Euthanasia in Belgium: Shortcomings of the Law and Its Application and of the Monitoring of Practice
Abstract
In 2002 with the passing of the Euthanasia Law, Belgium became one of the few countries worldwide to legalize euthanasia. In the 18 years since the passing of the law, much has changed. We argue that in Belgium a widening of the use of euthanasia is occurring and that this can be ethically and legally problematic. This is in part related to the fact that several legal requirements intended to operate as safeguards and procedural guarantees in reality often fail to operate as such. We focus on three kinds of safeguards or procedural guarantees: (1) the legally defined due care criteria for eligibility for euthanasia; (2) the consultation of a second (and sometimes third) physician; and (3) the reporting of euthanasia cases to the Federal Control and Evaluation Commission for Euthanasia. We will show how each of these three safeguards can exhibit shortcomings in theory and practice.
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Belgian guidelines require only 1 month as a safeguard for all applicants.
“For example, with regards to waiting periods, Belgian guidelines require only 1 month as a safeguard for all applicants.7 8”
From Medical Assistance in Dying for the Sole Underlying Condition of Mental Disorder (MAiD MD-SUMC): an analysis and qualitative evidence synthesis (2026) · cites this paper as [8]
Some evidence suggests that reporting requirements and safeguarding criteria are sometimes ignored and transgressed, especially in jurisdictions where transgressions are not always prosecuted.
“Some evidence suggests that reporting requirements and safeguarding criteria are sometimes ignored and transgressed, especially in jurisdictions where transgressions are not always prosecuted (33, 78–80).”
From Assisted death in eating disorders: a systematic review of cases and clinical rationales (2024) · cites this paper as [78]
In the Netherlands, research suggests that approximately 20% of euthanasia cases are not reported to the review committees, down from 46% in 2001.
“In the Netherlands, research suggests that approximately 20% of euthanasia cases are not reported to the review committees, down from 46% in 2001 (78, 81, 82).”
From Assisted death in eating disorders: a systematic review of cases and clinical rationales (2024) · cites this paper as [78]
Cites
An fMRI-Based Neurologic Signature of Physical Pain
Wager, T. D., Atlas, L. Y., Lindquist, M. A., Roy, M., Woo, C.-W., & Kross, E. (2013) · New England Journal of Medicine · doi:10.1056/nejmoa1204471 · Cited by 1,597 · see citing works
Comorbidity or multimorbidity: what's in a name? A review of literature
van den Akker, M., Buntinx, F., & Knottnerus, J. A. (1996) · European Journal of General Practice · doi:10.3109/13814789609162146 · Cited by 857 · see citing works
Conscientious objection in medicine
Savulescu, J. (2006) · BMJ · doi:10.1136/bmj.332.7536.294 · Cited by 442 · see citing works
Kim, S. Y. H., De Vries, R. G., & Peteet, J. R. (2016) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2015.2887 · Cited by 320 · cited 1× · see citing works
“5 The patient’s suffering should result from (a) a serious and incurable disorder (b) caused by illness or accident. physician’s assessment of voluntariness can be in the absence of standardized assessment tools (Kim, De Vries, and Peteet, 2016).”
BackgroundEuthanasia, Ethics and Public Policy
Keown, J. (2002) · Cambridge University Press eBooks · doi:10.1017/cbo9780511495335 · Cited by 258 · see citing works
Thienpont, L., Verhofstadt, M., Van Loon, T., Distelmans, W., Audenaert, K., & De Deyn, P. P. (2015) · BMJ Open · doi:10.1136/bmjopen-2014-007454 · Cited by 231 · cited 1× · see citing works
“In order for these patients to qualify for euthanasia, the psychiatrist required that: “All therapeutic options that could alleviate suffering, including palliative care, must be discussed with the patients and their practitioners” (Thienpont et al., 2015, 4).”
BackgroundRecent Trends in Euthanasia and Other End-of-Life Practices in Belgium
Chambaere, K., Stichele, R. V., Mortier, F., Cohen, J., & Deliëns, L. (2015) · New England Journal of Medicine · doi:10.1056/nejmc1414527 · Cited by 187 · see citing works
Conscientious Objection in Medicine
Wicclair, M. R. (2000) · Bioethics · doi:10.1111/1467-8519.00191 · Cited by 170 · see citing works
Smets, T., Bilsen, J. J. R., Cohen, J., Rurup, M. L., Mortier, F., & Deliëns, L. (2010) · BMJ · doi:10.1136/bmj.c5174 · Cited by 137 · see citing works
Acute pain assessment tools: let us move beyond simple pain ratings
Gordon, D. B. (2015) · Current Opinion in Anaesthesiology · doi:10.1097/aco.0000000000000225 · Cited by 129 · see citing works
Dierickx, S., Deliens, L., Cohen, J., & Chambaere, K. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1369-0 · Cited by 129 · see citing works
End-of-life decisions in the Netherlands over 25 years
van der Heide, A., van Delden, J. J. M., & Onwuteaka-Philipsen, B. D. (2017) · New England Journal of Medicine · doi:10.1056/nejmc1705630 · Cited by 124 · see citing works
Preference for Palliative Care in Cancer Patients: Are Men and Women Alike?
