LIÈGE — In a first-floor room near elevator A, in the depths of the Citadel Hospital in the Belgian city of Liège, Dr. François Damas reserves half a day per week to meet with chronically ill patients inquiring about euthanasia.

Some come from France, and since the autumn of 2017, when Anne Bert, a French writer suffering from Charcot disease, publicized her decision to go to Belgium to die, the numbers have increased dramatically.

Damas, 65, says he now gets one or two calls per week, versus one every six months before. The requests are mostly from people with neurodegenerative pathologies or cancers, and who are frustrated with French law, which only allows for deep and continuous sedation until death.

The physician goes over some of the requests he has received by email. Some are straight to the point. "Hello. French 42-year-old with ataxia. Exhausted all the time. How can I benefit from your services? I can pay several thousand euros if you come to…"

In the exchange that followed, Dr. Damas spelled out some basic ground rules. He told the patient that they'd first have to come to Belgium for a consultation, that their doctor in France would have to give their medical opinion and then, though not required by Belgian law, their relatives must be notified.

"I have to convince you?" the man replied. He seemed surprised.

"That is a key point of the endeavor," Dr. Damas then explained. "You have to make me agree to your request."

Of the 100 or so requests he receives every year, only a few actually end with an euthanasia​ procedure. Damas dismisses some requests for being too "far-fetched." Others don't fall within the necessary legal framework. And sometimes, he explains, patients plan to return to Belgium, but end up dying in-hospital in France.

What France is forcing these sick people to do is shameful.

Dr. Damas claims that, last year, he helped a dozen French people die. A good portion, in other words, of the 40-50 French people believed to have been euthanized in Belgium in 2019. He also says he has 20 to 30 people who are waiting for euthanasia​ and with whom he corresponds regularly.

The numbers reflect the fact that there aren't many doctors in Belgium willing to respond to requests for euthanasia from foreign patients. On the internet, only a few names of practitioners frequently appear, often because they have agreed to speak to journalists.

"As soon as doctors are identified, they're harassed, in part by unjustified requests," Jacqueline Herremans, president of the Association for the Right to Die with Dignity (ADMD), said regretfully. "Ten years ago, requests from French people were very rare because there was the belief that it wasn't possible."

In reality, there are no legal restrictions for the euthanasia of a non-resident. The difference now is that people in France are just more aware of this fact. "But it would be unmanageable if all requests for euthanasia in Europe were handled in Belgium," Herremans adds. "It wouldn't be physically possible for doctors."

Michèle Morret-Rauis, the former director of the palliative care unit at Brugmann hospital in Brussels and vice-president of the ADMD, recalls that after a report on France 4 was broadcasted a few years ago, "the phone was ringing non-stop for more than two weeks with people saying: "Hello, am I speaking with the euthanasia unit?" Once the French have a lead, it spreads quickly. Word of mouth is powerful."

The response was overwhelming for caregivers and later, in early 2016, a new head of department decided to suspend the arrival of foreign patients. That suspension is still in effect today.

At Charleroi hospital, Dr. Jean-Claude Legrand, 69, admits that he "hesitated to accept French patients' as part of his end-of-life consultations. "Isn't it taking the responsibility away from France to take on these cases? We don't want our facility to become the "euthanizer" for the French."

Legrand acknowledges, nevertheless, that in the past two years he has euthanized five or six French patients and has five or six more requests "in process," including two from the south of France, "thanks to Ryanair, which operates not far from the hospital."

"It would be unmanageable if all requests for euthanasia in Europe were handled in Belgium" — Photo: Karl-Josef Hildenbrand/DPA/ZUMA

Some requests must pass through less direct channels. Approximately 200 kilometers from Brussels, near the Belgian border in Longwy (Meurthe-et-Moselle), 72-year-old Claudette Pierret, a retiring executive secretary, receives three or four new requests from French patients everyday. The ADMD volunteer calls them "cries for help."

Many of them are addressed to Dr. Yves de Locht, a general practitioner from Brussels who recently published a book called Docteur, rendez-moi ma liberté ("Doctor, give me my freedom back"). Pierret believes that in recent years she helped about 30 French people receive euthanasia in Belgium.

"I have three waiting and Yves only does one per month," she says. "There are some who asked for March and April … After that, they have to wait."

Getting euthanasia in Belgium can be a real "obstacle course," warns the ADMD. The association automatically sends a response to any request for information (in 2019, 348 were made by "non-residents'), a standard letter listing the foreseeable difficulties. "Belgian doctors are currently extremely reluctant when it comes to taking care of non-resident patients, because of the obvious practical difficulties that this implies," the document reads.

In order to receive care, a French patient must report extreme physical or mental suffering caused by a serious and incurable condition. They must also establish a "therapeutic relationship" with a Belgian doctor. In other words, they must first go to a consultation and then submit for a second medical opinion.

It must cost between 5,000 and 6,000 euros for a French national to come and die in Belgium.

But for people who are seriously ill, making the trip to Belgium can itself be a trying ordeal. "I have patients who sometimes arrive by ambulance after having traveled nearly a 1,000 kilometers," Yves de Locht says. "What France is forcing these sick people to do is shameful," agrees Claudette Pierret.

In addition to the strain of the journey, there is also the question of cost. In Brussels, Yves de Locht charges 50 euros for the first consultation and 150 euros for the lethal injection. He also advises his patients to add in the cost of one night in the hospital, about 2,500 euros, the cost of which is sometimes covered afterwards by French insurance.

"Taking everything into account, it must cost between 5,000 and 6,000 euros for a French national to come and die in Belgium," Dr. de Locht estimates. "It costs nothing for a Belgian who decides to die at home, apart from the product and a few consultations. There is a glaring inequality there."