The engagement of psychiatrists in the assessment of euthanasia requests from psychiatric patients in Belgium: a survey study
Open accessAbstract
Background: Since its legalisation in 2002, the number of times euthanasia has been carried out in response to requests from adults with psychiatric conditions (APC) has continued to increase. However, little is known about why and how psychiatrists become engaged in the assessment of such euthanasia requests. Methods: A cross-sectional survey study was conducted between November 2018 and April 2019 of 499 psychiatrists affiliated with the Flemish Psychiatry Association. Chi square/Fisher’s exact tests were performed to examine if, and to what extent, psychiatrists’ backgrounds relate to their concrete experiences. The answers to the open question regarding motives for (non-) engagement were thematically coded. Results: Two hundred one psychiatrists participated, a response rate of 40%. During their careers, 80% of those responding have been confronted with at least one euthanasia request from an APC patient and 73% have become involved in the assessment procedure. Their engagement was limited to the roles of: referring physician (in 44% of the psychiatrists), attending physician (30%), legally required ‘advising physician’ (22%), and physician participating in the actual administration of the lethal drugs (5%). Within the most recent 12 months of practice, 61% of the respondents have been actively engaged in a euthanasia assessment procedure and 9% have refused at least once to be actively engaged due to their own conscientious objections and/or the complexity of the assessment. The main motive for psychiatrists to engage in euthanasia is the patient’s fundamental right in Belgian law to ask for euthanasia and the psychiatrist’s duty to respect that. The perception that they were sufficiently competent to engage in a euthanasia procedure was greater in psychiatrists who have already had concrete experience in the procedure. Conclusions: Although the majority of psychiatrists have been confronted with euthanasia requests from their APC patients, their engagement is often limited to referring the request to a colleague physician for further assessment. More research is needed to identify the determinants of a psychiatrist’s engagement in euthanasia for their APC patients and to discover the consequences of their non-, or their restricted or full engagement, on both the psychotherapeutic relationship and the course of the euthanasia request.
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Although about 80% of Belgian psychiatrists had to deal with at least one MAiD-NT request, only 5% were actually involved in the administration of lethal drugs or attended when another physician was performing the act for their own patient.
“although about 80% psychiatrists in Belgium had to deal with at least one MAiD-NT request, only 5% were actually involved in the administration of lethal drugs or attended when another physician was performing the act for their own patient [50]”
From Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders (2022) · cites this paper as [50]
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 [15]
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 [15]
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 [15]
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 [15]
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Cites
Research Methods for Human-Computer Interaction
Cairns, P. A., & Cox, A. (2008) · Cambridge University Press eBooks · doi:10.1017/cbo9780511814570 · Cited by 2,166 · see citing works
Questionnaires, in-depth interviews and focus groups
Adams, A., & Cox, A. L. (2008) · Cambridge University Press eBooks · doi:10.1017/cbo9780511814570.003 · Cited by 287 · see citing works
Bolt, E. E., Snijdewind, M. C., Willems, D. L., van der Heide, A., & Onwuteaka-Philipsen, B. D. (2015) · Journal of Medical Ethics · doi:10.1136/medethics-2014-102150 · Cited by 178 · see citing works
