Background:In 2002, the Belgian Act on Euthanasia came into effect, regulating the intentional ending of life by a physician at the patient’s explicit request. We undertook this study to describe trends in officially reported euthanasia cases in Belgium with regard to patients’ sociodemographic and clinical profiles, as well as decision-making and performance characteristics.
Methods:We used the database of all euthanasia cases reported to the Federal Control and Evaluation Committee on Euthanasia in Belgium between Jan. 1, 2003, and Dec. 31, 2013 (
n = 8752). The committee collected these data with a standardized registration form. We analyzed trends in patient, decision-making and performance characteristics using a χ
2 technique. We also compared and analyzed trends for cases reported in Dutch and in French.
Results:The number of reported euthanasia cases increased every year, from 235 (0.2% of all deaths) in 2003 to 1807 (1.7% of all deaths) in 2013. The rate of euthanasia increased significantly among those aged 80 years or older, those who died in a nursing home, those with a disease other than cancer and those not expected to die in the near future (
p < 0.001 for all increases). Reported cases in 2013 most often concerned those with cancer (68.7%) and those under 80 years (65.0%). Palliative care teams were increasingly often consulted about euthanasia requests, beyond the legal requirements to do so (
p < 0.001). Among cases reported in Dutch, the proportion in which the person was expected to die in the foreseeable future decreased from 93.9% in 2003 to 84.1% in 2013, and palliative care teams were increasingly consulted about the euthanasia request (from 34.0% in 2003 to 42.6% in 2013). These trends were not significant for cases reported in French.
Interpretation:Since legalization of euthanasia in Belgium, the number of reported cases has increased each year. Most of those receiving euthanasia were younger than 80 years and were dying of cancer. Given the increases observed among non–terminally ill and older patients, this analysis shows the importance of detailed monitoring of developments in euthanasia practice.In 2002, Belgium legalized euthanasia, defined as the intentional ending of life by a physician at the patient’s explicit request.
1,2 For a patient to be eligible for euthanasia, certain formal criteria for due care must be met.
1 These include a voluntary, well-considered, repeated and written request, expressed by a person with full mental capacity who is fully informed about his or her medical condition and the remaining therapeutic possibilities.
1 The person must be in a state of constant and unbearable physical or mental suffering that cannot be alleviated. Due care criteria for the procedure include an a priori consultation with a second independent physician, consultation with a third physician in cases where death is not expected in the foreseeable future and a posteriori reporting of the case for evaluation purposes.
1To safeguard due process and legal compliance and to enable societal control and evaluation, a mandatory notification procedure was built into the legislation.
3 Physicians are required to report each case of euthanasia to the multidisciplinary Belgian Federal Control and Evaluation Committee on Euthanasia by completing and submitting a registration form within 4 working days after a death by euthanasia.
1,3 The evaluation committee reviews the form and determines whether euthanasia was performed in accordance with the legal requirements. Initially, only anonymous information is reviewed; where there is doubt about legality, the committee can revoke anonymity by majority decision and can ask the reporting physician for additional information. If the committee is of the opinion, based on a two-thirds majority, that the legal requirements were not fulfilled, the case is sent to the public prosecutor.
1,3 Although not mentioned in the Belgian law, physician-assisted suicide is treated as a form of euthanasia by the committee.
4To facilitate societal control, the Federal Control and Evaluation Committee on Euthanasia is legally required to issue biennial reports of all reported cases,
1,3–9 providing basic statistics, an evaluation of the law and further recommendations. However, these statistics do not provide an overview of long-term trends. A more complete and thorough evaluation of case characteristics and analysis of trends is needed. In this way, adherence to the legal criteria can be evaluated, and developments in euthanasia practice that might raise concerns can be identified and addressed.Belgium has 2 main language communities: those who speak Dutch (roughly 60% of the population), who mainly live in Flanders, and those who speak French (about 40%), who mainly live in Wallonia. The Brussels-Capital Region is officially bilingual, but predominantly French-speaking. Several empirical studies have found differences in end-of-life practices, knowledge and attitudes between the regions and language communities, showing that Dutch-speaking physicians more often receive and grant euthanasia requests and are more inclined to adhere to legal safeguards.
10–14 The reports issued by the Federal Control and Evaluation Committee on Euthanasia show a striking disparity in euthanasia reporting between the 2 language communities.
4–9 Trends in the characteristics of reported cases and differences among them have not yet been studied.The committee’s reports have shown a continuing increase in the number of euthanasia cases.
4–9 The primary objective of this study was to examine changes in the number and incidence of euthanasia cases and the proportion of euthanasia cases relative to all deaths in Belgium up to and including 2013. The secondary objectives were to determine and report the sociodemographic and clinical characteristics of patients, the decision-making and performance characteristics of reported cases and the differences in trends in characteristics between cases reported in Dutch and cases reported in French.
相似文献