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E-raamat: Euthanasia and Law in Europe: With Special Reference to the Netherlands and Belgium [Hart e-raamatud]

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  • Formaat: 648 pages
  • Ilmumisaeg: 21-May-2008
  • Kirjastus: Hart Publishing
  • ISBN-13: 9781847314307
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Euthanasia and Law in Europe: With Special Reference to the Netherlands and BelgiumSuurem pilt
  • Formaat: 648 pages
  • Ilmumisaeg: 21-May-2008
  • Kirjastus: Hart Publishing
  • ISBN-13: 9781847314307
Teised raamatud teemal:
Wiley OnlineRohkem infot Hart e-raamatute kohta
This book is a successor to Euthanasia and Law in the Netherlands (Amsterdam University Press 1998). This second edition emphasizes recent legal developments and new research, and has been expanded to include a full treatment of Belgium, where, since 2002, euthanasia has also become legal. Also included are short descriptions of the legal situations and what is known about actual practices in a number of other European countries - the UK, Switzerland, France, and Spain. The book strives for as complete and dispassionate a description of the situation as possible, covering in detail: --- the substantive law applicable to euthanasia, physician-assisted suicide, withholding and withdrawing treatment, use of pain relief in potentially lethal doses, terminal sedation, and termination of life without a request - particularly in the case of newborn babies --- the process of legal development that has led to the current state of the law --- the system of legal control and its operation in practice --- the results of empirical research concerning actual medical practice

This book is a successor to J Griffiths, A Bood and H Weyers, Euthanasia and Law in the Netherlands (Amsterdam University Press 1998) which was widely praised for its thoroughness, clarity, and accuracy. The new book emphasises recent legal developments and new research, and has been expanded to include a full treatment of Belgium, where since 2002 euthanasia has also become legal. The book also includes descriptions written by local specialists of the legal situation and what is known about actual practice in a number of other European countries (England and Wales, France, Italy, Scandinavia, Spain, Switzerland).

The book strives for as complete and dispassionate a description of the situation as possible. It covers in detail:

- the substantive law applicable to euthanasia, physician-assisted suicide, withholding and withdrawing treatment, use of pain relief in potentially lethal doses, palliative and terminal sedation, and termination of life without a request (in particular in the case of newborn babies);

-the process of legal development that has led to the current state of the law;

-the system of legal control and its operation in practice;

-the results of empirical research concerning actual medical practice.

A concluding part deals with some general questions that arise out of the material presented: Is the legalisation of euthanasia an example of the decline of law or should it, on the contrary, be seen as part and parcel of the increasing juridification of the doctor-patient relationship? Does the Dutch experience with legalised euthanasia support the idea of a 'slippery slope' toward a situation in which life-especially of the more vulnerable members of society-is less effectively protected? Is it possible to explain and to predict when a society will decide to legalise euthanasia?



This book includes recent legal developments and research and has been expanded to include a treatment of Belgium where euthanasia is now legal.
Foreword v
List of Tables, Boxes and Graphs xxv
About the Authors xxix
Note to the Reader xxxiii
Table of Cases xxxv
Table of Statutes xli
1 Introduction 1
1.1 This Book and its Readers 1
1.2 The Definition of 'Euthanasia' and of Other 'Medical Behaviour that Shortens Life' 2
1.3 The Legal Status of Medical Behaviour that Terminates Life in the Netherlands and Belgium 3
1.4 Reactions from Abroad to the Dutch and Belgian Situation 4
1.5 Four Theoretical Themes 5
1.5.1 The Emergence and Diffusion of Euthanasia Law
6
1.5.2 The Quantity of (Euthanasia) Law
7
1.5.3 The Spectre of a 'Slippery Slope'
7
1.5.4 Varieties of (Legal) Comparison
7
PART I THE NETHERLANDS 11
2 The Netherlands and the Dutch Health Care System
13
2.1 Dutch (Political) Structure and Culture
13
2.2 Health Care in the Netherlands
15
2.2.1 The Dutch Health Care System
15
2.2.2 Institutions for Health Care and Care of the Elderly
16
Hospitals
17
Nursing Homes
17
Residential Homes
18
Institutions for Terminal Palliative Care
18
Home Care
19
Where People Die
19
2.2.3 Health Care Professionals
19
2.2.3.1 Doctors
20
General Practitioners
20
Specialists
21
Nursing-Home Doctors
22
2.2.3.2 Nurses and Nursing Assistants
22
2.2.3.3 Pharmacists
22
2.2.3.4 Municipal Pathologists
23
2.2.3.5 The Medical Inspectorate and Medical Disciplinary Law
23
2.3 Public and Professional Opinion concerning Euthanasia
24
2.3.1 Dutch Public Opinion concerning Euthanasia
24
2.3.2 Dutch Medical Opinion concerning Euthanasia
27
2.4 Concluding Remark
28
3 Recent Legal Developments in the Netherlands
29
3.1 Legal Developments through 1998
29
3.2 Statutory Legalisation
32
3.3 The Brongersma Case
35
3.4 The Limits of Relief of Suffering in the Terminal Phase
39
Terminal Sedation
41
3.5 Assisted Suicide for Patients with Dementia
45
3.6 Assistance with Suicide by Non-Doctors
46
A Second Model?