Dees, M. K., Vernooij-Dassen, M. J., Dekkers, W. J., Elwyn, G., Vissers, K. C., & van Weel, C. (2013) · Palliative Medicine · doi:10.1177/0269216312463259 · Cited by 146 · 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
Self-citationAttitudes and Experiences of Belgian Physicians Regarding Euthanasia Practice and the Euthanasia Law
Smets, T., Cohen, J., Bilsen, J. J. R., Wesemael, Y. V., Rurup, M. L., & Deliëns, L. (2010) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2010.05.015 · Cited by 105 · see citing works
Capacity evaluations of psychiatric patients requesting assisted death in The Netherlands
Doernberg, S. N., Peteet, J. R., & Kim, S. Y. H. (2016) · Psychosomatics · doi:10.1016/j.psym.2016.06.005 · Cited by 103 · see citing works
Cohen, J., Van Wesemael, Y., Smets, T., Bilsen, J., & Deliens, L. (2012) · Social Science & Medicine · doi:10.1016/j.socscimed.2012.04.021 · Cited by 93 · see citing works
Childhood maltreatment and suicide attempts in prisoners: a systematic meta-analytic review
Angelakis, I., Austin, J. L., & Gooding, P. A. (2019) · Psychological Medicine · doi:10.1017/s0033291719002848 · Cited by 75 · see citing works
Miller, D. G., & Kim, S. Y. H. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-017628 · Cited by 69 · see citing works
Evenblij, K., Pasman, H. R. W., Pronk, R., & Onwuteaka-Philipsen, B. D. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2053-3 · Cited by 67 · see citing works
Verhofstadt, M., Van Assche, K., Sterckx, S., Audenaert, K., & Chambaere, K. (2019) · International Journal of Law and Psychiatry · doi:10.1016/j.ijlp.2019.04.004 · Cited by 60 · see citing works
Self-citationNicolini, M. E., Peteet, J. R., Donovan, G. K., & Kim, S. Y. H. (2020) · Psychological Medicine · doi:10.1017/s0033291719000333 · Cited by 52 · see citing works
Pasman, H. R. W., Willems, D. L., & Onwuteaka-Philipsen, B. D. (2013) · Patient Education and Counseling · doi:10.1016/j.pec.2013.06.007 · Cited by 44 · see citing works
van der Heide, A., Onwuteaka-Philipsen, B. D., van Delden, J. J. M., Gevers, J. K. M., van der Maas, P. J., & van der Wal, G. (2005) · PubMed · Cited by 43 · see citing works
Evaluatie Wet toetsing levensbeëindiging op verzoek en hulp bij zelfdoding
Onwuteaka-Philipsen, B. D., Gevers, J. K. M., van der Heide, A., van Delden, J. J. M., Pasman, H. R. W., Rientjens, J. A. C., Rürup, M., Buiting, H. M., Wolf, J., Janssen, A. G. J. M., et al. (2007) · Data Archiving and Networked Services (DANS) · Cited by 37 · see citing works
Lærum, A. M. W., Reitan, S. K., Evensen, K. A. I., Lydersen, S., Brubakk, A., Skranes, J. S., & Indredavik, M. S. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2202-8 · Cited by 37 · see citing works
Verhofstadt, M., Audenaert, K., Van den Broeck, K., Deliens, L., Mortier, F., Titeca, K., Pardon, K., & Chambaere, K. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02775-x · Cited by 28 · see citing works
Self-citation(2012) · Data Archiving and Networked Services (DANS) · Cited by 27 · see citing works
Cohen, J., Wesemael, Y. V., Smets, T., Bilsen, J. J. R., Onwuteaka-Philipsen, B. D., Distelmans, W., & Deliëns, L. (2014) · BMC Health Services Research · doi:10.1186/1472-6963-14-307 · Cited by 23 · see citing works
How do general practitioners assess the criteria for due care for euthanasia in concrete cases?
Wolf, J. E. H.-D., Pasman, H. R. W., & Onwuteaka-Philipsen, B. D. (2008) · Health Policy · doi:10.1016/j.healthpol.2007.12.009 · Cited by 17 · see citing works
Derde evaluatie Wet toetsing levensbeëindiging op verzoek en hulp bij zelfdoding
Onwuteaka-Philipsen, B., Legemaate, J., van der Heide, A., van Delden, H., Evenblij, K., Hammoud, I. E., Ploem, M. C., Pronk, R., van de Vathorst, S., & Willems, D. L. (2017) · Data Archiving and Networked Services (DANS) · Cited by 6 · see citing works
Flagged first, then by citations
1 of the 23 references couldn’t be matched to a known paper.
