• Peter Ketelslegers with wife Conny and children Alex and Thomas. (SBS Dateline)
Imagine choosing to die when you don’t have a terminal illness. Is it a choice we should have? A powerful Dateline special gets rare access to film the journeys of two people in Belgium – going behind the most liberal euthanasia laws in the world.
Airdate: 
Tuesday, November 24, 2015 - 21:30

Peter Ketelslegers is a 33-year-old father of two, Simona de Moor is a physically healthy 85-year-old. Both of them want to die.

Peter suffers cluster headaches, which have left him unable to work and look after his family. Ultimately, he feels, unable to live.

“It’s like a knife being stuck in my head,” he tells reporter Brett Mason. “It spreads through my whole head. I hit it to get rid of the pain.”

The intense headaches can last up to three hours, several times a day. He’s tried many different treatments, including drastic brain surgery last month, but nothing has worked.

“If there’s no other solution than just an injection, and gone… do I have to say it? Euthanasia,” he explains.

“I don’t want to be a burden to anyone… I should take care of the children rather than them taking care of me, but I can’t.”

Simona has been unable to accept the death of her daughter from a sudden heart attack, and sees no reason to go on.

“The moment they broke the news to me, five minutes later I knew,” she tells Brett of when she decided she wanted to end her life. “And nobody in the world will take it away from me.”

“It’s driving me mad and I don’t want to go to a mad house, I want to die here.”

Belgium’s controversial euthanasia laws allow both of them to voluntarily have their lives ended by doctors despite the fact they are not terminally ill.

The law is based on the notion of ‘incurable, unbearable suffering’ and it’s the patient who defines what is ‘unbearable’.

Since the law was introduced, cases for mental suffering have spiked. Even children can choose to be euthanised there, although that part of the law has not yet been tested.

‘The hardest story I’ve told’: Euthanasia blog
A woman I have come to know and like has invited me to share and document the final moments of her life, writes Brett Mason about his story on euthanasia for Dateline.

Brett follows both Peter and Simona’s journeys, as this hour-long Dateline special examines all sides of the right to die debate.

And he’s there as Simona’s journey reaches its end with one of Belgium’s most vocal euthanasia advocates, Dr Marc Van Hoey, at her side.

“Are you really ready?” Dr Van Hoey asks her before administering the drink that will end her life. “Absolutely, 100 per cent,” she replies.

Away from Simona’s room, Brett asks him how many people he has euthanised.

“To be frank, I don’t know, maybe hundreds, or over a hundred,” he replies.

“A lot of elderly people are not really suffering in the narrow meaning of the word, but one plus one plus one plus one makes a whole,” he says.

“That in addition to their age gives them no future, there is nothing left any more, and so quite often they say, I’ve had it with my life.”

But following the first broadcast of Dateline’s story in September, Simona’s case has been referred for judicial review in Belgium.

It’s the first time that’s happened since the nation legalised the practice in 2002.

Police are now investigating and Dr Van Hoey could face criminal charges. He says he’s done nothing wrong and will defend any action against him.

Belgian euthanasia doctor could face criminal charges
A leading euthanasia practitioner in Belgium is facing possible criminal charges after performing the voluntary euthanasia of an 85-year-old patient for incurable depression.

Before that review, those against Belgium’s legislation told Dateline they believe it’s encouraging euthanasia unnecessarily with limited safeguards.

"Euthanasia and assisted dying increasingly are being used for patients that have months or years or even decades to live,” Theo Boer tells Brett.

The Netherlands was the first country in the world to legalise euthanasia. Belgium’s laws are based on the Dutch example and include almost identical safeguards.  

Euthanasia: A matter of life and death
Dateline's special, Allow Me To Die, examines the world's most liberal euthanasia laws in Belgium. Our explainer has more about the debate worldwide.

Theo Boer reviewed around 4,000 cases for the Dutch Euthanasia Commission, but last year he stepped down.

“There were several cases where we did accept the case, where I had sleepless nights,” he says on how far euthanasia laws can go. “Something is going terribly wrong."

Tom Mortier’s mother was euthanised for depression without his knowledge.

“If you're also going to include mental suffering then it's really a pandora's box,” he tells Brett. “It's very, very, very difficult to have a good law on euthanasia.”

Peter Ketelslegers has already sought approval from doctors for his euthanasia, as hopes fade of him finding an alternative solution.