Saeed, F., Hoerger, M. P., Norton, S. A., Guancial, E. A., Epstein, R. M., & Duberstein, P. R. (2018) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2018.03.014 · Cited by 124 · see citing works
Comparison of the Expression and Granting of Requests for Euthanasia in Belgium in 2007 vs 2013
Dierickx, S., Deliëns, L., Cohen, J., & Chambaere, K. (2015) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2015.3982 · Cited by 117 · see citing works
van Tol, D. G., Rietjens, J. A. C., & van der Heide, A. (2010) · Health Policy · doi:10.1016/j.healthpol.2010.04.007 · Cited by 85 · see citing works
Euthanasia and Assisted Suicide: Lessons from Belgium
(2017) · doi:10.1017/9781108182799 · Cited by 81 · see citing works
Process and outcomes of euthanasia requests under the Belgian Act on Euthanasia: A nationwide survey
Van Wesemael, Y., Cohen, J., Bilsen, J., Smets, T., Onwuteaka-Philipsen, B., & Deliens, L. (2011) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2011.02.011 · Cited by 69 · see citing works
Snijdewind, M. C., van Tol, D. G., Onwuteaka-Philipsen, B. D., & Willems, D. L. (2016) · Journal of Medical Ethics · doi:10.1136/medethics-2016-103405 · Cited by 64 · see citing works
Euthanasia, assisted suicide and psychiatry: a Pandora's box
Kelly, B. D., & McLoughlin, D. M. (2002) · The British Journal of Psychiatry · doi:10.1192/bjp.181.4.278 · Cited by 50 · see citing works
Kienle, J., Rockstroh, B. S., Bohus, M., Fiess, J., Huffziger, S., & Steffen, A. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1414-z · Cited by 50 · see citing works
Euthanasia, Ethics and Public Policy
Keown, J. (2018) · Cambridge University Press eBooks · doi:10.1017/9781107337909 · Cited by 45 · see citing works
Euthanasia: law and practice in The Netherlands
Gevers, S. (1996) · British Medical Bulletin · doi:10.1093/oxfordjournals.bmb.a011547 · Cited by 36 · see citing works
Florijn, B. W. (2018) · Health Policy · doi:10.1016/j.healthpol.2018.01.007 · Cited by 27 · see citing works
Dutch practice of euthanasia and assisted suicide: a glimpse at the edges of the practice
Quill, T. E. (2018) · Journal of Medical Ethics · doi:10.1136/medethics-2018-104759 · Cited by 23 · see citing works
Dierickx, S., Cohen, J., Stichele, R. V., Deliëns, L., & Chambaere, K. (2018) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2018.06.015 · Cited by 17 · see citing works
Euthanasia for Mental Suffering
Raus, K., & Sterckx, S. (2015) · International library of ethics, law, and the new medicine/The international library of ethics, law, and the new medicine · doi:10.1007/978-3-319-22050-5_6 · Cited by 13 · see citing works
Self-citationvan Wijngaarden, E. J. (2016) · University of Humanistic Studies OAI Repository · Cited by 8 · see citing works
Vansweevelt, T. (2003) · Cited by 4 · see citing works
Cosyns, M., Vansweevelt, T., Nys, H., Balthazar, T., & Legemaate, J. (2003) · Ghent University Academic Bibliography (Ghent University) · Cited by 3 · see citing works
Adams, M., & Geudens, G. (2000) · Cited by 2 · see citing works
Polypathologie en de Belgische euthanasiewet
Proot, L., & Distelmans, W. (2018) · Tijdschrift voor Geneeskunde · doi:10.47671/tvg.74.13.2002632 · Cited by 2 · see citing works
Flagged first, then by citations
4 of the 35 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Binder, M. D., Loos, S., Sterckx, S., Thys, E., & Assche, K. V. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.933748 · Cited by 26 · see citing works
Self-citationMarijnissen, R. M., Chambaere, K., & Oude Voshaar, R. C. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.857131 · Cited by 25 · see citing works
Yun, Y. H., Sim, J.-A., Choi, Y., & Yoon, H. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19095183 · Cited by 20 · see citing works
The Belgian euthanasia law under scrutiny of the highest courts
Binder, M. D., Loos, S., & Assche, K. V. (2022) · The Lancet Regional Health - Europe · doi:10.1016/j.lanepe.2022.100549 · Cited by 20 · see citing works
Advance Care Planning in Belgium
Dupont, C., Vleminck, A. D., Deliëns, L., & Gilissen, J. (2023) · Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen · doi:10.1016/j.zefq.2023.05.003 · Cited by 18 · see citing works
Assisted death in eating disorders: a systematic review of cases and clinical rationales
Roff, C., & Cook-Cottone, C. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1431771 · Cited by 16 · see citing works
“In the Netherlands, research suggests that approximately 20% of euthanasia cases are not reported to the review committees, down from 46% in 2001 (78, 81, 82).”
