Should a Belgian murderer be allowed euthanasia?

A murderer serving a life sentence in a Belgian jail, who asked to be allowed to die by lethal injection, was told in September that his wish would be granted. This week the Justice Ministry reversed that decision.

The case raises an interesting question - whether prisoners serving long jail terms should be allowed to choose medically assisted death. In Belgium, euthanasia is available for the terminally ill, and also for those who wish to end psychological suffering.

Here three philosophers give their view on Frank Van den Bleeken's case, and whether he should be allowed to die.

YES

Rebecca Roache, lecturer in philosophy, Royal Holloway, University of London

Should Van den Bleeken be allowed to escape his mental suffering by dying? Or is it right that, given his crimes, he should be forced to endure incarceration? There are arguments on both sides. On the one hand, Van den Bleeken has a very traumatic past and psychiatric problems so severe that he has been deemed not criminally responsible by a court, making him a good candidate—if anyone is—for euthanasia on the grounds of psychological suffering.

On the other hand, some might argue that prison is not supposed to be enjoyable, and that it is inappropriate to allow prisoners an escape from their deserved suffering via euthanasia.

There is, however, a strong argument for allowing Van den Bleeken to die as he wishes. If we view euthanasia as a type of medical treatment—as there is good reason to do, at least in Belgium, where it is implemented by medical professionals in response to medical problems—then Van den Bleeken should be treated like any free citizen. This is because prisoners, in any civilised country, are not denied access to medical treatment as part of their punishment. That Van den Bleeken has committed appalling crimes is a red herring: if his plea for euthanasia would be granted were he a free man, then it should be granted despite the crimes he has committed.

Because of this, it was not appropriate for the justice minister to become involved and to overturn the decision to allow Van den Bleeken to die. Questions about whether an individual should be allowed access to medical treatments should not be answered by a justice minister, regardless of whether or not the individual in question is a criminal.

NO

Daniel Sokol, barrister and medical ethicist

Allowing a prisoner, who is not terminally ill, to die by euthanasia has a whiff of the death penalty.

Before his request for euthanasia, Van den Bleeken had asked to be treated in a specialised psychiatric centre in the Netherlands, a request that was initially turned down by the Belgian justice ministry. This suggests that he still hoped to get better - and as it turns out, the Belgian authorities now say they are arranging his transfer to the Dutch facility.

The combination of his mental illness, the intense hardships of the environment at Merksplas prison where he has been held (and which was criticised by the European Court of Human Rights in an earlier case involving a mentally ill prisoner), and his request for treatment raises the troubling possibility that, rather than respecting his autonomy, allowing him to die would represent a form of abandonment.

"Abandon away!" many might say, pointing to Van den Bleeken's rape and murder of a 19-year-old girl, Christiane Remacle, in 1989 and his rape of three further women, including an 11-year-old child, following his release from a prison psychiatric ward. The trail of misery he left behind remains for the victims and their loved ones. Remacle's sisters allegedly opposed euthanasia for Van den Bleeken, wanting him to "languish in prison" for the rest of his days.

In Reflections on the Guillotine, the French philosopher Albert Camus told the story of his father, who woke early one morning to attend the public execution of a murderer who had slaughtered an entire family, including children. His father thought decapitation too mild a punishment. After the execution, he returned home, pale as a ghost, lay on the bed and vomited. Instead of satisfying his father's wish to see justice done, the execution had simply nauseated him. Camus wrote that "far from repairing the offence to society, the death penalty adds a new stain to the first".

Allowing prisoners with severe mental illness to kill themselves by euthanasia, without offering adequate psychiatric support and treatment, represents a stain on civilised society. It cannot be described as voluntary euthanasia. If a prisoner with a gangrenous foot was left untreated, in unbearable pain, and asked for euthanasia, it would not be a free choice either. It would be borne out of necessity, with only a semblance of voluntariness.

Van den Bleeken's case raises pressing questions about the level of psychiatric care in prisons, in Belgium and elsewhere. Are the psychiatric services adequate? Are they accessible? Is enough money invested in them?

The case is not a one-off. After Van den Bleeken's request for euthanasia was approved in September, 15 other inmates made applications to be euthanised.

MAYBE

Victor Tadros, Professor of Criminal Law and Legal Theory, Warwick University

Frank Van den Bleeken, it seems, wishes to be put to death because he believes that his alternative is to spend the rest of his life in prison, and this alternative is a fate worse than death. Should he be granted the right to die? I am not sure.

Suppose that those who will otherwise suffer a fate worse than death generally have the right to die, if they so choose, but that it would normally be wrong to assist a person to die where they have a fate that is better than death. Suppose, also, that Van den Bleeken is sufficiently competent to make decisions for himself.

We might nevertheless doubt whether spending the rest of his life in prison is, for Van den Bleeken, a fate worse than death. We might also doubt that his conditions couldn't be improved to make his fate better than death - perhaps his psychiatric treatment will achieve this? Van den Bleeken might believe that his fate will be worse than death even if he is given such treatment, though.

Some may argue that if Van den Bleeken believes that his fate will be worse than death, it must be so. However, it is difficult for us to imagine how well or badly our lives will go, even when we know, broadly, what will happen to us. Van den Bleeken is no exception. Perhaps, though, Van den Bleeken's judgement should be decisive, even if it could be mistaken, either because it is most likely to be right, or because we should respect his judgement.

Suppose that Van den Bleeken is right, or that we should respect his judgement even if it is wrong. Should he have the right to die? Some might believe that a fate worse than death is a proportionate punishment given the gravity of his crimes. Allowing him to die would then render his punishment too light. I find this hard to accept. The reason why he will most likely never be released is public protection, not because a fate worse than death is a proportionate punishment.

Still, perhaps others - especially the victims and their families - have interests in him being kept alive. One reason that might be offered is that the victims, or their families, take satisfaction in his suffering. His death will reduce that satisfaction. Alternatively, and I think more plausibly, the victims and their families might have an interest in Van den Bleeken recognising the significance of the crimes that he has committed. Assuming that he has not done this already, he can do so only if he is kept alive. Could this be a decisive reason not to allow him to die? This idea seems more attractive, but I am not sure whether it is sufficient to deny him the right to die if his fate will indeed be worse than death if he is forced to stay alive.