“You would be enormously selfish to keep your husband with you when you know that he’s in so much pain,” his wife Conny says.

“You’ll let him have his wish?” Brett asks her. “Yes, with pain in my heart, but yes.”

This updated version of Dateline's hour-long special, first broadcast in September 2015, was shown in November as part of Dateline's Best of 2015 series.

Support and Advice

If you’re affected by this story and would like to speak to a GP or health professional now for support and advice, phone one of these 24 hour helplines:

Credits

Transcript

None of us know when our time is up and who, if anyone will be there to share it. But I’m driving to meet a man who made this decision for a 50-year-old woman.

NAVMAN: After 200 metres you have reached your destination.

But I am driving to meet the man who made this decision for a 50 year old woman. He was the first doctor to help a perfectly healthy person suffering depression to die.

REPORTER: Hi, I found you OK! Lovely place you have here.

DR CHABOT: It is! It is! Let’s go around.

REPORTER: Fantastic. Thank you for having us.

In these sprawling gardens of what was once a pigs stable, lives psychiatrist Dr Chabot.

DR CHABOT: Look around, the climate is lovely. The sculpture is called into the grave. So, this is the very prominent mouth and the eyes are receding, and a big wave is taking this person away, into where - wherever, we don't know - into the grave – very special.

24 years ago, he made a decision that broke open the limits of euthanasia.

NEWS REPORT (Translation): On the 28th of September 1991 a 50-year-old woman from Ruinen ended her life. Her house was full of flowers when she took the deadly dose.

DR CHABOT: They called me the doctor who prescribed suicide. She was a fully-healthy social worker aged 50 who had lost both her two sons under dramatic circumstances. She said the only thing for which I am coming to you is to get medicines to have a peaceful death. I’ve buried three graves next to each other and I want to be in the middle.

A court ruled the woman’s mental suffering was unbearable and had no prospect of improvement.

REPORTER: How difficult was that decision for you to make?

DR CHABOT: Well, extremely difficult. Am I morally entitled to be an agent in her death at age 50?

Chabot’s case was a catalyst for Belgium’s euthanasia laws. Today, it’s granted not just for terminal illness but for mental suffering. The laws are the most liberal in the world, even children can be approved, though no child has yet been euthanized. So I’ve come to Belgium because I want to do know if they’ve got it or if they have gone too far. These silent, daily car trips are something Conny Ketelslegers has come to dread. With sons Alex and Thomas, they’re driving to a hospital just outside Brussels.

THOMAS KETELSLEGERS (Translation): I feel sad when my Dad gets an attack, he hits his head very hard and shakes it violently. You can see him suffering from the pain.

Their dad Peter suffers from a rare condition known as cluster headaches. It won’t kill him, but there’s no known cause or cure.

CONNY KETELSLEGERS (Translation): Hey, are you awake?

Here he only gets basic paint management.

CONNY KETELSLEGERS: He’s passed out.

PETER KETELSLEGERS (Translation): My eye! My eye!

CONNY KETELSLEGERS: The pain is getting stronger and stronger. This is now the beginning.

PETER KETELSLEGERS (Translation): Stop it! Goddammit!

Peter has tried almost everything to stop these intense headaches. Nothing has worked. They can happen several times a day and last up to three hours.

PETER KETELSLEGERS (Translation): Go away!

Conny and the boys can do little but watch on.

PETER KETELSLEGERS (Translation): It’s like a knife being stuck into my head. The pressure can’t go anywhere. It spreads through my whole head. I hit it to get rid of the pain.

Peter’s suffering seems unbearable and it’s these two words, unbearable, suffering, that are the keystone of Belgium’s euthanasia laws. But what does that mean?

NURSE (Translation): Try and calm down. It’s so intense.

And how do you, we or a doctor define it?

CONNY KETELSLEGERS: But he does so many strange things when he has a seizure. He runs into the wall. He wants to scratch out his own eyes. Once he told me, if they say I have to chop my arm off so the pain would go away, I will chop my both hands off he says.

THOMAS KETELSLEGERS (Translation): It doesn’t make me feel great. At the moment he’s very bad. I wish it would go away.

REPORTER: So, what do you think the solution to this problem is?

PETER KETELSLEGERS (Translation): If there’s no other solution other than just an injection and gone... Do I have to say it? Euthanasia.

