Cultural differences affecting euthanasia practice in Belgium: one law but different attitudes and practices in Flanders and Wallonia
Abstract
Since 2002, Belgium has had a national law legalising euthanasia. The law prescribes several substantive due care requirements and two procedural due care requirements, i.e. consultation with an independent physician and reporting of euthanasia to a Federal Control Committee. A large discrepancy in reporting rates between the Dutch-speaking (Flanders) and the French-speaking (Wallonia) parts of Belgium has led to speculation about cultural differences affecting the practice of euthanasia in both regions. Using Belgian data from the European Values Study conducted in 2008 among a representative sample of the general public and data from a large-scale mail questionnaire survey on euthanasia of 480 physicians from Flanders and 305 from Wallonia (conducted in 2009), this study presents empirical evidence of differences between both regions in attitudes towards and practice of euthanasia. Acceptance of euthanasia by the general population was found to be slightly higher in Flanders than in Wallonia. Compared with their Flemish counterparts, Walloon physicians held more negative attitudes towards performing euthanasia and towards the reporting obligation, less often labelled hypothetical cases correctly as euthanasia, and less often defined a case of euthanasia having to be reported. A higher proportion of Flemish physicians had received a euthanasia request since the introduction of the law. In cases of a euthanasia request, Walloon physicians consulted less often with an independent physician. Requests were more often granted in Flanders than in Wallonia (51% vs 38%), and performed euthanasia cases were more often reported (73% vs 58%). The study points out some significant differences between Flanders and Wallonia in practice, knowledge and attitudes regarding euthanasia and its legal requirements which are likely to explain the discrepancy between Wallonia and Flanders in the number of euthanasia cases reported. Cultural factors seem to play an important role in the practice of (legal) euthanasia and the extent to which legal safeguards are followed.
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In Belgium, official statistics reveal higher propensities for euthanasia in the Flemish region.
“In Belgium, official statistics reveal higher propensities for euthanasia in the Flemish region [22], with most research predominantly focussed on Flanders [23,24].”
From Trends in assisted dying among patients with psychiatric disorders and dementia in Belgium: A health registry study (2025) · cites this paper as [22]
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Keown, J. (2018) · Cambridge University Press eBooks · doi:10.1017/9781107337909.013
Keown, J. (2018) · Cambridge University Press eBooks · doi:10.1017/9781107337909.027
Keown, J. (2018) · Cambridge University Press eBooks · doi:10.1017/9781107337909.029
Keown, J. (2018) · Cambridge University Press eBooks · doi:10.1017/9781107337909.001
Keown, J. (2018) · Cambridge University Press eBooks · doi:10.1017/9781107337909.011
Keown, J. (2018) · Cambridge University Press eBooks · doi:10.1017/9781107337909.010
Keown, J. (2018) · Cambridge University Press eBooks · doi:10.1017/9781107337909.024
Keown, J. (2018) · Cambridge University Press eBooks · doi:10.1017/9781107337909.008
Keown, J. (2018) · Cambridge University Press eBooks · doi:10.1017/9781107337909.022
Keown, J. (2018) · Cambridge University Press eBooks · doi:10.1017/9781107337909.018
Canada’s Euthanasia Legislation
Keown, J. (2018) · Cambridge University Press eBooks · doi:10.1017/9781107337909.028
Assisted Suicide for the Elderly with ‘Completed Lives’
Keown, J. (2018) · Cambridge University Press eBooks · doi:10.1017/9781107337909.021
Keown, J. (2018) · Cambridge University Press eBooks · doi:10.1017/9781107337909.019
Keown, J. (2018) · Cambridge University Press eBooks · doi:10.1017/9781107337909.014
Keown, J. (2018) · Cambridge University Press eBooks · doi:10.1017/9781107337909.031
Keown, J. (2018) · Cambridge University Press eBooks · doi:10.1017/9781107337909.016
Keown, J. (2018) · Cambridge University Press eBooks · doi:10.1017/9781107337909.032
Keown, J. (2018) · Cambridge University Press eBooks · doi:10.1017/9781107337909.004
Keown, J. (2018) · Cambridge University Press eBooks · doi:10.1017/9781107337909.015
Assisted Dying and Public Health
Chambaere, K., Dierickx, S., & Cohen, J. (2024) · Elsevier eBooks · doi:10.1016/b978-0-323-99967-0.00194-0
Self-citationWels, J., & Hamarat, N. (2025) · medRxiv · doi:10.1101/2025.01.09.25320248
Marsico, G., Dauchy, S., Peroni, L., et al. (2024) · [Pratiques ou les cahiers de la médecine utopique]. · doi:10.3917/prat.107.0053
A closer look at regional differences in euthanasia practices in the Netherlands
Ligtenberg, W. M. R., Boer, T. A., & Groenewoud, S. (2025) · Research in Health Services & Regions · doi:10.1007/s43999-025-00069-x
“…both by doctors and the general public, did not differ between the regions, there were large differences in the proportion of physicians that had received requests and the willingness/reluctance to perform euthanasia (over-all more requests and willingness in Flanders than in Wallonia) [4].”
Watamura, E., Ioku, T., & Yamamoto, M. (2025) · Death Studies · doi:10.1080/07481187.2025.2604577
- Authors
- Cohen, J., Van Wesemael, Y., Smets, T., Bilsen, J., & Deliens, L.
- Affiliations
- Vrije Universiteit Brussel (BE)
- Corresponding author
- Cohen, Joachim
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 2012-09
- Volume
- 75
- Issue
- 5
- Pages
- 845-853
- ISSN
- 0277-9536 (ISSN-L)
- OpenAlex
- W2035147736
- Semantic Scholar
- f8692a3a0b2b62cb5654f9a8004c0b53fd322577
- Cited by
- 93
- References
- 34
- Citations by year
- 2025: 7 · 2024: 6 · 2023: 4 · 2022: 5 · 2021: 5 · 2020: 5 · 2019: 3 · 2018: 37 · 2017: 2 · 2016: 6 · 2015: 3 · 2014: 8 · 2013: 2
- FWCI
- 4.02
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- VUBIR (Vrije Universiteit Brussel) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- 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 › Ethics and bioethics in healthcare
- Keywords
- euthanasia, cultural differences, Flanders, Wallonia, Belgian euthanasia law, physician attitudes, euthanasia requests, legal protection, regional disparities
- MeSH terms
- Adult, Attitude of Health Personnel, Attitude to Health, Belgium, Cross-Cultural Comparison, Euthanasia, Female, Humans, Male, Middle Aged, Practice Patterns, Physicians', Surveys and Questionnaires, Qualitative Research
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