Tag Archives: Belgium

Euthanasia dispute in Belgium: When do doctors cross a line?

A disputed case of euthanasia in Belgium, involving the death of a dementia patient who never formally asked to die, has again raised concerns about weak oversight in a country with some of the world’s most liberal euthanasia laws.

The case is described in a letter provided to The Associated Press, written by a doctor who resigned from Belgium’s euthanasia commission in protest over the group’s actions on this and other cases.

Some experts say the case as documented in the letter amounts to murder; the patient lacked the mental capacity to ask for euthanasia and the request for the bedridden patient to be killed came from family members. The co-chairs of the commission say the doctor mistakenly reported the death as euthanasia.

Although euthanasia has been legal in Belgium since 2002 and has overwhelming public support, critics have raised concerns in recent months about certain practices, including how quickly some doctors approve requests to die from psychiatric patients.

Petition for tighter controls

The AP revealed a rift last year between Dr. Willem Distelmans, co-chair of the euthanasia commission, and Dr. Lieve Thienpont, an advocate of euthanasia for the mentally ill. Distelmans suggested some of Thienpont’s patients might have been killed without meeting all the legal requirements. Prompted by the AP’s reporting, more than 360 doctors, academics and others have signed a petition calling for tighter controls on euthanasia for psychiatric patients.

Euthanasia — when doctors kill patients at their request — can be granted in Belgium to people with both physical and mental health illnesses. The condition does not need to be fatal, but suffering must be “unbearable and untreatable.” It can only be performed if specific criteria are fulfilled, including a “voluntary, well-considered and repeated” request from the person.

But Belgium’s euthanasia commission routinely violates the law, according to a September letter of resignation written by Dr. Ludo Vanopdenbosch, a neurologist, to senior party leaders in the Belgian Parliament who appoint members of the group.

The most striking example took place at a meeting in early September, Vanopdenbosch writes, when the group discussed the case of a patient with severe dementia, who also had Parkinson’s disease. To demonstrate the patient’s lack of competence, a video was played showing what Vanopdenbosch characterized as “a deeply demented patient.”

Euthanized at family’s request

The patient, whose identity was not disclosed, was euthanized at the family’s request, according to Vanopdenbosch’s letter. There was no record of any prior request for euthanasia from the patient.

After hours of debate, the commission declined to refer the case to the public prosecutor to investigate if criminal charges were warranted.

Vanopdenbosch confirmed the letter was genuine but would not comment further about the specific case details.

The two co-chairs of the euthanasia commission, Distelmans and Gilles Genicot, a lawyer, said the doctor treating the patient mistakenly called the procedure euthanasia, and that he should have called it palliative sedation instead. Palliative sedation is the process of drugging patients near the end of life to relieve symptoms, but it is not meant to end life.

“This was not a case of illegal euthanasia but rather a case of legitimate end-of-life decision improperly considered by the physician as euthanasia,” Genicot and Distelmans said in an email.

Vanopdenbosch, who is also a palliative care specialist, wrote that the doctor’s intention was “to kill the patient” and that “the means of alleviating the patient’s suffering was disproportionate.”

‘I don’t know another word other than murder to describe this,’– Dr. An HaekensAlexianen Psychiatric Hospital

Though no one outside the commission has access to the case’s medical records — the group is not allowed by law to release that information — some critics were stunned by the details in Vanopdenbosch’s letter.

“It’s not euthanasia because the patient didn’t ask, so it’s the voluntary taking of a life,” said Dr. An Haekens, psychiatric director at the Alexianen Psychiatric Hospital in Tienen, Belgium. “I don’t know another word other than murder to describe this.”

Kristof Van Assche, a professor of health law at the University of Antwerp, wrote in an email the commission itself wasn’t breaking the law because the group is not required to refer a case unless two-thirds of the group agree — even if the case “blatantly disregards” criteria for euthanasia.

Belgium Euthanasia Controversy

Protestors stand in front of a banner which reads ‘Euthanasia Stop’ during an anti-euthanasia demonstration in Brussels in this Feb. 2, 2014, file photo. Belgium has some of the world’s most liberal euthanasia laws. (Virginia Mayo/Associated Press)

But without a request from the patient, the case “would normally constitute manslaughter or murder,” he wrote. “The main question is why this case was not deemed sufficiently problematic” to prompt the commission to refer the case to prosecutors.

Commission acts with ‘impunity,’ critic says

Vanopdenbosch, who in the letter called himself a “big believer” in euthanasia, cited other problems with the commission. He said that when he expressed concerns about potentially problematic cases, he was immediately “silenced” by others. And he added that because many of the doctors on the commission are leading euthanasia practitioners, they can protect each other from scrutiny, and act with “impunity.”

Vanopdenbosch wrote that when cases of euthanasia are identified that don’t meet the legal criteria, they are not forwarded to the public prosecutor’s office as is required by law, but that the commission itself acts as the court.

In the 15 years since euthanasia was legalized in Belgium, more than 10,000 people have been euthanized, and just one of those cases has been referred to prosecutors.

Genicot and Distelmans said the group thoroughly assesses every euthanasia case to be sure all legal conditions have been met.

“It can obviously occur that some debate emerges among members but our role is to make sure that the law is observed and certainly not to trespass it,” they said. They said it was “absolutely false” that Vanopdenbosch had been muzzled and said they regretted his resignation.

