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F.E.A.M.C.
FEDERATION EUROPEENNE
DES ASSOCIATIONS MEDICALES CATHOLIQUES

EUROPEAN FEDERATION
OF THE CATHOLIC MEDICAL ASSOCIATIONS
Website: http://www.feamc.eu

WHOLE DEBATE ON EUTHANASIA
IN THE COUNCIL OF EUROPE
(2003-2005)

1) June 1999: Recommendation 1418 on "Protection of the human rights and dignity of the terminally ill and the dying":
http://assembly.coe.int/Documents/AdoptedText/ta99/erec1418.htm

2) 10th September 2003: Marty Report:
http://assembly.coe.int//Documents/WorkingDocs/doc03/EDOC9898.htm

3) 23th September 2003: McNamara Report:
http://assembly.coe.int/Mainf.asp?link=http://assembly.coe.int/Documents/WorkingDocs/Doc03/EDOC9923.htm

4) 18th January 2004: FEAMC Statement:

"The European Federation of the Catholic Medical Associations (FEAMC) protests strongly against the Marty report which aims to the legalisation of euthanasia in the member states of the Council of Europe

This report conveys a serious misreading of the signification of the demand of death from the patients, even if they are at the end of their lives. The respect of patient's autonomy must not be an alibi to euthanasia: should we refrain from treating suicide attempts on the pretext that it was the patient's will?

Euthanasia is not clearly defined:
- it is not distinguished from withholding and withdrawing treatments, becoming futile or refused by the patient (which comes within good medical practice);
- neither from some practices of alleviation of resistant pain or of unbearable anguish, which could eventually provoke a non wanted death.

The sense of the patient's "loss of dignity" is questionable.

The serious drifts, already observed in the Netherlands - only country having allowed euthanasia (under conditions) for several years - have not been mentioned.

The FEAMC reasserts its commitment:
- to the refusal of aggressive treatments without hope of recovery, and to withhold and/or withdraw active treatments as soon as it appears clearly that they have become futile, protecting patient's dignity by doing so.
- to the deeply human attitude of palliative care, to their development, and to their progress:
- to the human support of the patients at the end of their lives, and to the care of the deep distress which may be expressed by a demand of death, towards which euthanasia seems a simplistic and inhuman remedy.

The FEAMC
- worries about the risks that decriminalization of euthanasia could let run to the patients, and to the confidence they have in their physicians.

The FEAMC
- approves the amendments to the Draft Resolution of the Marty report proposed by Mr McNamara, and the corresponding Explanatory Memorandum
- worries about the remaining paragraphs of this draft resolution, which seem unacceptable
- maintain its commitment to the Council of Europe Recommendation 1418 (June 1999) on 'Protection of the human rights and dignity of the terminally ill and the dying'"

In the name of the Committee of FEAMC
Prof. Josef Marek, MD, Ph.D, President of FEAMC

5) 19th January 2004: FIAMC Statement:

On Thursday, 29 January 2004 the Parliamentary Assembly of the Council of Europe will hold a discussion on the Marty Report on Euthanasia (Doc. 9898), drafted by the Swiss Rapporteur of the Social, Health and Family Affairs Committee, Mr Dick Marty. Mr Kevin McNamara, Rapporteur of the Committee on Legal Affairs and Human Rights for the United Kingdom will submit his opinion document on the same issue. The Marty report aims at introducing, in the Countries where they do not exit yet, laws exempting the physicians who help incurable patients put an end to their lives (if they request it) from legal prosecution. In other words, the Marty Report will ask all European Countries to promote the introduction of an euthanasia law, similarly to what has already been done in Holland and Belgium. Although not coercitive for the individual countries, the resolution, if approved, will constitute a tremendous element of pressure on national Parliaments, medical doctors and public opinion, and it could lead, in the future, to incentives for the countries permitting euthanasia and restrictions for those which oppose it.

As Catholic Doctors, we protest against the Marty report and its possible legal consequences.

1. First of all, we are afraid that it will exert a pressure on physicians (both as individuals and as a profession) to act against their conviction and to act against to the Geneva Human Rights Convention when it states that the mandate for the physician is for him "to preserve the utmost respect for human life from its beginning even under threat and I will not use my medical knowledge contrary to the laws of humanity". In addition, we identify a risk that the exercise of the medical profession will be precluded in the future to physicians, who will not accept to perform euthanasia or physician assisted suicide, as it already happened for certain categories in some countries with reference to abortion. We demand that in all laws concerning medical ethical matters physicians and nurses are guaranteed the right to lawfully abstain from actions that are in conflict with their religious faith and/or moral convictions.