48
3.7 Reflections
48
4 Dutch Law on Euthanasia and Other MBPSL
51
4.1 Law concerning Medical Behaviour that Potentially Shortens Life (MBPSL)
52
4.2 Current Law in the Netherlands
54
4.2.1 'Normal Medical Practice', the 'Medical Exception' and a 'Natural Death'
55
4.2.2 'Normal Medical Practice'
56
4.2.2.1 Refusal of Treatment and Advance Directives
57
4.2.2.2 Withholding or Withdrawing Treatment Based on 'Medical Futility'
59
4.2.2.3 Pain Relief with Life-Shortening Effect and the Idea of 'Double Effect'
64
4.2.2.4 Palliative and Terminal Sedation
66
4.2.2.5 Help in Dying (stervenshulp)
71
4.2.3 'Termination of Life'
73
4.2.3.1 Euthanasia and PAS
76
4.2.3.2 The Legal Status of Euthanasia and PAS before the Law of 2002
77
4.2.3.2(A) Substantive Requirements
78
4.2.3.2(B) Procedural Requirements
80
4.2.3.2(C) Enforcement
82
4.2.3.3 Euthanasia and PAS under the Law of 2002
82
4.2.3.3(A) The Substantive Grounds and Procedural Requirements
83
4.2.3.3(B) A 'Voluntary and Carefully Considered' Request
85
Written Request
85
Timely Request
86
Well-Informed Request
86
Request Not Under Pressure
87
Request Not the Result of Impaired Capacity
87
Euthanasia Pursuant to an Advance Written Request
88
4.2.3.3(C) 'Unbearable Suffering with No Prospect of Improvement'
89
Unbearable Suffering
89
Suffering with No Prospect of Improvement
91
4.2.3.3(D) The 'Doctor Responsible for Treatment'
93
4.2.3.3(E) Consultation
94
Independence of the Consultant
96
Expertise
96
Timing
97
Quality of Consultation and Consultant's Report
98
Agreement between Consulted and Consulting Doctor
99
4.2.3.3(F) Other Requirements of Due Care
99
Carrying Out the Decision with 'Due Medical Care and Attention'
99
Record-Keeping
101
Reporting (and Supplying the Review Committees with Information)
102
Discussion with Family and/or Intimate Friends and with Nurses
103
4.2.3.3(G) Minors 12-18
105
4.2.3.3(H) Euthanasia versus Physician-Assisted Suicide
106
4.2.3.3(I) The Patient's 'Right' to Euthanasia
107
4.2.3.3(J) The Legal Position of Third Parties
108
Nurses
108
Pharmacists
111
Lay Persons
112
4.2.3.4 Assistance with Suicide in the Absence of 'Somatic' Suffering
113
4.2.3.4(A) The Chabot Case
114
4.2.3.4(B) Suffering Due to a Psychiatric Disorder
115
Voluntary, Well-Considered Request
116
Unbearable Suffering
116
Treatment Perspective
117
Consultation
117
Carrying Out Assisted Suicide
118
Other 'Requirements of Due Care'
119
Record-Keeping
119
Institutionalised Patients
120
Conscientious Objections
120
Why a Psychiatrist?
