Belgium

Belgium’s Euthanasia Act 2002 allows for doctors to administer lethal drugs with the intention of ending life after the person has made an explicit request. The law was amended in 2014 to remove age limits, so that children can now be legally euthanised. Numbers have steadily risen, with 2,309 people be euthanized in 2017.

Legalisation

Amendments to the Law

January 2001

The euthanasia commission of Belgium’s upper house voted in favour of euthanasia.

October 2001

Belgium’s senate approved the proposed law: 44 for, 23 against, 2 abstentions and 2 senators who failed to register a vote.

May 2002

The Belgian House of Representatives passed the Act Concerning Euthanasia (2002), which came into force in September 2002.

2005

To offer legal security to the pharmacist who delivers euthanatica to be used by the physician.

2014

To allow non-emancipated, capable minors to request euthanasia. There is no minimum age.

Eligibility

Patients seeking euthanasia must

  • Reside in Belgium.
  • Have made considered, voluntary and repeated requests that their lives be ended.
  • Be in a hopeless medical condition that is the result of a serious and incurable accidental or pathological condition.
  • Complain of constant and unbearable physical or mental pain that cannot be relieved.

The medical practitioner must

  • Inform the patient about his/her state of health, life expectancy, and request for euthanasia.
  • Discuss the possible options available to the patient regarding both treatment and the palliative care available.
  • Consult with another independent and competent medical practitioner.
  • Discuss the patient’s request with the medical team treating the patient and with the patient’s close family, if the patient requests it.

Euthanasia Cases

Since the legalization of euthanasia, the number of cases has risen consistently from 235 in 2003 to 2309 in 2017. In total, 14,985 people have been euthanized. This includes the reported cases only.

Euthanasia Number by Year

Over the last 5 years…

28% increase in number of cases (1807 to 2309).

Over the last 10 years…

228% increase in number of cases (704 to 2309).

3 cases of euthanasia of minors

There have been 3 cases of euthanasia of minors since the law changed in 2014, two in 2016 and one in 2017.

  • 17 year old who had muscular dystrophy.
  • 9 year old who had a brain tumour.
  • 11 year old who had cystic fibrosis.

Euthanasia in Flanders and Wallonia

Population Percentage

Screen Shot 2018-12-08 at 10.40.28 PM

Euthanasia by Region

Screen Shot 2018-12-08 at 10.42.30 PM

Flanders, the northern Dutch-speaking part makes up 56% of Belgium’s population. 

Wallonia, the southern French-speaking part makes up 33% of Belgium’s population.

78% of euthanasia cases are in Flanders and 22% in Wallonia. There is some debate whether this reflects a difference in practices or a reluctance to report.

Between 2007 and 2013, the number of euthanasia in Flanders increased from 1.9% to 4.6% of all deaths.

Euthanasia for Psychiatric Cases

Psychiatric cases between 2002 and 2013

Between 2002 and 2013, 179 cases of euthanasia occurred because of a psychiatric disorder or dementia diagnosis only.

179 cases

46.4% were mood disorders
34.6% were dementia
12.3% were other psychiatric disorders
6.7% were mood disorders + by another psychiatric disorder

Most were women

The majority of these euthanasia cases concerned women, with percentages ranging from 58.1% in dementia to 77.1% in mood disorders.

38.6% of mood disorder cases were 80+ years

Of all the reported euthanasia cases with a mood disorder diagnosis, 38.6% were aged 80 or older.

Psychiatric cases between 2014 and 2017

There were 201 euthanasia cases because of psychiatric conditions between 2014 and 2017. Below is a breakdown of the different conditions.  

Euthanasia without Consent

Professor Cohen-Almagor of the University of Hull, in a paper published in the Journal of Medical Ethics, says that 1.7% of all deaths in Belgium in 2013 were caused by life-ending drugs “with the intention to shorten life and without explicit request”.

Abigail Wilkinson, CNS News, 18 June 2015

1.7% of all euthanasia deaths in 2013 were without explicit request

52.7% were of patients aged 80 years or older

"Discussion would have been harmful to the patient's best interests"

The decision to euthanize was not discussed with the patient in 77.9 percent of the cases because he/she was comatose, had dementia, or “because discussion would have been harmful to the patient’s best interest,” according to the study.

Reporting

Not all euthanasia cases are reported to the Commission fédérale de Contrôle et d’Évaluation (Federal Control and Evaluation Committee), as is required by law. A study of death certificates followed up by questionnaires to doctors found that approximately half of euthanasia cases were reported to the review committee.

77% did not report because they did not perceive their act as euthanasia. 

18% did not report because they considered reporting is too much of an administrative burden. 

12% did not report because the legal due care requirements had possibly not all been met. 

9% did not report because they considered euthanasia a private matter between physician and patient. 

2% did not report because of possible legal consequences (multiple answers were possible).

[1] Cohen-Almagor R Belgian euthanasia law: a critical analysis Journal of Medical Ethics 2009;35:436-439; Jones, David Albert, Chris Gastmans, and Calum MacKellar, eds. Euthanasia and Assisted Suicide: Lessons from Belgium. Vol. 42. Cambridge University Press, 2017.

[2] European Institute of Bioethics, Euthanasia: A summary of the legal framework law of May 28, 2002, https://www.ieb-eib.org/en/document/euthanasia-a-summary-of-the-legal-framework-law-of-may-28-2002-373.html

[3] Dierickx, Sigrid, et al. “Comparison of the expression and granting of requests for euthanasia in Belgium in 2007 vs 2013.” JAMA internal medicine 175.10 (2015): 1703-1706.

[4] Commission fédérale de Contrôle et d’Évaluation de l’Euthanasie. Huitième rapport aux Chambres législatives années 2016 – 2017. https://organesdeconcertation.sante.belgique.be/sites/default/files/documents/8_rapport-euthanasie_2016-2017-fr.pdf

[5] Smets, Tinne, et al. “Reporting of euthanasia in medical practice in Flanders, Belgium: cross sectional analysis of reported and unreported cases.” Bmj 341 (2010): c5174.

[6] Dierickx, Sigrid, et al. “Euthanasia for people with psychiatric disorders or dementia in Belgium: analysis of officially reported cases.” BMC psychiatry 17.1 (2017): 203.

[7] Commission fédérale de Contrôle et d’Évaluation de l’Euthanasie. Huitième rapport aux Chambres législatives années 2016 – 2017. https://organesdeconcertation.sante.belgique.be/sites/default/files/documents/8_rapport-euthanasie_2016-2017-fr.pdf

[8] Cohen, J., Van Wesemael, Y., Smets, T., Bilsen, J., & Deliens, L. (2012). Cultural differences affecting euthanasia practice in Belgium: One law but different attitudes and practices in Flanders and Wallonia. Social science & medicine, 75(5), 845-853.