” Social Science & Medicine 58(5) (2004): 975-985.
11. Dowbiggin, A Concise History of Euthanasia, p. 50.
12. Kemp, Merciful Release, p. 15.
13. This end-of-life practice was also known as ‘passive euthanasia’, championed by some because a physician lets the patient die without willingly shortening their lifespan. The term fell into disuse in Belgium during the 1990s. It is generally opposed to ‘active euthanasia’, which implies that the physician administers drugs which intentionally shorten the patient’s lifespan. The two practices are now called palliative sedation and euthanasia.
14. J.M. Hoefler and B.E. Kamoie, Deathright: culture, medicine, politics and the right to die (Colorado: Westview Press, 1994), p. 67.
15. Isaac Van der Sluis, “The movement for euthanasia, 1875–1975,” Janus 66(1-3)(1979): 161. Euthanasia movements tended to have ‘a powerful undercurrent in favour of the suppression of defective and old people, even against their will’.
16. Wouter De Raes, “Eugenetica in de Belgische medische wereld tijdens het interbellum,” ,” Belgisch Tijdschrift voor Nieuwste Geschiedenis/ Revue belge d’Histoire contemporaine 20(3-4) (1989): 416. The pre- and inter-war eugenics movement had very little resonance in Belgium.
17. Weytjens, Euthanasie, (Antwerp: Humanistisch Verbond, 1962).
18. Ian Dowbiggin, “A Prey on Normal People: C. Killick Millard and the Euthanasia Movement in Great Britain, 1930–55,” Journal of Contemporary History 36(1)(2001): 61; Tim Helme, “The Voluntary Euthanasia (Legalisation) Bill (1936) Revisited,” Journal of Medical Ethics 17(1)(1991): 25-29. The VELS counted as the leading euthanasia lobbying group and had some prominent British nationals as its members. Examples include George Bernard Shaw, H.G. Wells, and Virginia Woolf.
19. For an account of euthanasia in relation in Nazi Germany, see: Andrej Michalsen and Konrad Reinhart. “Euthanasia: a confusing term, abused under the Nazi regime and misused i21. n present end-of-life debate,” Intensive Care Med 32(2006): 1304-1310.
20. BE CAVA, Archive Het Vrije Woord/Lichtpunt, debate euthanasia 03-04-1985; Blontrock, Interview, 09:00-11:00. Lydia Blontrock, president of the Humanist League in the 1980s, admitted that the organisation chose to advocate for abortion over euthanasia since “the Nazi connotation was much stronger with ending an existing life than ending one that had not yet fully begun.” In a 1985 debate on national television, ethicist Hugo Van den Enden, professor at the Universiteit Gent and vice-president of RWS, stated that “the association of voluntary euthanasia with Nazi Germany is still strong.”
21. More specific advocacy groups were only founded later on. The ADMD in 1981 and RWS in 1983.
22. For an account of the HV’s history see: De Nutte, “Vrijzinnigheid: Post-War Humanism in Flanders,” 43-74.
23. Idem; Jean-Claude Burgelman, Omroep en politiek in België, (Brussels: Belgische Radio- en Televisieomroep, 1990), pp. 46-47; Karel Cuypers, “Euthanasie,” Het Vrije Woord 3(4)(1959): 54-58. The broadcast was led by the prominent Belgian humanist Karel Cuypers and was titled, “Euthanasie: mogen wij bewust het leven verkorten van een ongeneeslijke lijdende mens.” Flemish humanist and freethinker organisations had fortnightly broadcasts on national television since 1958. The Nationaal Instituut voor Radio-omroep (NIR) only started national televised broadcasting in 1953. Belgium was, compared to the rest of Europe, late in the introduction and development of television.
24. Weytjens, Euthanasie.
25. For information on the circumstances of the trial see: J. Paules and J. Rozet, Le procès de la Thalidomide (Paris: Editions Gallimard, 1963).
26. The meaning of euthanasia at that time was not unambiguously defined in the Belgian context. Until the 1970s, articles that implicitly view euthanasia as mercy killing are equally present in printed media as those dealing with the ‘euthanasia trials’ of post-war Germany.
27. For specifics on Dr Sander and the trial see: Gina Lopez, Dying with Dignity: A Legal Approach to Assisted Death (Santa Barbara (CA): Praeger, 2015), pp. 56-64.
28. This motion picture was based on the eponymous book by Belgian novelist Charles Plisnier (1896–1952). The lead was played by French actor Fernandel, who portrayed a man ending the life of his cancer-suffering wife at her own request, effectively euthanising her.
