The news that the Belgian senate last week opened a major debate on approaches to euthanasia and doctor assisted suicide legislation is a significant boost to international campaigners for the right to die in dignity.
The Belgian debate follows the Dutch government's decision this summer to legalise the practice, dating from the 1970s, of not prosecuting doctors who assist patients to die if they abide by strict ethical guidelines.
Radical enough but not the most startling point of the original bill. The government was proposing to give children as young as 12 the right to request, and in certain circumstances be granted, death from their doctor even when their parents disagreed.
In September, however, in the face of a wave of public concern, the Dutch health minister, Dr Els Borst, said the children's right would probably be dropped, for the time being.
The essence of the Dutch legislation remains intact - the idea is not to make euthanasia any more available but to reassure the public that its practice is well supervised, by ethics boards rather than public prosecutors.
The reality is that although doctors already know they will not face prosecution, surveys suggest that because of the stigma of illegality they report only some 40 per cent of cases to the police, some 2,000 to 3,000 cases a year. The challenge is to substantially increase that reporting figure.
Surveys show that the approach taken enjoys widespread support and confidence with the public - over 90 per cent support the idea that in certain circumstances doctors should be able to give lethal injections to terminal patients, up from just over 50 per cent in 1960. (The figures are significantly lower in respect of euthanasia for the mentally incapacitated).
A recent survey in La Libre Belgique suggests 80 per cent of Belgians would favour a law legalising euthanasia in certain circumstances.
The perception that it is already practised widely by doctors in Belgium and that the law needs to reflect that reality is at the heart of what appears to be a substantial consensus among the political parties that the issue needs regulation. Currently suicide is legal but assisting a suicide and euthanasia are not.
As in Holland, the tone of the debate is not strident or absolutist in terms of the sacredness of human life. It is about dignity and control by patients of their care and differing views of the potential of modern pain relief.
Alone of the major parties the Christian Democrats of the Parti Social Chretien (PSC) are distancing themselves from the more radical decriminalisation solutions, although even the PSC accepts the need for legislation. The party would not make the taking of life legal, but accepts that there may come a point very close to death when a doctor may face a situation of unbearable pain and feel that he has to act "as a necessity".
Decisions taken in such circumstances, as long as they involved widespread consultation with the patient, family, care team and ethics committee, although illegal, would be subject to legal examination but not sanction.
That mildly permissive view is not shared by the Catholic Church, however, which is likely to lead the No campaign. The Socialist legislative draft has been prepared by the former senator, Mr Roger Lallemand, a member of the francophone voluntary euthanasia society, ADMD. It posits two sets of conditions under which euthanasia would be permissible: for those fully able to take decisions and suffering from an incurable condition, and for those suffering from an incurable condition but who, when mentally competent, signed a "living will" declaration that they wanted to avail of euthanasia if faced with an incurable condition.
The doctor would in such cases always be obliged to notify the authorities of the cause of death and would not ever be obliged to accede to the demand for euthanasia.
Mr Lallemand emphasises a specific obligation on doctors: "In the case of an incurable illness - say a man crippled by paraplegia - the doctor must fight against the tendency to despair."
A Liberal proposal from the VLD mirrors the proposed Dutch model closely. A doctor faced with a request from a patient for euthanasia would be under an obligation to consult a medical colleague, the care team and the family if the patient agreed. There would be a specific onus to ensure that the request is voluntarily expressed, serious, thought-out, and permanent. Finally, the request would be put before a special ethics committee. But is it really necessary, Mr Lallemand was asked recently, to amend legislation which is not enforced? "Yes," he insists, "law must never stray too far from reality, because such circumstances allow both good and bad practice to flourish simultaneously."