2. Recent medical research has shown that colleagues who are poorly trained in palliative medicine and colleagues who are overburdened are the ones seen to consider euthanasia and physician assisted suicide in difficult clinical situations1, 2. Notwithstanding the principal issue of euthanasia and physician assisted suicide, it must be considered outrageous if patients are killed or assisted in taking their own life because of poor medical conduct. We therefore demand that the European Council acts to encourage the individual governments to provide training of physicians in palliative medicine, both during their basic medical training and during their vocational training. We also find it important that palliative medicine be established as a medical speciality in all European countries in the same way that it has been done, for example, in the United Kingdom.

3. The role of the medical profession must never be that of killing patients. Provisions for optimal palliative care at the end of life, especially for the weak patient, are mandatory for a society that wishes to be characterised as advanced. This care should be offered in a loving environment where the patient does not feel himself a burden to neither his relatives nor the society. It is the responsibility of the society to guarantee such care facilities.

4. While we are against any participation of medical doctors in euthanasia or physician assisted suicide, at the same time we are against any therapeutic obstinacy that cannot cure patients, but only prolong the process of dying.

5. We protest against the use of physicians to provide an unethical and unnecessary medical solution to a problem that is basically of a social nature: Solitude of the elderly and poor care at the end of life. It is exactly these problems that prompt demands for euthanasia and physician assisted suicide. Recent documents produced by important professional societies, as the European Association of Palliative Care (EAPC) made this view very clear.

We strongly urge the Members of the Parliamentary Assembly of the Council of Europe to vote against the draft resolution proposed by the Marty Report and to stand firmly against any attempt of promoting euthanasia and physician assisted suicide in Europe.
The Members should also feel the moral duty to be present during the debate on January 29th and to propose amendments to the Marty Report before the deadline of Wednesday 28 January at 3 pm.

On behalf of the World Federation of Catholic Medical Associations (FIAMC)
Gian Luigi Gigli, MD (President)

6) 27th April 2004: Euthanasia: report sent back to committee (AFP)
« Following a long debate on euthanasia, based on the report by Dick Marty (Switzerland, LDR), the Assembly decided not to vote on the text but instead to refer it back to committee.
The parliamentarians gave the Social, Health and Family Affairs Committee a year to prepare a new text which brings together the widely diverging approaches expressed during the debate.
Dick Marty, who himself proposed the reference back to committee, nonetheless regretted the "too numerous misunderstandings" on the question and deplored "taboos, dogmatism and a refusal to discuss".
He hoped that the committee would submit a revised text which "no longer speaks of euthanasia, but uses another term which can do justice to a real problem existing in our society"».

7) 17th December 2004: Draft resolution on "Assistance to patients at end of life" presented by Mr Dick Marty to the "Commission of social, health, and family affairs" (adopted by 13 votes against 7), and to be submitted to the Parliamentary Assembly of the Council of Europe on the 27th April 2005).
http://assembly.coe.int/ASP/APFeaturesManager/defaultArtSiteView.asp?ArtId=119

8) 20th April 2005: 2nd FEAMC and FIAMC statement on the Draft resolution on "Assistance to patients at end of life"

The catholic doctors of the European Federation of Catholic Medical Associations (FEAMC), and of the World Federation of Catholic Medical Associations (FIAMC)

o learning that a draft resolution entitled "Assistance to patients at end of life", which has already been approved by the "Social, Health and Family Affairs Committee" of the Council of Europe, and is to be tabled soon for voting by the Parliamentary Assembly;

o are surprised at this particularly ambiguous text which is far less focused on "assistance to patients at end of life" than the Recommendation 1418 of 1999, and whose final goal seems to be to give birth to legislation regulating euthanasia in the member states.

Some elements of this resolution recall recommendation 1418 on "protecting the human rights and dignity of the terminally ill and the dying" by:
- requoting the recommendation; (1)
- reasserting that "it is forbidden to cause someone's death deliberately"; (1)
- urging "promotion of palliative treatment" (4a , 6c)
- reasserting the rights of the patient "to be properly informed... of his or her condition" (5a), and "to decline the treatment proposed" (5b)

Others clauses concern the prevention of suicide such as:
- duty to "implement a genuine policy of assistance to patients at end of life which does not cause them to want to die" (4)
- "promotion or reinforcement of a genuine suicide prevention policy" (4e, 6d)
- "particular attention to ensuring that the current social changes in many countries in Europe, such as the ageing of the population and increasing health costs, do not give rise to social or family pressure to seek assistance with suicide, undermining society's feeling of responsibility towards elderly and dependent persons" (6h)

However, the above recommendations seem to be a "smokescreen" intended to mask the promotion of legislation favouring euthanasia in member states. Otherwise why
- quote the Dutch and Belgian legislation (2a), and propose that member states "analyse them objectively and in depth" (6a)
- quote "opinion polls" favourable to euthanasia (2c) and mention "serious scientific studies", without any reference as to the source, revealing the practice of illegal euthanasia (2d)
- recommend to "reduce as far as possible the practice of euthanasia in secret or in a legal vacuum", or because of "outdated norms" (?) (5, 6e)

