Legal Euthanasia in Belgium: Characteristics of All Reported Euthanasia Cases
Open accessAbstract
OBJECTIVES: To study the reported medical practice of euthanasia in Belgium since implementation of the euthanasia law. RESEARCH DESIGN: Analysis of the anonymous database of all euthanasia cases reported to the Federal Control and Evaluation Committee Euthanasia. SUBJECTS: All euthanasia cases reported by physicians for review between implementation of the euthanasia law on September 22nd, 2002 and December 31, 2007 (n = 1917). MEASURES: Frequency of reported euthanasia cases, characteristics of patients and the decision for euthanasia, drugs used in euthanasia cases, and trends in reported cases over time. RESULTS: The number of reported euthanasia cases increased every year from 0.23% of all deaths in 2002 to 0.49% in 2007. Compared with all deaths in the population, patients who died by euthanasia were more often younger (82.1% of patients who received euthanasia compared with 49.8% of all deaths were younger than 80, P < 0.001), men (52.7% vs. 49.5%, P = 0.005), cancer patients (82.5% vs. 23.5%, P < 0.001), and more often died at home (42.2% vs. 22.4%, P < 0.001). Euthanasia was most often performed with a barbiturate, sometimes in combination with neuromuscular relaxants (92.4%) and seldom with morphine (0.9%). In almost all patients, unbearable physical (95.6%) and/or psychological suffering (68%) were reported. A small minority of cases (6.6%) concerned nonterminal patients, mainly suffering from neuromuscular diseases. CONCLUSIONS: The frequency of reported euthanasia cases has increased every year since legalization. Euthanasia is most often chosen as a last resort at the end of life by younger patients, patients with cancer, and seldom by nonterminal patients.
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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 [79]
The Discussion (page unavailable) says physicians may not always report euthanasia cases and notes possible bias in information about legal due-care criteria. It also says the Belgian committee had never sent a reported case to judicial authorities. These passages raise concerns about reporting and oversight, but do not establish that safeguards were transgressed or that known transgressions went unprosecuted. (LLM, conf=0.79)
Experimental — accuracy not yet measuredIf a physician determines that a patient requesting euthanasia meets the criteria, this must be confirmed by the assessment of a second, independent consulting physician.
“If a physician determines that a patient requesting euthanasia meets these criteria, this must be confirmed by the assessment of a second, independent consulting physician.1 3 5”
From Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: a retrospective, descriptive study (2015) · cites this paper as [5]
The paper’s opening discussion of Belgian law says the physician must consult another independent physician about the serious and incurable character of the patient’s condition. It supports the requirement for an independent consultation, but does not say the second physician must confirm that the patient meets all the euthanasia criteria. Page numbers are unavailable in our copy. (LLM, conf=0.83)
Experimental — accuracy not yet measuredIn Belgium, a valid request for euthanasia must be made in writing, without coercion, by an adult or an emancipated minor who is legally competent and conscious at the time of making the request.
“In Belgium, a valid request for euthanasia must be made in writing, without coercion, by an adult or an emancipated minor who is legally competent and conscious at the time of making the request.1 3 5 10”
From Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: a retrospective, descriptive study (2015) · cites this paper as [5]
The paper’s introductory discussion of Belgian law says a patient must be an adult, conscious, and legally competent when making a legitimate request. Table 3 describes requests as voluntary and written, supporting the writing and absence-of-coercion elements. Our copy does not include emancipated minors as eligible; it says the patient must be an adult. (LLM, conf=0.89)
Experimental — accuracy not yet measuredFor some studies it was difficult to determine whether the psychiatric disorder was the reason for requesting pEAS or was comorbid to another condition.
“For other studies it was difficult to determine whether the psychiatric disorder was the reason for requesting pEAS or was comorbid to another condition (e.g., (Smets et al., 2010;Snijdewind et al., 2015)).”
From Euthanasia and assisted suicide in psychiatric patients: A systematic review of the literature (2021) · cites this paper as Smets et al., 2010
Table 4 and its footnote (Discussion; page unavailable) list neuropsychiatric diseases, including depression and psychosis, among reported euthanasia cases. The paper does not say whether a psychiatric disorder prompted the request or was comorbid with another condition, so the cited study supports the presence of such diagnoses but not the specific distinction the citing sentence describes. (LLM, conf=0.72)
Experimental — accuracy not yet measuredWhen the patient is not expected to die in the near future, additional advice is required from a third physician, who should be a psychiatrist or medical specialist in the patient's pathology.
“When the patient is not expected to die in the near future, additional advice is required from a third physician, who should be a psychiatrist or medical specialist in the patient's pathology.1 3 5”
From Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: a retrospective, descriptive study (2015) · cites this paper as [5]
The majority of unreported cases (92%) involved acts of euthanasia that the consulting physician did not perceive to be euthanasia.
“The majority of unreported cases (92%) involved acts of euthanasia that the consulting physician did not perceive to be euthanasia (79).”
From Assisted death in eating disorders: a systematic review of cases and clinical rationales (2024) · cites this paper as [79]
The Discussion states that the study analyzed officially reported euthanasia cases and could not determine whether unreported cases differed. A search for the claimed 92% figure and for physicians not perceiving acts as euthanasia found no passage addressing either point. (LLM, conf=0.78)
Experimental — accuracy not yet measuredSmets et al. found that half of assisted deaths in Belgium went unreported by physicians, and eligibility criteria were not met more frequently in unreported cases than in reported cases (88% vs 18%, respectively).
“Smets et al. (79) found that half of assisted deaths in Belgium went unreported by physicians, and eligibility criteria were not met more frequently in unreported cases than in reported cases (88% vs 18%, respectively).”
From Assisted death in eating disorders: a systematic review of cases and clinical rationales (2024) · cites this paper as [79]
The Data Sources section says the study analyzed officially reported euthanasia cases, and the Discussion says its data offer insight only into those cases. Searches for the claimed reporting rate and the 88% versus 18% eligibility comparison found neither figure in our copy; the Discussion says only that unreported cases might differ from reported ones. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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- Authors
- Smets, T., Bilsen, J., Cohen, J., Rurup, M. L., & Deliens, L.
- Affiliations
- Vrije Universiteit Brussel (BE)
- Amsterdam Public Health (NL)
- Corresponding author
- Smets, Tinne
- Bilsen, Johan
- Cohen, Joachim
- Venue
- Medical Care
- Published
- 2010-02
- Volume
- 48
- Issue
- 2
- Pages
- 187-192
- ISSN
- 0025-7079 (ISSN-L)
- OpenAlex
- W2097832199
- Cited by
- 81
- References
- 22
- Citations by year
- 2025: 3 · 2024: 5 · 2023: 1 · 2022: 2 · 2021: 2 · 2020: 3 · 2019: 3 · 2018: 4 · 2017: 5 · 2016: 6 · 2015: 7 · 2014: 7 · 2013: 6 · 2012: 12
- FWCI
- 10.52
- Type
- journal article
- Language
- en
- Open access
- green
- biblio.ugent.be
- Licence
- other-oa
- Locations
- Medical Care (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion, other-oa)
- Pure Amsterdam UMC (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- 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, euthanasia legislation, Belgium, barbiturates, neuromuscular relaxants, morphine, cancer patients, end-of-life care, patient suffering, neuromuscular disorders
- MeSH terms
- Adolescent, Adult, Aged, Belgium, Female, Humans, Male, Middle Aged, Euthanasia, Active, Voluntary
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