121
Reporting
121
4.2.3.4(C) Assistance with Suicide in the Absence of a 'Medical' Condition
122
4.2.3.5 Termination of Life Without an Explicit Request
124
4.2.4 The System of Control
124
4.2.4.1 The Reporting Procedure in Case of 'Natural' or 'Non-Natural' Death
126
4.2.4.2 Prosecution Policy
127
4.2.4.3 The Regional Review Committees
129
4.2.4.3(A) The Committees and their Procedures
131
4.2.4.3(B) The Jurisdiction of the Committees
133
4.2.4.3(C) The Committee's Judgments and the Follow-Up
135
4.2.4.3(D) The Range of Sanctions
136
4.2.4.3(E) The. Case Law of the Committees
137
4.2.4.3(F) An Assessment of the Functioning of the Committees
137
4.2.4.4 The Development of Before-the-Fact Assessment: SCEN
138
4.2.5 Concluding Reflections on Dutch Euthanasia Law and the System of Control
140
The Role of 'Intentions'
140
From 'Suffering' to 'Inhumane Death'?
142
The 'Medical' Character of Euthanasia/PAS
143
Tightening the Legal Rules
144
The System of Legal Control: Return of the 'Medical Exception'?
144
5 Dutch Euthanasia Law in Context and in Practice
147
5.1 Overview of Data on End-of-Life Practice
147
5.1.1 Frequencies and Characteristics of MBPSL in Four National Studies, 1990-2005
148
5.1.1.1 Methodology
149
5.1.1.2 How to Define Varieties of MBPSL
150
5.1.1.3 Frequencies and Characteristics of MBPSL
152
5.1.2 Data on Reported Cases, 1998-2006
156
5.2 Quantitative Information: Various MBPSL
158
5.2.1 'Normal Medical Practice'
158
5.2.1.1 Withholding and Withdrawing Treatment (Abstention)
158
Intensive Care Units
159
DNR Orders
160
Artificial Nutrition and Hydration (ANH)
160
Refusal of Treatment: 'Treatment Directives'
162
5.2.1.2 Pain Relief with Life-Shortening Effect
164
Palliative Sedation
164
5.2.2 'Termination of Life'
166
5.2.2.1 Euthanasia and Physician-Assisted Suicide
167
The Euthanasia Experience and Willingness of Dutch Doctors
167
Requests for and Communication about Euthanasia/PAS
168
Requests Not Carried Out
170
Children
172
Psychiatric Patients
173
Patients Suffering from Dementia
175
5.2.2.2 Special Topics
176
Terminal Sedation
176
Euthanasia vs Assistance with Suicide
178
Termination of Life Without the Patient's Explicit Request
180
5.2.2.3 'Auto-Euthanasia'
182
5.3 Euthanasia and Other MBPSL: The Patient's and the Family's Viewpoint
184
'Euthanasia Talk'