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Battlefront II Investigated in Belgium as EA’s Reddit AMA Bombs

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Update: There are reports that EA “compensated” for slashing the price of heroes by slashing how many credits you can earn in the single-player campaign and in Arcade Mode. Which… I mean, really, EA? Really? Is there an attached limb you won’t blow off?

Original Story Below:

EA has been playing defense on Star Wars Battlefront II for nearly a week. While early coverage of the game was positive, highlighting deeper multiplayer and a genuine single-player story, things have changed in the run-up to launch. Players were extremely unhappy to discover that it could take 40 hours to unlock heroes, and EA’s initial response to this absolutely didn’t help.

While the company has slashed the cost of major heroes, follow-up stories have detailed how the loot crate system is fundamentally a play-to-win gambit, in which players who spend real-world money will have huge advantages over those who don’t. Now, Belgium is investigating the loot crate situation and EA’s attempts to do damage control via a Reddit AMA appear to have backfired.

Let’s talk about Belgium first. Belgium is investigating EA on the grounds that the loot crates in Battlefront II could constitute gambling. The problem with EA’s approach here is partly that the game doesn’t just offer skins or visual effects for purchase — it’s selling content that makes it easier to excel. Moreover, it’s not exactly selling it cheap. Star Wars Gaming calculated how much it will cost to max out the game with upgrades for every class, hero, and vehicle type. There are four base trooper classes (Officer, Specialist, Assault, Heavy) and it’ll take 238 hours of play to hit max level, statistically, with each (950 hours total). Factoring in the amount of time it will take max out everything else, the current projected total is 4,528 hours of play or $ 2,100 dollars. That’s enough to get ears pricked in the EU, where Overwatch is also under investigation for its use of loot crates and overall game mechanics.

BF2-Loot-Crate

One response to the SWG estimates is most players don’t bother unlocking everything in a game. That’s quite true. If you play an MMO, you probably have 1-2 characters you focus on, even if you level up alts for fun. If you play games like Call of Duty, Overwatch, or Battlefield, you probably have specific heroes or classes you focus on.

But even if you slash the Battlefront II figures to 20 percent of base value, you’re looking at 906 hours played (that’s just over half a year at 40 hours per week) or $ 420. Counting the $ 60 base price, that’s $ 480 spent. In one game. For gear and options that used to be earned for free. Even unlocking 10 percent of the content would take 453 hours and well over $ 200, including the game’s base purchase price. I have no doubt that Battlefront II is a polished, engaging title in many respects, but there’s no way I’m paying over $ 200 for it or grinding for months given how little I can play anything on a daily basis.

Why AMAs Don’t Work in Situations Like This

As for the Battlefront II AMA, the developers ran face-first into a common problem in these situations: Fans want specific answers, but developers often can’t give them as quickly as desired. There are objective reasons why this is so: Microtransactions and the Battlefront II progression system are baked into the game as a way to generate additional revenue. The developer team and publisher are going to want to see hard data on how much money people are spending, how it impacts team play, whether the matchmaking system successfully keeps people matched against others of equivalent skill, and how over/under-powered various Star Cards are. At one point a dev disputes SWG’s figures on how long it will take to unlock content, but provides no hard data or information that disputes SWG’s math. This leaves gamers feeling as if they’re being blown off. Developers may in turn become frustrated when their earnest promises to examine problems with the gameplay loop and to fix them to keep the player base happy are ignored or denigrated for not containing specific examples of how systems will be tweaked.

It makes perfect sense for the developer team to promise it’s watching the data, taking player feedback into account, and plans to correct for problems and imbalances. It’s not a dodge, but it also doesn’t address the concerns of players who have seen the reviews, played the beta (in some cases), and question why the game shipped with such an absurd system in the first place. Either no one cared enough to do the math (bad) or the insane grind is a feature, not a bug (worse). Damion Schubert, a game developer who has worked extensively on F2P monetization, published an excellent Tweetstorm on the problem EA has created for itself and I recommend reading it through to the end.

As he writes, a great monetization rate today is 5 percent, meaning 5 percent of your players engage with your loot crate system. The other 95 percent of your player base experiences the normal, un-monetized version of the game. When the “regular” multiplayer requires an insane grind unless you’re willing to shuck out hundreds of dollars to skip it, it’s not hard to see the perverse incentive at work. Few things poison a game faster than the overwhelming resentment of a fan base forced to serve cannon fodder for the handful of players who can drop hundreds or thousands of dollars to buy every upgrade in the game.

Battlefront II’s developers probably couldn’t have given concrete answers to many of the questions redditors were asking, because the changes have to be evaluated, tested, and approved at multiple levels between DICE and EA. But the widespread dissatisfaction with the monetization system should serve as a wake-up call for what players will and won’t tolerate.

It’s one thing to sell skins, emotes, or cosmetic upgrades. For that matter, it’s fine to sell weapons, armor, resources, and other assets in single-player games, provided those items and elements of gameplay are reasonably abundant in-game and can be earned in a reasonable amount of time. But creating a AAA multiplayer game that so blatantly caters to pay-to-win was a huge mistake, and if Battlefront II goes down in flames it’ll be the fault of a publisher and/or developer that refused to consider how player blowback might doom its own project. I can accept DICE and EA may not have realized how much of a problem they were creating for themselves, but all that means is that these companies needed to engage with outside focus groups much more thoroughly than they obviously did.

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