Nearly 2,000 patients choose assisted death here every year, Peter’s just one of them and he’s not terminally ill. Terminal illness is why most supporters agree with euthanasia but Belgium’s approach is much more liberal. I’ve come to this tiny office in Leige to meet one of the laws early developers who explains the legal framework.

GILLES GENICOT, EUTHANASIA CONTROL COMMISSION: The patient has to be in an intractable medical situation. It doesn’t necessarily mean that he will die shortly.

Gilles says the key idea is incurable, unbearable, suffering. It could be physical or psychological. Anything from cancer to Alzheimer’s and everything in between, and it’s up to the patient to define.

GILLES GENICOT: It’s a broader notion encompassing a subjective approach. It’s really the patient that has to express the suffering he feels and how this is perceived as unbearable for him.

Here in Belgium, the majority of cases still relate to terminal cancer, but a growing number don’t. To find out more, I’ve been invited to Antwerp to meet an 85-year-old woman. These few objects tell the life of Simona de Moor. Her days here are sparse, but content.

SIMONA DE MOOR (Translation): That’s better.

Each morning begins the same.

SIMONA DE MOOR (Translation): Now waiting for breakfast.

She wakes up at 5:00.

AIDE (Translation): Here we are.

And eats at 8:00.

AIDE (Translation): Jam?

SIMONA DE MOOR (Translation): No, chocolate spread.

In two months, Simona will have lived like this for ten years.

SIMONA DE MOOR (Translation): I’ll go on my bike. It's Monday isn't it?

WOMAN (Translation): Monday it’s cycling. Yes, yes.

Simona was born in Belgium in 1929 – a time when the Catholic Party governed and back then, assisted dying laws would have seemed impossible.

SIMONA DE MOOR (Translation): I do this every morning for 15 minutes or I get stiff.

More than eight decades on, she is healthy and for an 85-year-old, she keeps an active routine.

REPORTER: How far have you gone? You have been working pretty hard there?

SIMONA DE MOOR (Translation): I don’t know, around 5km.

REPORTER: You’re making me feel bad, Simona. You’ve done more exercise than me and it’s not even 9:00 yet!

SIMONA DE MOOR (Translation): If you’re not content here, you won’t be content anywhere. I stopped, 6.6 kilometres. Not bad, eh?

Even so, Simona wants to die.

SIMONA DE MOOR (Translation): Yeah. That’s nice of you.

AIDE (Translation): There you are. Enjoy.

SIMONA DE MOOR (Translation): Thank you, dear.

A decision she’s disarmingly frank about.

SIMONA DE MOOR (Translation): Vitamins.

There’s no even a hint of sadness or regret when she tells me, she wants to die before her next birthday.

SIMONA DE MOOR (Translation): I have no reason to live anymore. The thought keeps going round in my head that it won’t be long now. If I see the doctor come in with the needle, it will be the happiest day of my life. Truly.

For me, this is an extremely strange conversation. Just around the corner works Simona’s long-time GP - Doctor Marc Van Hoey. To him, her request is reasonable, even unremarkable.

DR MARC VAN HOEY, GP: A lot of elderly people are not really suffering in the narrow meaning of the word. But one plus one plus one plus one, that makes a whole and that in addition to their age gives them no future. There is nothing left anymore, and so quite often they say, I’ve had it with my life.

Simona is letting me follow her euthanasia to document that this decision is hers and to show the process that has been in place here for 13 years. As she’s not terminally ill the law says three doctors must agree her suffering stems from incurable illness. Today, Dr Van Hoey’s giving the final green light.

DR MARC VAN HOEY: About ten days ago there was a second doctor who came here to give her opinion about her question and the procedure and then there's going to be a visit of a third doctor, he's going to give his opinion, and I'm going to discuss with Simone right now if she's going on with her procedure and if she's decided to leave this world.

Hi, Simona.

SIMONA DE MOOR (Translation): Hi, Dr Van Hoey. Happy to see you.

DR MARC VAN HOEY (Translation): Tell me, Simona. I would just like to know, do you stand by your decision?

SIMONA DE MOOR (Translation): Yes. Absolutely.

Here in Belgium, any GP can perform euthanasia. No special training is required – just a long standing relationship with the patient.

DR MARC VAN HOEY (Translation): The people around you at your table, did you speak to them?

SIMONA DE MOOR (Translation): Yes.