BackgroundIncidence and Prevalence of Reported Euthanasia Cases in Belgium, 2002 to 2023
Wels, J., & Hamarat, N. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.6841 · Cited by 15 · see citing works
The Physician-Assisted Suicide Pathway in Italy: Ethical Assessment and Safeguard Approaches
Riva, L. (2023) · Journal of Bioethical Inquiry · doi:10.1007/s11673-023-10302-2 · Cited by 11 · see citing works
Vallès-Poch, M., Jounou, I. P., Lozano, R. O., Delgado, J., Martínez‐López, M. V., Garrido, S., Tamayo-Velázquez, M. I., Caballero, R. T., & Rodríguez‐Arias, D. (2023) · International Journal of Qualitative Methods · doi:10.1177/16094069231202196 · Cited by 10 · see citing works
Comparison of official reporting on assisted suicide and euthanasia across jurisdictions
Worthington, A., Regnard, C., Sleeman, K. E., & Finlay, I. (2024) · BMJ Supportive & Palliative Care · doi:10.1136/spcare-2022-003944 · Cited by 10 · see citing works
Mroz, S., Deliëns, L., Cohen, J., & Chambaere, K. (2022) · Deutsches Ärzteblatt international · doi:10.3238/arztebl.m2022.0378 · Cited by 9 · see citing works
Binder, M. D., Loos, S., & Assche, K. V. (2022) · European Psychiatry · doi:10.1192/j.eurpsy.2022.2342 · Cited by 9 · see citing works
The Morality of Assisted Dying
Richards, S. B. (2025) · The Journal of Medicine and Philosophy A Forum for Bioethics and Philosophy of Medicine · doi:10.1093/jmp/jhaf003 · Cited by 8 · see citing works
Binder, M. D., Thys, E., Catthoor, K., den Broeck, K. V., Matthys, F., Vansteelandt, K., & Detraux, J. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.1050086 · Cited by 8 · see citing works
The Importance of Clear and Careful Thinking in Clinical Ethics
Parker, J. C. (2020) · The Journal of Medicine and Philosophy A Forum for Bioethics and Philosophy of Medicine · doi:10.1093/jmp/jhaa033 · Cited by 4 · see citing works
Harper, L., Tomaras, C. A., Powell, R. A., Reddon, J. R., & Hawrelak, E. (2025) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/10499091241247835 · Cited by 3 · see citing works
Suicidal behaviour is pathological: implications for psychiatric euthanasia
Sisti, D. A., Mann, J. J., & Oquendo, M. A. (2024) · Journal of Medical Ethics · doi:10.1136/jme-2023-109522 · Cited by 3 · see citing works
Assisted Suicide and Slippery Slopes: Reflections on Oregon
Finegan, T. (2024) · The New Bioethics · doi:10.1080/20502877.2024.2338317 · Cited by 3 · see citing works
Global Aging, Adaptation to It and Future Demographic Transformations
Grinin, L. E., Леонидович, Г. А., & Korotayev, A. (2024) · World-systems evolution and global futures · doi:10.1007/978-3-031-56764-3_7 · Cited by 3 · see citing works
Archer, M., Willmott, L., Chambaere, K., Deliëns, L., & White, B. P. (2023) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228231221839 · Cited by 5 · see citing works
When Anti-Discrimination Discriminates
Braswell, H., & Garland‐Thomson, R. (2023) · The American Journal of Bioethics · doi:10.1080/15265161.2023.2237808 · Cited by 3 · see citing works
Palliative care in cardiovascular medicine
Cekaj, E., Sand, F., Vogel, D. H. V., Spieth, P. M., Schrage, B., Uribarri, A., Roeck, F. D., Riera, J., Pappalardo, F., Mangner, N., et al. (2026) · European Heart Journal · doi:10.1093/eurheartj/ehag219 · Cited by 2 · see citing works
Assisted dying and medical practice: questions and considerations for healthcare organisations
Worthington, A., Finlay, I. G., & Regnard, C. (2022) · BMJ Supportive & Palliative Care · doi:10.1136/bmjspcare-2022-003652 · Cited by 2 · see citing works
Hert, M. D. H. M. D., Loos, S., & Assche, K. V. (2023) · Tijdschrift voor Geneeskunde · doi:10.47671/tvg.79.23.006 · Cited by 2 · see citing works
