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Book review: In Pursuit of a Dignified Life’s End: The Belgian Model

Author: Dr Geoff Wells
26 January 2017

Dr Geoff Wells, a Specialist Registrar training in Palliative Medicine who currently works at the Royal Marsden Palliative Care Team, shares his views on a new book by Belgian palliative care doctor Wim Distelmans about euthanasia.

This thought-provoking, highly readable, yet controversial book guides us through the historical and contemporary themes surrounding the subject of euthanasia.  At first glance this book has a light and airy feel, with its stark white cover and soft lettering – however the text within reveals the complexities and challenges we face when dealing with end of life decisions. 

The first few chapters are almost text-book like, describing the fundamental principles that underpin palliative care and oncological practice. Several sections focus on the pharmacological, non-pharmacological and physiological aspects of associated symptom management – doing so in an unfussy manner.    

Around two-thirds of the way into the book the reader is skilfully navigated through the medico-ethico-legal maze surrounding euthanasia in Belgium, with focus on those challenges faced when interpreting the semantics of end-of-life terminology.    

The author imparts his knowledge and views on the realities of terminal care as both an oncologist and palliative care physician, and provides distinct counter-arguments challenging the “sensationalised reporting” to which the public are often exposed.  The development of the Belgian system is endorsed as a model from which other countries can learn.

The seventeen chapters flow in a logical sequence from the development of early palliative care (with particular reference to UK influence), to Belgian euthanasia in practice and the future of a new care culture. Chapters are peppered with historical references suggesting that requests for assisted suicide and euthanasia date back beyond 500 years. 

The book sends a strong message to healthcare practitioners and society as a whole to change their attitude towards those with incurable illness.  It infers that current practice is still failing to respect patient individuality and the right to die with dignity; however it makes clear that it does not aim to promote euthanasia as the only way to a dignified death.

Arguably one the most interesting topics is the controversial notion that palliative sedation is tantamount to life termination without request, a recurring opinion throughout the book for which  the author provides justification, and one that certainly has the power to polarise opinion. 

Worthy of its own 19-page chapter, the book challenges therapeutic obstinacy and senseless medical treatment, suggesting that many patients are treated for far too long before being “dumped” on palliative care teams once all therapeutic options have been exhausted – an experience to which some may relate.

In summary, this book provides an insightful exploration and compelling argument for a topic that remains under continual debate within the UK.  Wim Distelmans imparts many controversial views and makes no apology for doing so - nor should he.  Readers will be left with more questions than answers, but will have garnered a richer understanding on the matter. A fascinating read.


*Hospice UK currently has ‘no collective view’ regarding the issue of whether the law should change to allow ‘assisted dying’ or ‘assisted suicide.  This is on the basis that our organisation represents over 220 member organisations, most of whom have not yet stated a clear position regarding this matter.  Further information is available on Hospice UK’s website.

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