DR MARC VAN HOEY (Translation): How did they reaction?

SIMONA DE MOOR (Translation): They were shocked, but that's normal, isn't it? I only have one wish, and that is to be at Schoonselhof cemetery with my daughter.

DR MARC VAN HOEY (Translation): I promised. I will keep my word.

SIMONA DE MOOR (Translation): Thank you.

DR MARC VAN HOEY (Translation): I’ll leave you for now.

SIMONA DE MOOR (Translation): I have great faith in you.

DR MARC VAN HOEY (Translation): It will be all right.

SIMONA DE MOOR (Translation): Thank you. Thank you, doctor. Now it’s time for lunch. It will probably be my last one.

The routine nature of this moment is really surprising. Simona now knows the date…

AIDE (Translation): There you are. ..

SIMONA DE MOOR (Translation): Thank you

and time…..of her death. Ten thirty the following Monday, two days before her 86th birthday. It’s confronting to meet someone who so willingly wants to die. Yes, Simona is old, but she is perfectly healthy and, unlike Peter, has no obvious physical suffering and yet here, both can choose to die. So how is this regulated? How do they keep this in check? In Brussels, regulating euthanasia cases is the job of the federal control and evaluation commission. Every case must be declared by doctors to be assessed.

JACQUELINE HERREMANS, EUTHANASIA CONTROL COMMISSION: Last year we have received 1907 declarations for one year.

GILLES GENICOT: Behind each piece of paper there is a human story and we should never forget that.

This federal commission is made up of just 16 members-mainly doctors and lawyers. Together they go through every case to check a doctor’s decision and ensure it meets the basic grounds of the law. But, in 13 years, not a single case has been passed on for judicial review.

GILLES GENICOT: And I think we can be very proud of this law that we have, and frankly ever since I studied this question, and I’m a member of the committee, I’ve never seen any abuse. Never.

Now, most would assume the commission’s review takes place before a case is performed. Actually, it happens only after the patient has died. It makes me wonder, how effective it can be? Euthanasia has been legal here 13 years and Simona’s doctor is head of its main advocacy group – Right to Die. He tells me every family in Belgium knows a euthanasia case and invites me to see just how widely it’s talked about.

WOMAN (Translation): Hot off the press.

GILLES GENICOT: And every year we organise a kind of symposium or congress, about the theme of life end decisions.

Today’s theme shocks me.

GILLES GENICOT (Translation): We are clearly seeing an increase in the amount of cases with a psychological component.

Ten years ago there was only three such cases but from 2012 to 2013, more than 100 people sought euthanasia for psychological illness. Today’s key speaker is a father whose son suffered severe depression.

LUC DELIANS (Translation): He was 43 and last November, because of psychological suffering in combination with tinnitus, he found relief.

He isn’t an advocate for euthanasia. He’s torn. Feeling compassion for his son’s suffering but also robbed of his life.

LUC DELIANS (Translation): The dilemma for us as parents and for his sister and brother who wanted to keep Barendt, but also to allow him the freedom to decide for himself. While it's understandable that many find euthanasia and the ethics of it difficult, it should be clear that euthanasia is an act of compassion. Should I find the courage to write more about the life of my son, then the book will be called, ‘Please Listen, as they Listened’.

This shows me just how complex the issue’s become. Belgian doctors are adopting increasingly loose interpretations of unbearable illness. I’m returning to see Simona de Moor to find out about her illness and why she’s being granted permission to die.

SIMONA DE MOOR (Translation): She cared more for me than for herself. That's what the work colleagues told me. She was an angel for me.

Of Simona’s few possessions, these are some of her most precious, all to do with her daughter.

SIMONA DE MOOR (Translation): ‘Sincere condolences on the death of your daughter’…

She keeps them close by at all times.

SIMONA DE MOOR (Translation): “You can count on me every hour of day”. I read them almost every day when I have time.. that gives me strength. She was very good and that's why it's so terrible, it was so sudden.

Simona’s daughter, Vivian, died suddenly three months ago after undergoing routine surgery. She says her daughter would call her every day.

REPORTER: Can you remember the first time you thought about euthanasia?

SIMONA DE MOOR (Translation): The moment they broke the news to me, five minutes later I knew. And nobody in the whole wide world will take it away from me. Grief is an unbearable pain. It’s driving me mad and I don’t want to go to a mad house. I want to die here. I was happy here until my daughter died. There is one from Dr Van Hoey too. A big one.

