FLIECE study 8
Background: In recent decades substantial changes have emerged in end-of-life care due to a considerable amount of deaths preceded by long-term and progressive illness and the increasing influence of medical-technological interventions. Medical end-of-life decisions have become a substantial part of contemporary medical practice. This can include decisions influencing the patient’s lifespan such as euthanasia (i.e. the administration of drugs with the explicit intention to end the patient’s life at the patient’s explicit request), a practice which was legalized in Belgium in 2002.
The frequency or incidence of medical end-of life practices such as euthanasia, but also the social-demographic patterns in their application (e.g. are there any risk groups or vulnerable groups), and the characteristics of the decision-making (e.g. are patient, family, and other healthcare providers involved in the decision) need to be monitored. First, trends and developments in end-of-life practices provide insight into evolutions in the quality of end-of-life practices, and practical and ethical priorities for medical practice at the end of patient’s lives can be identified. Second, further developments since the euthanasia law need to be monitored. Given the ethical contentiousness of euthanasia, particularly abroad, international concerns about developments in end-of-life practice in Belgium persist.
Aim: This study aims to provide representative data on the prevalence and major background characteristics of the euthanasia practice in Flanders.
Methods: Population-based death certificate study among physicians attending a random sample of deaths in Flanders, Belgium.
Official database of all euthanasia cases reported to the Federal Control and Evaluation Committee Euthanasia (2002-2013).
Results: Euthanasia incidence increased substantially between 2007 and 2013, from 1.9% to 4.6%, due to an increase in the number of euthanasia requests from patients as well as a higher granting rate from physicians. These shifts are particularly evident in patients aged 80 or older, women and nursing home residents. However, cancer patients, those dying at home, those younger than 80 and the highly educated continue to have the highest rates of requests and granting. We also observed a significant decrease in factors external to the patient’s medical condition, such as the physician’s personal objections and fear of legal consequences, as reasons for refusing a euthanasia request.