Belgian psychiatrists’ attitudes towards, and readiness to engage in, euthanasia assessment procedures with adults with psychiatric conditions: a survey
Open accessAbstract
Background: Although the Belgian assessment pathway for legal euthanasia requires the engagement of at least one psychiatrist, little is known about psychiatrists’ attitudes towards euthanasia for adults with psychiatric conditions (APC). This study aims to gauge psychiatrists’ attitudes towards and readiness to engage in euthanasia assessment and/or performance procedures in APC. Methods: This cross-sectional survey study was performed between November 2018 and April 2019. The survey was sent to a sample of 499 eligible psychiatrists affiliated to the Flemish Association for Psychiatry, a professional association that aims to unite and represent all psychiatrists working in Flanders, the Dutch-speaking, northern part of Belgium. The Association’s members comprise an estimated 80–90% of all psychiatrists active in Flanders. Only psychiatrists working with APC (83% of the association’s total membership) were included. Factorial Anova and Chi Square tests were performed to examine if and to what extent psychiatrists’ backgrounds were associated with, respectively, their attitudes and their readiness to play a role in euthanasia procedures concerning APC. Results: One hundred eighty-four psychiatrists completed the questionnaire (response rate 40.2%); 74.5% agree that euthanasia should remain permissible for APC. However, 68.9% question some of the approaches taken by other physicians during the euthanasia assessment and only half consider euthanasia assessment procedures compatible with the psychiatric care relationship. Where active engagement is concerned, an informal referral (68%) or preliminary advisory role (43.8%) is preferred to a formal role as a legally required advising physician (30.3%), let alone as performing physician (< 10%). Conclusion: Although three quarters agree with maintaining the legal option of euthanasia for APC, their readiness to take a formal role in euthanasia procedures appears to be limited. More insight is required into the barriers preventing engagement and what psychiatrists need, be it education or clarification of the legal requirements, to ensure that patients can have their euthanasia requests assessed adequately.
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Half of psychiatrists agree that MAiD-NT is compatible with a psychiatric care relationship in which it is possible to establish whether the desire to die is entangled with a psychiatric disorder.
“Half of them agree that MAiD-NT is compatible with a psychiatric care relationship [43] in which it is possible to establish whether the desire to die is entangled with a psychiatric disorder [41].”
From Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders (2022) · cites this paper as [43]
Despite support of Belgian psychiatrists for MAiD-NT, only 8.4% would actually engage in performing it with their own patients.
“despite the support of Belgian psychiatrists for MAiD-NT, only a minority (8.4%) would actually engage in performing it with their own patients”
From Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders (2022) · cites this paper as [43]
Even fewer Belgian psychiatrists (4.5%) would perform MAiD-NT for a colleague's patient.
“and even less would perform MAiD-NT for a colleague’s patient (4.5%) [43]”
From Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders (2022) · cites this paper as [43]
A recent Belgian survey study found psychiatrists struggle with these practices due to difficulties reconciling euthanasia assessment with the patient-psychiatrist relationship.
“A recent Belgian survey study gauging psychiatrists’ attitudes and experiences on this topic pointed out that psychiatrists struggle with these practices, due to the difficulties of reconciling euthanasia assessment with the patient-psychiatrist relationship.14,15”
From Euthanasia in adults with psychiatric conditions: A descriptive study of the experiences of Belgian psychiatrists (2021) · cites this paper as [14]
Symptoms of psychiatric disorders tend to change over time, even leading in some cases to remission and clinical and/or social rehabilitation.
“Symptoms of psychiatric disorders tend to change over time – even leading, in some cases, to remission and clinical and/or social rehabilitation”
From Euthanasia in adults with psychiatric conditions: A descriptive study of the experiences of Belgian psychiatrists (2021) · cites this paper as [14]
These cases illustrate the complexity of the procedures and the likely lack of consensus between the physicians involved, primarily concerning the incurability of the condition and the lack of reasonable perspectives for improvement.
“These cases again illustrate the complexity of the procedures and therefore the likely lack of consensus between the physicians involved,14,15 which, according to our study, primarily concerns the incurability of the condition and the lack of reasonable perspectives for improvement.”
From Euthanasia in adults with psychiatric conditions: A descriptive study of the experiences of Belgian psychiatrists (2021) · cites this paper as [14]
The finding that some legal criteria were not sufficiently met in the perception of the psychiatrists involved seems to corroborate concerns about whether requests are always assessed and monitored adequately and rigorously.
“the finding that some legal criteria were not (sufficiently) met in the perception of the psychiatrists involved seems to corroborate concerns about whether requests are always assessed and monitored adequately and rigorously.”
From Euthanasia in adults with psychiatric conditions: A descriptive study of the experiences of Belgian psychiatrists (2021) · cites this paper as [14]
The tendency of psychiatric symptoms to change over time underscores the challenge to operationalising the legal criterion of incurability in the field of psychiatry.
“this underscores the challenge to operationalising this legal criterion in the field of psychiatry, as stated in previous studies.14,15”
From Euthanasia in adults with psychiatric conditions: A descriptive study of the experiences of Belgian psychiatrists (2021) · cites this paper as [14]
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- Authors
- Verhofstadt, M., Audenaert, K., Van den Broeck, K., Deliens, L., Mortier, F., Titeca, K., Pardon, K., & Chambaere, K.
- Affiliations
- Vrije Universiteit Brussel (BE)
- Ghent University Hospital (BE)
- AZ Groeninge (BE)
- Corresponding author
- Verhofstadt, Monica
- Venue
- BMC Psychiatry
- Published
- 2020-07-16
- Volume
- 20
- Issue
- 1
- Pages
- 374-374
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC7364603
- OpenAlex
- W3042706780
- Cited by
- 28
- References
- 22
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 5 · 2023: 4 · 2022: 7 · 2021: 2 · 2020: 1
- FWCI
- 2.62
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- VUBIR (Vrije Universiteit Brussel) (submittedVersion)
- Funders
- Fonds Wetenschappelijk Onderzoek (Research project G017818N and PhD fellowship (1162618N))
- 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, psychiatrists' attitudes, barriers to engagement, Flanders
- MeSH terms
- Adult, Attitude of Health Personnel, Belgium, Cross-Sectional Studies, Euthanasia, Humans, Psychiatry, Surveys and Questionnaires
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