29. Le Journal de Charleroi, 10-11-1936, p. 2; De Standaard, 8-12-1936, p. 4.
30. Herman Balthazar, “Pleidooi voor een biografie van Janine De Rop (1927-2015),” Brood en Rozen 24(3)(2016): 52-53.
31. De Standaard, 24-08-1971, 2.
32. Henk De Smaele, Rechts Vlaanderen, religie en stemgedrag in negentiende-eeuws België (Leuven: University Press, 2009), pp. 96-106. Party loyalty in Belgium did not imply religiosity.
33. Vooruit, 5;12;19/02/1950, 2.
34. Niels De Nutte, “Vrijzinnigheid: Post-War Humanism in Flanders,” p. 51.
35. Luc Devuyst, “Wegwijs worden in vrijzinnige verenigingen,” in Actuele facetten van de vrijzinnigheid in Vlaanderen, ed. Ronald Willemyns (Brussels: Humanistisch Verbond, 1983), pp. 177-178.
36. Wim Distelmans, Een waardig levenseinde, (Antwerpen: Houtekiet, 2012), pp. 50-55. Legislative proposals to decriminalise euthanasia were submitted by a variety of MPs in 1984, ’86, ’88, ’93, ’94, ’95(3), ’96, ‘99(7). The last proposal, which resulted in the eventual law, was submitted by De Roeck, Leduc, Mahoux, Monfils, Nagi and Vandenberghe.
37. Gie van den Berghe, “Alle begin is moeilijk. De seksuele ‘revolutie’ in Vlaanderen,” Yang 37(4)(2001): 553-560. Jos Van Ussel, and Jaap Kruithof – his collaborator who would go on to become a prominent professor at Ghent University and a public intellectual – did admit that, however ground-breaking their work may have been, scientifically speaking it did not come close to the quality of Kinsey’s work.
38. Jeffrey Tyssens and Els Witte, De vrijzinnige traditie in België (Brussels: Vubpress, 1996), pp. 141-142.
39. Luc Devuyst, “Huldigingstoespraken door Luc Devuyst en Leo Ponteur,” UVV-INFO 13(4)(1996): 37. 1996.
40. For details on the subsidies, see: Jean-François Husson and Caroline Sägesser, “La reconnaissance et le financement de la laïcité (II),” Courrier hebdomadaire du CRISP 15(1760)(2002): 5-54.
41. For an overview of the CAL’s history see: Caroline Sägesser, “Secularism in French-speaking Belgium,” in Looking Back to Look Forward, pp. 23-42.
42. De Paepe, Interview, 07:45 – 8:30. In the early 1980s, counsellors were few and far between. Primarily philosophy graduates, most of them held responsibilities over large areas, making their work very diverse. As they were expected to educate themselves, their expertise varied according to their own personal interests, as well as local needs. Although not all, some of these early counsellors gained decent knowledge of end-of-life issues. One marked example here was Hilde De Paepe. Being a member of the Antwerp euthanasia taskforce and trained in the law, it was she who stressed the importance of the creation of a legally binding document when creating a living will.
43. This does not mean that the HV and UVV got along perfectly. Especially in the beginning, roles were not clearly defined and the HV did not always appreciate UVV taking over as the official umbrella organisation, something the HV had strived to become since its conception in 1951.
44. Anonymous, “Een intrigerende en inspirerende perscampagne,” UVV-INFO 13(4)(1996): 14-27.The content this campaign uses on ‘dying with dignity’ is taken from the seminal work of ethicist and RWS vice-president Hugo Van den Enden: Ons levenseinde humaniseren, over waardig sterven en euthanasie, further implying that the UVV itself had at that point in time not done much work on the subject.
45. BE CAVA, Archive HV, HV12, Board of Directors 1977-1984, 17-02-1981, 8.
46. Klazien Sybrandy, “Vrijwillige euthanasie in Nederland: een overzicht,” in Morele begeleiding en problemen van jongeren, werkloosheid, euthanasie, sterven, ed. Jaak Vanlandschoot (Brussels: Unie Vrijzinnige Verenigingen, 1986), p. 117. The NVVE was established in 1973 and reached 1,200 members overnight. By 2012, its membership had grown to 130,000 people.
47. In 1983, both organisations’ presidents participated in a debate on euthanasia, as part of a program of the humanist broadcast agency Het Vrije Woord. On that occasion, a photograph of a living will was aired as well. Unsurprisingly, this example was provided by the NVVE.