Wels, J., & Hamarat, N. (2024) · medRxiv · doi:10.1101/2024.10.16.24315619 · Cited by 2 · see citing works
Binder, M. D., Sterckx, S., & Assche, K. V. (2023) · The International Library of Bioethics · doi:10.1007/978-3-031-25315-7_11 · Cited by 1 · see citing works
Self-citationJones, D. A. (2025) · The New Bioethics · doi:10.1080/20502877.2025.2593200 · Cited by 1 · see citing works
Tobore, T. O. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1695897 · Cited by 1 · see citing works
Paternotte, D. (2024) · La Revue Nouvelle · doi:10.3917/rn.242.0044 · Cited by 1 · see citing works
Euthanasia and Assisted Suicide in Psychiatry: An Overview of the Field
Nicolini, M. (2025) · The International Library of Bioethics · doi:10.1007/978-94-024-2274-0_31 · Cited by 1 · see citing works
Eutanasia: razones, mitos y desatinos
Lozano, R. O., Martínez‐López, M. V., & Liedo, B. (2022) · Actualización en Medicina de Familia · doi:10.55783/amf.180503 · Cited by 1 · see citing works
Pawluk, A., Arksey, E., Jansens, H., Qiao, S., & McFarlane, L. (2026) · BMJ Open · doi:10.1136/bmjopen-2025-105129
Overview of Mindset and Attitudes of 2017 FK UKI Students about Euthanasia
Wijoyo, S. (2021) · International Journal of Health Sciences and Research · doi:10.52403/ijhsr.20211046
Ахтирська, Н. М., & Grodetsky, Y. V. (2021) · Wiadomości Lekarskie · doi:10.36740/wlek202111242
Bioethics: An International, Morally Diverse, and Often Political Endeavor
Cherry, M. J. (2022) · HEC Forum · doi:10.1007/s10730-022-09482-y
Vidalis, T. (2022) · Springer textbooks in law · doi:10.1007/978-3-031-02359-0_5
Assistierter Suizid und Tötung auf Verlangen in Belgien
Amschl-Strablegg, D. (2022) · Springer eBooks · doi:10.1007/978-3-662-64347-1_30
Feyerabend, E. (2022) · Vandenhoeck & Ruprecht eBooks · doi:10.13109/9783666523984.459
Envisioning Markets in Assisted Dying
Cholbi, M. J. (2023) · The International Library of Bioethics · doi:10.1007/978-3-031-25315-7_15
E-book: Ethiek en gezondheidsrecht - Uitgave 2023
Daniels, L. A., Vandersteegen, T., Marneffe, W., Braeckman, N., Dejans, E., Tongel, A. V., Ponnet, K. S., Baets, N. D., Wilde, L. F. D., Ravez, L., et al. (2023) · Tijdschrift voor Geneeskunde · doi:10.47671/tvg.79.23.e018
Melchiori, F. A. (2024) · Revista Jurídica Austral · doi:10.26422/rja.2024.0501.mel
Wels, J., Hamarat, N., González‐Hijón, J., & Proot, L. (2026) · Age and Ageing · doi:10.1093/ageing/afag153
Adam, D., Assche, 胡. K. V., & Tomáš, D. (2026) · BMC Medical Ethics · doi:10.1186/s12910-026-01485-5
Ganner, M., & Steiner, K. (2026) · Actualidad jurídica iberoamericana · doi:10.7203/aji.24bis.33337
- Authors
- Raus, K., Vanderhaegen, B., & Sterckx, S.
- Affiliations
- Ghent University Hospital (BE)
- Ghent University (BE)
- Corresponding author
- Raus, Kasper
- Venue
- The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-01-25
- Volume
- 46
- Issue
- 1
- Pages
- 80-107
- ISSN
- 0360-5310 (ISSN-L)
- 1744-5019
- OpenAlex
- W3123568793
- Cited by
- 45
- References
- 35
- Citations by year
- 2026: 6 · 2025: 4 · 2024: 8 · 2023: 10 · 2022: 13 · 2021: 3 · 2020: 1
- FWCI
- 5.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- The Journal of Medicine and Philosophy A Forum for Bioethics and Philosophy of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- Topics
- 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
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- euthanasia, euthanasia legislation, Belgium, legal protection, procedural guarantees, ethics of euthanasia
- MeSH terms
- Belgium, Euthanasia, Humans, Physicians
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