Dr Van Hoey confirms Simona’s grief and ongoing depression is the cause of her wish to die. She’s had no history of mental illness, so he’s confident her request is still sound. Even though he’s not a psychiatrist and by Belgium law isn’t required to be one to approve euthanasia.

DR MARC VAN HOEY: I started with the medication, the treatment, she took it for a few weeks or months but her request is still going on, so it’s not she doesn’t want to die because she’s depressed, no, she wants to die because she’s had it. See the difference?

It’s only been three months since Simona’s daughter died. If grief can lessen over time, I ask Dr Van Hoey, how can someone who is depressed really assess if euthanasia is right for them?

REPORTER: You’re comfortable that a psychiatrist wasn’t consulted in this case?

DR MARC VAN HOEY: No problem at all.

REPORTER: Why are you comfortable with that decision?

DR MARC VAN HOEY: Because, um, my experience. Hah. That’s the only way, yes.

REPORTER: In medical terms, what is the official cause of Simona’s unbearable suffering?

DR MARC VAN HOEY: Reactive depression, certainly.

REPORTER: As a result of her daughter’s death?

DR MARC VAN HOEY: Yes. And I will mark that on the death certificate. It’s a natural death. Euthanasia is a natural death, and then the second step will be untreatable depression. Next line will be, the death of her only daughter.

Before leaving Simona I learn a startling fact. It becomes clear Vivienne isn’t an only child. Simona tells me she has an elder daughter who is still alive. But after a dispute they’ve been estranged for over 30 years.

REPORTER: Have you told your daughter about the euthanasia?

SIMONA DE MOOR (Translation): No. I haven’t spoken to her and I haven’t heard from her. The people I wanted to say goodbye to I have written to. The rest they will hear once I am dead. I don’t have to justify myself to anybody. I decide.

It’s confronting that Simona’s euthanasia can legally proceed without her living daughter’s involvement. Someone who wasn’t told, but wishes he was, is Tom Mortier.

TOM MORTIER: On the 19th of April my mother was killed by lethal injection. Here in Belgium I can go to physician now, a psychiatrist or someone who’s willing to kill and I can say to this physician you have to kill me! You have to kill me! But don’t say anything to my wife or my children. This was me with my mother when my mother was around 40-years-old. When I studied the Belgium euthanasia law, the articles which appeared before the 2002 legislation, it was meant for very rare circumstances.

Tom’s mother suffered severe depression – regularly seeing therapists since she was 19.

TOM MORTIER: My mother, she really loved to travel so I think this is a picture which has been taken in Egypt.

In 2011 she sent him an email saying she was thinking about euthanasia. He later found out it went ahead without his knowledge or involvement.

TOM MORTIER: Well this is the letter I received in the mailbox from my mother, explaining that the euthanasia request has been executed. So, it’s a very difficult letter for me. I really couldn’t agree that a physician could kill a mother, a grandmother, without ever having contact with the children or grandchildren.

REPORTER: Why wasn’t he involved in consultation, or given a chance to say goodbye?

JACQUELINE HERREMANS: Because his mother didn’t want it and that was her wish and the doctor had to respect her wish.

Tom tried contacting the federal control commission that had assessed and approved his mother’s euthanasia. He wanted information, but laws protect patient confidentiality, so he was met with silence.

GILLES GENICOT: One of the key principles of the law is that you’ve got to trust doctors, patients and their relationships, which is secret. We are not putting doctors on trial.

Tom then made a shocking revelation. The federal control commission, the only body that assesses a doctor’s decision, is actually led by the man who euthanized his mother.

REPORTER: It appears that the people who perform euthanasia are the ones who are policing the laws enforcing it?

JACQUELINE HERREMANS: First of all, he’s not reviewing cases which involved his practice. That’s the first point.

REPORTER: But he’s in the room when you do, he might not be speaking but he’s there, isn’t he?

JACQUELINE HERREMANS: Like other people, like other members of the commission, he’s in the room.

For Tom, this raises serious questions about the laws most crucial safeguard.

REPORTER: Is the commission in your opinion there to protect patients and their families?

TOM MORTIER: No! This commission is there to protect the physicians. Their chairman is protected, not me. They’re protecting him, not family members, not my mother. My mother was trapped in his ideology.

