Concrete Experiences and Support Needs Regarding the Euthanasia Practice in Adults With Psychiatric Conditions: A Qualitative Interview Study Among Healthcare Professionals and Volunteers in Belgium
Open accessAbstract
Objective: Although euthanasia in the context of adult psychiatry is legalized in Belgium, it poses major ethical and clinical challenges for the health care professionals and volunteers involved. This study aimed to address these members' concrete experiences and support needs. Methods: A qualitative semi-structured interview study was conducted with 16 physicians and 14 other health care professionals and volunteers, with at least one concrete experience with euthanasia requests and procedures concerning adults with psychiatric conditions. Findings: Concrete experiences concerned the following 8 domains: (1) the impact of euthanasia on the clinical trajectory and (2) on the therapeutic relationship, (3) internal and (4) external collaborative partnerships, (5) patients' social inner circle (non-)involvement, (6) the use of recently published guidelines and, (7) the first criminal trials on this topic, and (8) the act of euthanasia. The following 8 main support needs emerged; (1) protocols addressing specific sub-populations and pathologies, (2) protocols specifically drawn up for non-medics, (3) guidance on how to adequately implement the two-track approach, (4) (after)care for patients, (5) (after)care for the health care team, (6) guidance on the patient's social inner circle involvement, (7) enhanced education measures, and (8) enhanced financial measures, including incentives for holistic, palliative care approaches. Conclusion: The health care professionals and volunteers reported many positive and negative experiences in dealing with euthanasia requests in adult psychiatry. They reported several support needs across the extensive euthanasia trajectory, pertaining to concrete management of thorny issues that guidelines do not (yet) touch on. Important implications of our study relate to tackling these existing issues, and to paying sufficient attention to the impact of a euthanasia trajectory on all actors, including the patients and their social inner circle, involved.
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In contrast, the option of EAS could lead to feelings of reassurance and encourage patients to refocus on treatment goals and to find relief from their suffering.
“In contrast, the option of EAS could lead to feelings of reassurance and encourage patients to refocus on treatment goals and to find relief from their suffering”
From A lived experience response to the proposed diagnosis of terminal anorexia nervosa: learning from iatrogenic harm, ambivalence and enduring hope (2023) · cites this paper as [201]
In a qualitative study among healthcare professionals and volunteers involved in EAS in Belgium, some participants experienced EAS legislation and initiation processes as a double-edged sword.
“In a qualitative study among healthcare professionals and volunteers involved in EAS in Belgium [201], some participants experienced EAS legislation and initiation processes as a double-edged sword.”
From A lived experience response to the proposed diagnosis of terminal anorexia nervosa: learning from iatrogenic harm, ambivalence and enduring hope (2023) · cites this paper as [201]
The option of EAS could have the effect of closing windows of opportunity for recovery and tipping their most vulnerable patients into experiencing a tunnel vision toward death, feeling discouraged and demoralised toward the likelihood of treatment success, applying for EAS, and being swept into a 'death track'.
“The option of EAS could have the effect of closing windows of opportunity for recovery and tipping their most vulnerable patients into experiencing a tunnel vision toward death, feeling discouraged and demoralised toward the likelihood of treatment success, applying for EAS, and being swept into a ‘death track’”
From A lived experience response to the proposed diagnosis of terminal anorexia nervosa: learning from iatrogenic harm, ambivalence and enduring hope (2023) · cites this paper as [201]
Recent qualitative studies raised concerns that the potential for young individuals to imitate self-destructive behavior might not have been fully considered when the law was drafted.
“Recent qualitative studies raised concerns that the potential for young individuals to imitate self-destructive behavior might not have been fully considered when the law was drafted ( 22 , 23 ).”
Guidelines and research often focus on psychiatrists, neglecting the roles of other mental health professionals like nurses, psychologists, moral consultants, and social workers.
“Finally, guidelines and research often focus on psychiatrists, neglecting the roles of other mental health professionals like nurses, psychologists, moral consultants, and social workers ( 23 ).”
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- Authors
- Verhofstadt, M., Audenaert, K., Mortier, F., Deliens, L., Liégeois, A., Pardon, K., & Chambaere, K.
- Affiliations
- Vrije Universiteit Brussel (BE)
- Ghent University Hospital (BE)
- KU Leuven (BE)
- Corresponding author
- Verhofstadt, Monica
- Venue
- Frontiers in Psychiatry
- Publisher
- Frontiers Media SA
- Published
- 2022-03-11
- Volume
- 13
- Pages
- 859745-859745
- ISSN
- 1664-0640 (ISSN-L)
- PMC
- PMC8963330
- OpenAlex
- W4221115286
- Cited by
- 14
- References
- 21
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 5 · 2023: 5
- FWCI
- 2.87
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion, cc-by)
- Lirias (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- VUBIR (Vrije Universiteit Brussel) (submittedVersion)
- Funders
- Fonds Wetenschappelijk Onderzoek (G017818N, 1162618N)
- Vlaamse regering
- 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, adult psychiatry, mental illness, healthcare workers, volunteers, support needs, therapeutic relationship, palliative care, follow-up care, euthanasia guidelines, criminal trials, professional education, Belgium
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