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Cited by 15Palliative Care and End-of-Life IssuesPalliative and Oncologic CareEthics and bioethics in healthcare

Incidence and Prevalence of Reported Euthanasia Cases in Belgium, 2002 to 2023

Open access
Wels, Jacques, Hamarat, Natasia·2025·JAMA Network Open
DOI 10.1001/jamanetworkopen.2025.6841PMC PMC12019508
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Abstract

Importance: Reported cases of assisted dying have increased in countries with such legislation. In Belgium, where euthanasia was legalized in mid-2002, cases rose from 236 in 2003 to 3423 in 2023. Most previous studies have focused on occurrence rates. Objective: To examine the magnitude of the increase in euthanasia cases and its association with demographic changes observed during the study period. Design, Setting, and Participants: This cross-sectional study analyzed complete data from the Belgian Federal Commission for the Control and Evaluation of Euthanasia (FCCEE) from September 1, 2002, to December 31, 2023, and adjusted the model for demographic composition and change by gender, age group, and region using data from the Belgian Office for Statistics. All cases of euthanasia reported to the FCCEE during the selected period were included. Exposure: Euthanasia reported to the FCCEE. Main Outcome and Measures: Poisson regression with and without a demographic offset was used to provide the rate ratios (RRs) and the prevalence rates (PRs) for euthanasia. The RRs were calculated by age, gender, region, and euthanasia characteristics. Estimates used a model including demographic offsets to calculate PRs and explore interactions across subcategories. Results: During the selected period, 33 647 cases of euthanasia were reported (50.23% male; 84.74% 60 years or older); analyses focused on 33 580 valid cases. The yearly RR was 1.07 (95% CI, 1.07-1.07), while the yearly PR was 1.05 (95% CI, 1.05-1.06), indicating that demographic changes were associated with the observed increase. The PR for euthanasia among males relative to females was overall higher (PR, 1.36; 95% CI, 1.33-1.39) but has decreased slightly (PR, 0.99; 95% CI, 0.99-1.00). Cases citing multimorbidity increased relative to those citing tumors (PR, 1.03; 95% CI, 1.02-1.04), whereas cases related to psychiatric disorders and deaths in care homes did not show significant increases. Higher prevalence was observed in the Flemish region relative to Wallonia (PR, 1.51; 95% CI, 1.47-1.55), but the gap has narrowed over the years. Conclusions and Relevance: This study found that a substantial part of the increase in euthanasia cases was attributable to demographic changes. Early increases were mainly due to the regulatory onset, while recent trends reflect a growing influence of demographic factors and regional adjustments. These findings suggest that considering demographic shifts is essential, and long-term trends should be monitored.

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  • Much of the scientific literature on ADE consists of opinion pieces and relies on ethical debates.

    “Empirical research on ADE using data is sparse [1], and much of the scientific literature—often consisting of opinion pieces [2,3]—relies on ethical debates [4].”

    From Trends in assisted dying among patients with psychiatric disorders and dementia in Belgium: A health registry study (2025) · cites this paper as [4]

    The Introduction (page unavailable) says studies of the slippery-slope assumption rarely focus on data, and the Conclusions say such studies often lack evidence. Neither passage establishes that much of the broader scientific literature on ADE consists of opinion pieces or relies on ethical debates. In the printed sentence, this paper appears to be citation [1] for the narrower claim about sparse data-based research, not the citations attached to the quoted claim. (LLM, conf=0.82)

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  • Failing to account for population change when analysing annual ADE cases can lead to trends that are overstated due to demographic shifts.

    “We have recently demonstrated that failing to account for population change when analysing annual ADE cases can lead to trends that are overstated due to demographic shifts.”

    From Trends in assisted dying among patients with psychiatric disorders and dementia in Belgium: A health registry study (2025) · cites this paper as [4]

  • When data are mobilised, they are often examined at a very descriptive level, focusing on ADE trends while overlooking changes in population structures.

    “When data are mobilised, they are often examined at a very descriptive level, focussing on ADE trends while overlooking changes in population structures [4,5].”

    From Trends in assisted dying among patients with psychiatric disorders and dementia in Belgium: A health registry study (2025) · cites this paper as [4]

  • Population ageing contributes to increased number of euthanasia cases, as euthanasia rates are higher among older age groups.

    “For example, population ageing contributes to increased number of cases, as euthanasia rates are higher among older age groups [4].”

    From Trends in assisted dying among patients with psychiatric disorders and dementia in Belgium: A health registry study (2025) · cites this paper as [4]

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Authors
Wels, J., & Hamarat, N.
Affiliations
Université Libre de Bruxelles (BE)
Corresponding author
Wels, Jacques
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2025-04-23
Volume
8
Issue
4
Pages
e256841
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2025.6841
PMC
PMC12019508
OpenAlex
W4409728591
Cited by
15
References
43
Citations by year
2026: 9 · 2025: 6
FWCI
13.66
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
Keywords
euthanasia, assisted dying, legalization of euthanasia, Belgium, demographic trends, sex differences, multimorbidity, terminal illness, mental illness, care homes, end-of-life care
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Belgium, Cross-Sectional Studies, Euthanasia, Female, Humans, Male, Middle Aged, Incidence, Prevalence, Suicide, Assisted, Young Adult

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