The man in question is dubbed by media as Belgium’s Dr Death. Known to stretch the boundaries of the law, he once agreed to euthanize twins because they were going blind. He also pushed for euthanasia to be extended to children.

PROFESSOR DR WIM DISTELMANS (Translation): Suffering has no age limit. I don’t think there shouldn’t be a legal limit.

Today in Brussels I track him down, being celebrated as Belgium’s Humanist of the Year. His name is Dr Wim Distelmans. He’s the country’s most popular euthanasia advocate.

PROFESSOR DR WIM DISTELMANS (Translation): How do you keep coming up with this stuff?

But he’s also well known for avoiding international media.

PROFESSOR DR WIM DISTELMANS (Translation): Top journalists have shared our frustration and defended our efforts. And this is in sharp contrast with the many emotional and even aggressive reactions in the international press which lack understanding and don’t even want to know how we define euthanasia. There’s no encore!

REPORTER: There has been some criticism though of the laws in Belgium and in particular of you as a practitioner of those laws.

PROFESSOR DR WIM DISTELMANS: They should come over and observe what is being done here in Belgium. We respect what people really want and that is very…I think the most important thing.

REPORTER: In regards to the Tom Mortier case, I know you’ve been…

PROFESSOR DR WIM DISTELMANS: No. … I don’t.

REPORTER: It’s not something you are prepared to comment on?

PROFESSOR DR WIM DISTELMANS: No, I can’t because ah, it’s ah, professional secrecy.

REPORTER: But even on a personal note, you wouldn’t want to send a message to Mr Mortier.

PROFESSOR DR WIM DISTELMANS: No. I don’t like to discuss this any further.

REPORTER: OK, thank you doctor.

After months of interview requests, this is the only exchange I get with Dr Wim Distelmans. I’m crossing over into the neighbouring Netherlands to meet a man who served nearly ten years on the Dutch Euthanasia Commission, but now has serious reservations.

THEO BOER, DUTCH COMMISSION 2005-2015: But what I see in Belgium is unprecedented action in favour of euthanasia by both the review committee in Belgium and by many politicians the supply of euthanasia will stir its demand. I think that is definitely the case. And that is especially dangerous in the cases of psychiatric illnesses.

After reviewing around 4,000 cases, last year Theo stood down. They’d begun to cause him sleepless nights.

THEO BOER: What we have seen is that euthanasia and assisted dying are increasingly being used for patients that have months, or years or even decades to live and I think the law wasn’t meant for these situations.

It’s one thing to talk about this as a matter of law but it’s another thing entirely to see the Ketelslegers family having their own sleepless nights.

CONNY KETELSLEGERS:  My husband is a farmer so we have 300 animals, I was always thinking we have to expand so we can leave it to the children when we were old and grey. So this was Peter’s whole world a stable full of animals, now they are completely empty. He was quite happy working from until morning until the evening. Even at night it was his domain, his place, and now it’s all gone mainly because of his disease. He cannot work with this. The bank took it all and now we have nothing anymore.

Due to his incurable headaches, Peter Ketelslegers has been forced to give up the farm. It’s been in his family three generations.

REPORTER: How does having that taken away make you feel?

PETER KETELSLEGERS (Translation): I feel shitty about it. I mull it over and over. I think about it a lot, that I’ve lost everything.

Peter considers euthanasia an absolute last resort and in his mind, not just as a way to free himself from pain but also as a way to set his family free from living with this illness.

PETER KETELSLEGERS (Translation): I am letting everyone down. I don't want to be a burden to anyone. Normally, I should be able to take care of my children – rather than them taking care of me.

Discussing euthanasia for the first time was incredibly difficult.

CONNY KETELSLEGERS: He told me, I don’t want to do suicide, because then I’m afraid, who is going to find me? Is it you or is it my children, they’re going to be ruined for the rest of their lives. So, he says I want to do it just lie down on a bed, do it easy, do it proper. My heart stood still.

Even though it’s something talked about at school, raising the option with her children is one of the hardest decisions for Conny.

THOMAS KETELSLEGERS (Translation): I won’t like it if dad is euthanized because I will miss him so much.

It’s heartbreaking listening to her and 12-year-old Tom.

CONNY KETELSLEGERS (Translation): If dad told you he would like to be euthanized, what would you say to him then?

THOMAS KETELSLEGERS (Translation): I really don’t want to talk about that.