Research works printed but not linked: 2
- [4]Cheng M Doctors clash over euthanasia for mentally ill 2017 New York Associated Press
- [30]Verhofstadt M, Audenaert K, Van den Broeck, K, Deliens L., Mortier F., Titeca K, et al. Psychiatrists’ encounters with and engagement in the assessment of euthanasia requests from psychiatric patients in Flanders and Brussels (forthcoming). PMC7414658 32770966
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Grassi, L., Folesani, F., Marella, M., Tiberto, E., Riba, M. B., Bortolotti, L., Toffanin, T., Palagini, L., Belvederi Murri, M., Biancosino, B., et al. (2022) · Current Psychiatry Reports · doi:10.1007/s11920-022-01339-y · Cited by 39 · see citing works
Verhofstadt, M., Pardon, K., Audenaert, K., Deliens, L., Mortier, F., Liégeois, A., & Chambaere, K. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.09.032 · Cited by 32 · see citing works
Self-citationBinder, 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
Verhofstadt, M., Audenaert, K., Van den Broeck, K., Deliens, L., Mortier, F., Titeca, K., De Bacquer, D., & Chambaere, K. (2021) · Science Progress · doi:10.1177/00368504211029775 · Cited by 21 · see citing works
Self-citationVerhofstadt, M., Moureau, L., Pardon, K., & Liégeois, A. (2024) · BMC Medical Ethics · doi:10.1186/s12910-024-01063-7 · Cited by 11 · see citing works
Self-citationVerhofstadt, M., Assche, K. V., Pardon, K., Gleydura, M., Titeca, K., & Chambaere, K. (2024) · International Journal of Law and Psychiatry · doi:10.1016/j.ijlp.2024.101961 · Cited by 12 · see citing works
Self-citationArcher, M., Willmott, L., Chambaere, K., Deliëns, L., & White, B. P. (2025) · Palliative Care and Social Practice · doi:10.1177/26323524251318044 · Cited by 5 · see citing works
Self-citationArcher, 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
Self-citationBinder, 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
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Vachon, J., Mercy, P., Gasser, M., & Aubry, R. (2022) · Éthique & Santé · doi:10.1016/j.etiqe.2022.04.003 · Cited by 1 · see citing works
Vissers, S., Dierickx, S., Deliëns, L., Mortier, F., Cohen, J., & Chambaere, K. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1100353
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Chambaere, K., Dierickx, S., & Cohen, J. (2024) · Elsevier eBooks · doi:10.1016/b978-0-323-99967-0.00194-0
Self-citationFirmly in the saddle? A scoping review of the role of consultation-liaison clinicians as gatekeepers
Stiefel, F., Bourquin, C., Chanel, H., & Michaud, L. (2026) · Journal of Health Psychology · doi:10.1177/13591053261445922
- Authors
- Verhofstadt, M., Audenaert, K., Van den Broeck, K., Deliens, L., Mortier, F., Titeca, K., Pardon, K., De Bacquer, D., & Chambaere, K.
- Affiliations
- Vrije Universiteit Brussel (BE)
- Ghent University Hospital (BE)
- AZ Groeninge (BE)
- Corresponding author
- Verhofstadt, Monica
- Venue
- BMC Psychiatry
- Published
- 2020-08-08
- Volume
- 20
- Issue
- 1
- Pages
- 400-400
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC7414658
- OpenAlex
- W3047795441
- Cited by
- 14
- References
- 23
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 3 · 2022: 3 · 2021: 2 · 2020: 1
- FWCI
- 1.68
- 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 (G017818N and 1162618N)
- 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, psychiatric patients, euthanasia requests, Belgian euthanasia law, conscientious objection, physician competence, referring physicians, therapeutic relationship, legalization of euthanasia
- MeSH terms
- Adult, Belgium, Cross-Sectional Studies, Euthanasia, Humans, Psychiatry, Surveys and Questionnaires
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