185
Doctor–Patient Communication and Patient Autonomy
186
Suicide Without the Assistance of a Doctor
188
5.4 The Dutch Control System for Euthanasia in Practice
188
5.4.1 Institutional Policies and Protocols
189
The Euthanasia Protocol of the Albert Schweitzer Hospital
192
5.4.2 Consultation
194
5.4.3 Reporting
196
The Disappointing Reporting Rate
199
The 'Lying Doctor' Hypothesis
200
An Alternative Hypothesis
202
5.4.4 Review and Sanctions
204
5.4.4.1 Regional Review Committees
205
5.4.4.2 Prosecutorial Authorities
206
5.4.5 Conclusions concerning the Functioning of the Control System
209
APPENDIX: 'Not Careful' Judgments of the RRCs, 2000-2006
213
6 Termination of Life in Neonatology
217
6.1 Introduction
217
6.2 The Legal Situation and Medical Practice
218
6.2.1 The Legal Context
218
6.2.2 Legal Developments concerning End-of-Life Treatment
220
6.2.2.1 The CAL and NVK Reports
220
Withholding and Withdrawing Treatment
221
The Role of the Parents
223
Termination of Life
224
The Priority Principle
226
6.2.2.2 The Reporting Procedure
226
6.2.2.3 The Prins and Kadijk Cases
227
6.2.2.4 The Consultative Committee's Report
228
6.2.2.5 The 'Groningen Protocol'
231
6.2.2.6 The Creation of a National 'Committee of Experts'
234
Critical. Note in Connection with the Committee of Experts
237
6.2.2.7 Prosecution Policy
238
6.2.3 Current Dutch Law on Termination of Life in the case of Newborn Babies
239
6.2.4 Medical Practice in the Netherlands
241
6.2.4.1 Data from the Four National Surveys
241
6.2.4.2 End-of-Life Practice in Two Academic Hospitals
243
6.2.4.3 The Role of the Parents
245
6.3 Comparative Data
246
6.3.1 Belgium: The Legal Situation and Medical Practice
246
6.3.2 A Qualitative Comparison of Belgium and the Netherlands
247
6.3.3 Other European Countries
249
6.3.4 How Meaningful Are Data on 'Termination of Life' in Neonatology?
250
6.3.5 Concluding Reflection
252
APPENDICES
253
Appendix 1: Third-Trimester Abortion
253
Appendix 2: The Case of Coma (and PVS) Patients
254
PART II BELGIUM 257
7 Belgium and the Belgian Health Care System
259
7.1 Belgian Political Structure and Culture
259
7.2 Health Care in Belgium
264
7.2.1 The Belgian Health Care System
264
7.2.2 Institutions for Health Care and Care of the Elderly
266
Hospitals
266
'Rest and Nursing Homes'
267
Residential Homes
268
Home Care
268
Palliative Care
269
Where People Die
269
7.2.3 Health Care Professionals
270
Doctors
270
The Order of Physicians and Other Doctors' Organisations
271
Nurses
272
Pharmacists
272
7.3 Public and Medical Opinion
272
8 The Legalisation of Euthanasia in Belgium
275
8.1 The Situation Before the Legislative Change of 2002
275
8.2 The Period Leading Up to Legal Change: 1980-1997
276
The First Study Commissions
276
The First Draft Bills
277
8.3 The Second Phase of Legal Change: 1997-1999
279
The Recommendation of the Advisory Committee on Bioethics
279
The Recommendation of 22 February 1999
282
8.4 The Third Phase of Legal Change: 1999-2002
283
Autumn 1999: The Majority Bill
283
The Parliamentary Procedure in the Senate
287
The Procedure in the Chamber of Representatives
290
The Final Vote in the Chamber of Representatives
290
8.5 Reflections on the Process of Legal Change
291
9 Belgian Law on Euthanasia and Other MBPSL
295
9.1 Current Law in Belgium
295
9.2 'Normal Medical Practice'
297
9.2.1 Refusal of Treatment and Advance Refusal of Treatment
298
9.2.2 Withholding or Withdrawing Treatment Based on 'Medical Futility'
300
9.2.3 Pain Relief with Life-Shortening Effects and the Idea of 'Double Effect'
302
9.2.4 Palliative and Terminal Sedation
304
9.3 The Legal Status of Euthanasia and Physician-Assisted Suicide before 2002
304
9.4 Euthanasia and Physician-Assisted Suicide under the Law on Euthanasia of 2002
306
9.4.1 Statutory Requirements
306
9.4.2 The Definition of Euthanasia and Physician-Assisted Suicide
309
9.4.3 Substantive Requirements under the Law on Euthanasia
312
9.4.3.1 The Patient
312
9.4.3.2 The Doctor
313
9.4.3.3 Current Requests (art 3)
315
9.4.3.4 The Patient's Medical Situation in the Case of a Current Request
317
9.4.3.5 Requests in Advance (art 4)