CONNY KETELSLEGERS (Translation): How was it today?

THOMAS KETELSLEGERS (Translation): We were in the fields.

CONNY KETELSLEGERS: At some point you would be enormously selfish to keep your husband with you when he knows that he’s in so much pain, so I stand behind him.

REPORTER: You’ll let him have his wish?

CONNY KETELSLEGERS: Yeah. With pain in my heart, but yeah.

Peter’s only a few years older than me, I can’t imagine how severe his pain and suffering must be for him to believe euthanasia is his best option, is it giving up or dying with dignity? Today is the day Dr Van Hoey will perform Simona’s euthanasia. Her decision is weighing on me. She says she is adamant, sound of mind. She wants to die. But grief is such a human, normal part of life.

I didn’t get much sleep last night thinking about it. It’s been really difficult to know when, where and how someone is going to die. It’s just a very uncomfortable feeling, and not really knowing what to say to her when we arrive here at the nursing home. Inside - Simona is already awake and waiting outside the dining room for breakfast.

REPORTER: How did you sleep last night - did you get a good night’s sleep?

SIMONA DE MOOR (Translation): I slept well and I woke up happy.

REPORTER: You're not nervous at all about today?

SIMONA DE MOOR (Translation): No, no. The opposite in fact, I'm very calm.

It’s just another day at this nursing home, except Simona won’t live long enough for lunch. Imagine being healthy and deciding to die because of grief. That’s the option Simone de Moor is taking today.

SIMONA DE MOOR (Translation): That’s better.

And not everyone is happy about it.

REPORTER: Your neighbours aren't here this morning – how do they feel about what's happening today?

SIMONA DE MOOR (Translation): She will come.

Her next door neighbour has boycotted her last meal.

SIMONA DE MOOR (Translation): She wouldn’t allow me to do it, but nobody can talk me out of it. Good morning, Allovise and Anneke.

And for this husband and wife, Simona’s decision raises difficult questions about their own mortality. Conversation is awkward.

SIMONA DE MOOR (Translation): Did you sleep well?

ALLOVISE (Translation): Yes.

In her final hours, Simona surprisingly maintains her routine. The lack of emotion is difficult for me but not Simona, I watch her cycle for the last time. As Dr Van Hoey arrives, Simona tries to find her neighbour to say goodbye.

SIMONA DE MOOR (Translation): She’s not in.

She almost misses the moment.

SIMONA DE MOOR (Translation): She didn’t turn up for breakfast. She is there! He saw her. Inside?
Then she hasn’t heard me.

But then, she gets her chance.

NEIGHBOUR (Translation): What do you want?

SIMONA DE MOOR (Translation): I couldn’t say goodbye before as you weren’t at breakfast. You weren’t at the table?

NEIGHBOUR (Translation): Now you know how I feel, Simona.

SIMONA DE MOOR (Translation): It will be a long time before we see each other again.

NEIGHBOUR (Translation): Yeah, many years.

Other farewells are slightly easier.

SIMONA DE MOOR (Translation): Let's hope you have a long life, lad.

ALLOVISE (Translation): Yes.

ANNAKE (Translation): I hope you may meet your daughter.

SIMONA DE MOOR (Translation): Yes, I most certainly will. Now I’ve done everything. I am ready to die, to go to my daughter. I am happy now. Thank you.

GILLES GENICOT: This idea that with a euthanasia law you will get elderly slaughtered from elderly homes because they are useless and they cost a great deal to society is completely nonsense. Euthanasia is dying with open eyes, facing death until the very last moment.

TOM MORTIER: If you're also going to include the mental suffering than it's really a pandora's box. It's very, very, very difficult to have a good law on euthanasia.

DR MARC VAN HOEY: Today's the day Simona going to leave us. This is the syrup.

REPORTER: Simona is very confident but do you always feel anxious at this point? How do you feel emotionally?

DR MARC VAN HOEY: Always bear in mind it's her decision, and till the very last moment I will be asking her, do you want to go through and are you really decided? Are you really ready?

SIMONA DE MOOR (Translation): Absolutely. 100%.

DR MARC VAN HOEY (Translation): It doesn’t happen straight away. You’ll drift away slowly. Like. I’m feeling a bit sleepy and then we lay you down.

As Dr Van Hoey prepares, I find a close friend of Simona’s.