Lastly, some recommendations should be very interpreted cautiously, namely:
- "development of codes of medical ethics to avoid superfluous treatments ..." (4d)
- "accurately define the responsibilities and procedures for discontinuing treatment where it will only secure a slight prolongation of life ..." (6f)
- "promote public discussion so as to create the greatest possible transparency and accountability in an area too often subject to decisions taken by the medical profession ..." (6g)

o approve the amendments voted by the "Committee on Legal Affairs and Human Rights", notably those concerning paragraphs 4, 4a, 5b, and 6.

o implore the Parliamentary Assembly to delete the elements which tend to promote euthanasia: namely the whole of paragraph 2, first two sentences of paragraph 5 and sub-paragraphs 6a, 6e, and 6g.

o maintain their commitment to the Recommendation 1418 of the Council of Europe on the "Protection of the human rights and dignity of the terminally ill and the dying".

In the name of the Committees of FEAMC and FIAMC
Prof. Josef Marek, MD, Ph.D, President of FEAMC
Dr Gian Luigi Gigli, MD, President of FIAMC

9) 27th April 2005: New failure for a resolution on euthanasia in the Council of Europe (AFP, Strasbourg, 27 April 2005) - The members of parliament of the Council of Europe showed again on Wednesday their differences on euthanasia, by rejecting massively a resolution which invited the 46 States members of the organization to discuss the "Assistance to patients at end of life".
For lack of consensus, debate on a report elaborated by Swiss Dick Marty (Liberal) had been already removed of the agenda of the parliamentary Assembly of the Council of Europe ( APCE) in Strasbourg in September 2003, then in January 2004 before being sent back in commission in April, 2004. On Wednesday, a new version of Mr Marty's resolution, which wanted to be more consensual than the first one, was rejected by 138 votes against 26, to the term of more than three hours of debates and the presentation of 71 amendments.
These last ones aimed to satisfy the adversaries the euthanasia by calling notably "to inform better the public about dangers associated to the legislation favorable to the euthanasia" or by clarifying in the resolution that "allow euthanasia mean violating the principle of the respect for the rights and the dignity of man".
"Passive or active euthanasia is a daily reality which one did not want to see opposite today" Mr Marty regretted in front of the press, after the debates.
He clarified to be however satisfied by the final refusal of his resolution "distorted" by amendments: "Nobody asks for the legalization of the euthanasia, we wanted simply to draw the attention of the governments on the underground and vague legal which surrounds euthanasia and to ask that a debate is opened in every country" he added, estimating that his resolution had been rejected because the members of parliament "do not want to hear speaking about euthanasia".

9a) 27 avril 2005 (French original text): Nouvel échec pour une résolution sur l'euthanasie au Conseil de l'Europe (AFP, Strasbourg, 27 avril 2005) - Les parlementaires du Conseil de l'Europe ont une nouvelle fois affiché mercredi leurs divergences sur l'euthanasie, en rejetant massivement une résolution qui invitait les 46 Etats membres de l'organisation à débattre de l'"accompagnement des malades en fin de vie".
Faute de consensus, le débat sur un rapport élaboré par le Suisse Dick Marty (Libéral) avait déjà été retiré de l'ordre du jour de l'Assemblée parlementaire du Conseil de l'Europe (APCE) à Strasbourg en septembre 2003, puis en janvier 2004 avant d'être renvoyé en commission en avril 2004. Mercredi, une nouvelle version de la résolution de M. Marty qui se voulait plus consensuelle que la première, a été rejetée par 138 voix contre et 26 pour, au terme de plus de trois heures de débats et la présentation de 71 amendements.
Ces derniers visaient à satisfaire les opposants à l'euthanasie en appelant notamment à "mieux informer le public sur les dangers associés à la législation favorable à l'euthanasie" ou en précisant dans la résolution que "permettre l'euthanasie signifie violer le principe du respect des droits et de la dignité de l'homme".
"L'euthanasie passive ou active est une réalité quotidienne qu'on n'a pas voulu voir en face aujourd'hui", a regretté M. Marty devant la presse, après les débats.
Il a précisé être toutefois satisfait du rejet final de sa résolution "dénaturée" par les amendements.
"Personne ne demande la légalisation de l'euthanasie, nous voulions simplement attirer l'attention des gouvernements sur la clandestinité et le flou juridique qui entoure l'euthanasie et demander qu'un débat soit engagé dans chaque pays", a-t-il ajouté, estimant que sa résolution avait été rejetée car les parlementaires "ne veulent pas entendre parler d'euthanasie".