319
9.4.3.6 The Patient's Medical Condition in Case of an Advance Request
320
9.4.3.7 Consultation
321
9.4.3.8 Specially-Trained Consultants (LEIF and Medecins EOL)
321
9.4.3.9 Carrying Out Euthanasia
322
9.4.3.10 The Role of the Pharmacist and the Availability of Euthanatica
322
9.4.3.11 The Moral Foundation of the Belgian Law on Euthanasia
323
9.4.4 The System of Control
323
9,4.4.1 The Reporting Procedure in Case of 'Natural' and 'Non-Natural' Death
323
9.4.4.2 The Review Procedure
324
9 4.4.3 Criminal Liability in the Case of Failure to Fulfil the Legal Requirements
327
9.4.5 Possible Future Developments
327
9.5 Concluding Remarks
328
10 Belgian Euthanasia Law in Context and in Practice 331
10.1 Survey Data on the Frequencies of MBPSL in Flanders
331
10.2 Reported Cases of Euthanasia/PAS in Belgium
335
Physician-Assisted Suicide
336
10.3 The System of Control
338
10.3.1 Institutional Policies
338
10.3.2 Consultation
339
10.3.3 Reporting
339
The Reporting Rate
340
10.3.4 The Federal Control and Evaluation Commission
342
Comment on the FCEC Biennial Reports
343
10.4 Concluding Comparative Remark
343
PART III OTHER EUROPEAN COUNTRIES 345
Introduction to Part III 347
11 England and Wales 349
11.1 General principles
349
The 'Medical Exception'
349
'Double Effect' and the Role of 'Purpose'
350
11.2 Medical Decision-Making in the Case of Incompetent Adults
351
Withdrawal or Withholding of Life-Prolonging Treatment
352
Judicial Involvement in PVS Cases
353
11.3 Medical Decision-Making in the Case of Incompetent Children
354
11.4 Medical Decision-Making in the Case of Competent Patients
356
Consent to Treatment
357
Advance Refusals
358
11.5 Palliative and Terminal Sedation
359
11.6 Euthanasia and Assisted Suicide
359
Diminished Responsibility
360
The Defence of Necessity: Cannibals and Conjoined Twins
361
Assistance with Suicide
364
11.7 Termination of Life Without an Explicit Request and 'Help in Dying'
365
11.8 The Reporting Procedure in Cases of 'Non-Natural' Death
366
11.9 Empirical Data concerning MBPSL in the United Kingdom
367
11.9.1 Prevalence
367
11.9.2 Public and Medical Opinion
368
11.10 Conclusion
370
12 France 371
12.1 The Public Debate
371
12.1.1 Historical Background
371
12.1.2 The Humbert Case
374
12.1.3 Medical and Public Opinion
375
12.1.4 A Concluding Reflection on the French Debate
377
12.2 Legal Regulation
377
12.2.1 Informed Consent and the Right to Refuse Treatment
377
12.2.1.1 Medical Paternalism
378
12.2.1.2 Judicial Reluctance to Enforce the Requirement of Informed Consent
379
The Gamier Case
379
The Senanayake Case
380
The 2002 Law on Patients' Rights
380
The Feuillatey Case
381
12.2.1.3 The Law of 2005 on Patients' Rights at the End of Life
382
The Right to Refuse Treatment
383
Advance Treatment Directives
383
Representation
384
Withdrawing or Withholding Life-Prolonging Treatment: 'Futility'
384
Concluding Reflection
385
12.2.2 Pain Relief and Palliative/Terminal Sedation
385
12.2.3 Physician-Assisted Suicide
386
12.2.4 Euthanasia
387
12.3 Empirical Data: What Does the End of Life Look Like in France?
389
12.4 Neonatology
391
12.5 Summary and Conclusions
393
13 Italy 395
13.1 Introduction
395
13.2 The Position of the Roman Catholic Church
397
13.3 MBPSL: Law and Practice
399
13.3.1 Refusal of Treatment
399
The Case of 'Maria'
400
The Welby Case
401
The Nuvoli Case
406
13.3.2 The ITAELD Study
407
13.3.3 Advance Refusals of Treatment (Advance Directives)
408
13.3.4 Health Care Proxies
409
The Englaro Case
410
13.3.5 Pain Relief and Palliative Sedation
413
13.3.6 'Medical Futility' and Abstention
414
13.4 Euthanasia and PAS
415
The Vastalegna Case
416
The Papini Case
417
The Forzatti Case
418
13.5 The Neonatology Setting
419
The University Hospital of Padua Guidelines
419
The Florence Protocol
420
13.6 Modalities of Control
421
13.6.1 The Criminal Justice System
421
13.6.2 The Doctor's Duty to Report
421
13.6.3 Medical Disciplinary Law and Tribunals
422
The Conciani Case
422
13.7 Concluding Remarks
422
14 Scandinavia 425
14.1 Legal Provisions
425
Norway
425
Denmark
427
Sweden
429
14.2 Medical Ethics Codes
430
Norway
430
Denmark