PATRICIA (Translation): I called her Aunty Simona even though she's not really family but she took care of me since I was a baby, like a substitute mother. I have tried to support her and to guide her in the process and I found it very important to be there with her and for myself too.

DR MARC VAN HOEY (Translation): Do you want to say anything to Patricia?

SIMONA DE MOOR (Translation): I have already thanked her for everything.

PATRICIA (Translation): We have said everything. Simona, I just want to give you a kiss. We have said everything. I can’t thank you enough.

DR MARC VAN HOEY (Translation): You see it's not a lot. If I give you this syrup, you don't drink it down too fast, don't gulp it down, but calmly. Slow and steady. Are you really ready, Simona?

SIMONA DE MOOR (Translation): Yes.

DR MARC VAN HOEY: It is very difficult, to really decide that the psychic suffering is unbearable. But on the other hand if a person makes the decision that he or she doesn’t want to live anymore, you don’t want to suffer. I’ll sit with you. You did that well.

SIMONA DE MOOR (Translation): It is sweet.

DR MARC VAN HOEY (Translation): Oh my, that was very very determined of you, you couldn't have taken that any quicker. We all hope that you will see Vivienne again somewhere.

SIMONA DE MOOR (Translation): I hope so too.

DR MARC VAN HOEY (Translation): Do you want to lie down?

SIMONA DE MOOR (Translation): Maybe.

DR MARC VAN HOEY (Translation): Lay this way. Just a little left.

It’s over in less than five minutes.

DR MARC VAN HOEY (Translation): She’s at peace.

PATRICIA (Translation): Yes, she’s content.

DR MARC VAN HOEY (Translation): It’s good you came.

PATRICIA (Translation): Yeah, yeah, I’m so glad I’m here.

DR MARC VAN HOEY: She left me a note. Dr Van Hoey, I want to thank you from the deepest of my heart, to fulfil my only wish. Simona. And that's what I'm going to keep as a kind of souvenir.

REPORTER: Euthanasia for psychological cases is perhaps the most controversial. Do you worry that you might get a phone call after performing a procedure like this?

DR MARC VAN HOEY: Not at all. Not at all.

REPORTER: And you're happy with how that job was performed today?

DR MARC VAN HOEY: I think Simona was happy and that's the most important thing.

I’m taken aback by just how mundane and unremarkable the procedure is for those who perform it here. Since filming in Belgium questions have repeatedly been asked about how its euthanasia laws are safeguarded. For me, Simona’s death illustrates some of these concerns, mostly it just feels sad to say goodbye to someone who is healthy and sharp of mind, yet still believes her best treatment is death.

I’m making a final visit to Conny and Peter, for them, this decision moves slowly but they’re moving closer to choosing euthanasia, and today it’s Father’s Day.

THOMAS KETELSLEGERS (Translation): Here you are.

PETER KETELSLEGERS (Translation): Thank you. What is it?

ALEX KETELSLEGERS (Translation): It's from us. You can take lots of photos.

PETER KETELSLEGERS (Translation): It’s lovely.

ALEX KETELSLEGERS (Translation): Dear Dad, today is Father's Day, the whole of Belgium is celebrating. Everybody loves their dad but I do the most. So, enjoy your special day and love from your little son Alex.

PETER KETELSLEGERS (Translation): Thank you.

I’ve spent six months filming with the family, this is the first time I’ve seen Peter smile.

PETER KETELSLEGERS (Translation): Come here.

Peter’s still holding out for an alternative.

CONNY KETELSLEGERS (Translation): Look at me! Smile!

But he is now in contact with Doctor Wim Distelmans and a second doctor has already approved his euthanasia.

CONNY KETELSLEGERS (Translation): Give me a big hug.

Choosing to die will never sit easily, even for those who decide it’s their best option.

PETER KETELSLEGERS (Translation): The children will understand, surely? I hope that they will understand. They see what they see, I don’t know what else I can say about this.

Video Journalist
BRETT MASON

Producers
CALLISTE WEITENBERG
BERNADINE LIM
JONATHAN CHALLIS

Fixer
MEREL BOCKEN

Editors
MICAH MCGOWN
SIMON PHEGAN

Thanks to
THE KETELSLEGERS FAMILY
DAVID STAM

Translations
ANNEKE MACKAY-SMITH
MARC VAN DINTHER

Music
VICKI HANSEN

15th September 2015