48. BE CAVA, Archive HV, HV16, Lydia Blontrock: task forces HV, varia 1983, 181: ethical issues, 29-05-1979, passim. Since the late 1970s, the HV also possessed American examples of living wills, even using one in a television broadcast. It is unclear how they got into HV’s possession. Most likely this was due to some international contacts via the International Humanist and Ethical Union (now Humanists International).
49. BE CAVA, Archive HV, HV12, Board of Directors 1985-1990, memorandum, 1985, passim
50. The relationship between euthanasia movements and the will to supress certain members of society is addressed in: Wesley Smith, Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder (New York: Times Books, 1997); Isaac Van Der Sluis, “The Movement for Euthanasia,” 131-172.
51. Paul Defosse, ed., Dictionnaire historique de la laïcité en Belgique (Brussels : Editions Luc Pire, 2005), p. 36; Maurizio Mori, “The Discourses of Bioethics in Western Europe, Europe,” in The Cambridge World History of Medical Ethics, eds. Robert B. Baker and Laurence B. McCullough (Cambridge: University Press, 2018), p. 491. In France, bioethics was established with the new Comité Consultatif National d’Ethique in 1983 and, by the middle of the decade, the concept found its way into debates held at the Free Universities in Brussels (the French speaking ULB and the Dutch speaking VUB).
52. Especially for Antwerp, this comes as no surprise, as it is one of the oldest free-thinking cities in Flanders, together with Ghent. Antwerp could be considered the epicentre of post-war humanist action. The role of Antwerp as a centre of inter- and post-war freethought is discussed by Jeffrey Tyssens in: “Tegen de stroom: vrijzinnig militantisme in Antwerpen 1919-1939,” in Een Leven van Inzet: Liber Amicorum Michel Magits, ed. Dave De Ruysscher, Paul De Hert and Machteld De Metsenaere (Mechelen: Kluwer, 2012), 169-195.
53. For an overview of the Belgian legal situation in relation to end-of-life decisions at that time, see: Hilde De Paepe, “Situatieschets van de euthanasieproblematiek in België,” in Morele begeleiding en problemen van jongeren, werkloosheid, euthanasie, sterven, ed. Jaak Vanlandschoot (Brussels: Unie Vrijzinnige Verenigingen, 1986), pp. 129-139.
54. Niels De Nutte, “Vrijzinnigheid: Post-War Humanism in Flanders,” p. 67.
55. BE CAVA, Archive UVV, UVV5, 1983-1988: RvB, DB, AV, press conference 1986, annual report 1987, passim; CAVA, Archive UVV, UVV7, Annual reports 1988, 1989, 1990, annual report 1988, 12.
56. Blontrock, Interview, 27:30-30:00.
57. Belgisch Staatsblad/Moniteur Belge/ Belgian Official Gazette, 22 October 2002. This is the law of 21 June 2002, concerning the Central Council of non-denominational philosophical communities in Belgium, and representatives and establishments responsible for looking after the material and financial interests of recognised non-denominational philosophical communities.
58. The simultaneous emergence of euthanasia advocacy and palliative care is discussed in: Jan L. Bernheim e.a., “Development of palliative care and legalization of euthanasia: antagonism or synergy?” British Medical Journal 336(2008): 864-867. The pluralist composition of the council was applauded by A. Weale in: “Bio-ethiek en pluralisme: een beschouwing vanuit het Verenigd Koninkrijk,” in 15 jaar Raadgevend Comité voor Bio-ethiek: terugblik en perspectieven, ed. M.G. Pinsart and Paul Schotsmans (Leuven: Campus, 2012), pp. 227-240.
59. Bernheim e.a., p. 864.
60. Etienne Vermeersch, “Verleden en toekomst van de Belgische euthanasiewet,” in Een goede dood, 2002-2012: tien jaar ‘controversiële’ euthanasiewet, ed. Franky Bussche and Wim Distelmans (Brussels, Vubpress, 2012), pp. 232-233.
61. For an extensive report of the debates held on euthanasia in the Belgian senate at the end of the 1990s, see: Wautier, “l’Ouverture du débat sur l’euthanasie au sénat,”.
62. Kemp, Merciful Release, p. 205.
63. An overview of these ‘earthquake elections’ can be found in: Kim Deschouwer, “Belgium’s quasi-regional elections of June 1999,” 125-132. Regional and Federal Studies 10(1)(2007): 125-132.
64. Bernheim e.a., 865.
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