433
Sweden
434
14.3 Doctors' Attitudes and Medical Practice
434
14.3.1 Norway
435
Attitudes towards Euthanasia and PAS
435
Experience with Euthanasia and PAS
436
Experience with Potentially Life-Shortening Pain Relief
437
Forgoing Medical Treatment
437
14.3.2 Sweden and Denmark
438
Attitudes towards Euthanasia and PAS
438
Experience with Euthanasia and PAS
439
Attitudes and Experience with Potentially Life-Shortening Pain Relief
439
Forgoing Life-Sustaining Treatment
440
14.4 Summary and Conclusions
440
15 Spain 443
15.1 Law
443
15.2 Medical Practice
449
15.3 Public and Medical Opinion
449
15.4 Criminal Prosecutions and the Public and Political Debate
452
The Sampedro Case
453
The Leganes Case
455
The Leon Case
456
The Echevarria Case
456
The Madeleine Z Case
457
15.5 The Position of the Spanish Catholic Church
458
15.6 Reports of Institutes for Medical Ethics
460
15.7 Conclusions
461
16 Switzerland 463
16.1 Introduction
463
16.2 Medical Behaviour that Potentially Shortens Life
463
Definitions
463
Regulation
464
16.2.1 Passive Sterbehilfe (Withholding and Withdrawing Life-Prolonging Treatment)
465
16.2.2 Indirect Sterbehilfe (Pain Relief) and Palliative Sedatiom
467
16.2.3 Active Sterbehilfe (Euthanasia)
468
16.3 Empirical Findings concerning MBPSL
469
Attitudes
469
Medical Practice
470
16.4 Assisted Suicide in Switzerland
470
16.4.1 Legal Background and Origins
470
16.4.2 The Role of Doctors in the Swiss Model—Narcotics and Health Law
472
16.4.3 The Role of Right-to-Die Organisations—Internal Guidelines
474
16.4.4 Criminal Prosecutions in the Context of Assisted Suicide
475
16.4.5 Empirical Findings on Assisted Suicide
476
16.4.6 Safety and Transparency Issues
478
16.4.7 Current Political Developments
479
16.5 What can the Swiss Model Contribute to the International Discussion on Assisted Dying
480
17 Some European Comparisons 483
17.1 Comparative Data on Public and Professional Opinion
483
17.2 Comparative Data on the Frequency of MBPSL
488
The Total Level of MBPSL
488
'Permissive' and 'Not Permissive' Countries
488
Withdrawing or Withholding Treatment
490
Pain Relief with Life-Shortening Effect: Palliative and Terminal Sedation
492
Termination of Life Without an Explicit Request from the Patient
492
17.3 Conclusions Concerning Medical Practice
493
17.4 Legal Comparisons
493
PART IV THEMATIC REFLECTIONS 497
Introduction to Part IV 499
18 The Nude Beach Phenomenon: Euthanasia and the Juridification of the Doctor–Patient Relationship 501
18.1 The Official Application of Legal Control to the Behaviour of Individual Doctors
504
SCEN Consultation
504
Reporting and Review
504
Prosecutions, Convictions, Punishments
505
Medical Disciplinary Cases
506
The Total of Legal Control to which Doctors have been Exposed
506
18.2 The Pressure of Regulation
507
18.3 Rule-Following
509
18.4 Change and Difference in the Quantity of Euthanasia Law
510
18.5 Explanatory Reflections
511
19 Slithering Up the Slippery Slope 513
19.1 The 'Conceptual' Slippery Slope Argument
513
19.2 The 'Empirical' Slippery Slope Argument
514
Legal Control
514
Legal (and Moral) Change
518
19.3 Conclusion: Slipping into More Control and into More Careful Practice
520
20 'Prediction is very difficult, especially about the future' 521
20.1 Values Relevant to Euthanasia
522
Post-Materialism
523
Bodily Self-Determination
523
Public Pressure
524
Conclusion
525
20.2 Political Opportunity Structures and Euthanasia Legislation
525
20.2.1 The Netherlands and Belgium
525
National Cleavage Structures
525
Political Structure
526
Political Culture
528
Alliance Structure
528
Conclusion
529
20.2.2 Euthanasia and the Political Agenda in Western European Countries
529
20.3 Diffusion of Law
530
20.4 Conclusions
531
References 533
Index 575
John Griffiths is Professor of Sociology of Law (Emeritus) at the University of Groningen. Heleen Weyers is Lecturer in Legal Theory at the University of Groningen. Maurice Adams is Professor of Law at Tilburg University (the Netherlands) and part time Professor of Comparative Law at the University of Antwerp (Belgium).
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