Assisted dying request assessments by trained consultants: changes in practice and quality - Repeated cross-sectional surveys (2008-2019)

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OBJECTIVES: To study changes in the peer consultation practice of assessing assisted dying requests and its quality among trained 'Life End Information Forum' (LEIF) consultants in Belgium between 2008 and 2019.

METHODS: Cross-sectional surveys conducted in 2008 (N=132) and 2019 (N=527) among all registered LEIF consultants.

RESULTS: The response rate was 75% in 2008 and 57% in 2019. In 2019 compared with 2008, more LEIF consultants were significantly less than 40 years old (25%/10%, p=0.006) and at least 60 years old (34%/20%, p=0.006). In their activities regarding assessments of assisted dying requests over 12 months, we found a significant increase in the number of patients who did not meet the substantive requirements for assisted dying in 2019 compared with 2008 (1-4 patients: 41.1 %/58.8%, p=0.020). In their most recent assessments of an assisted dying request, LEIF consultants in 2019 made significantly more assessments of patients aged 80 years or older than in 2008 (31%/9%, p<0.001), and significantly fewer assessments for patients with cancer (53%/70%, p=0.034). Regarding adherence to quality criteria for consultation, LEIF consultants discussed unbearable suffering (87%/65%, p=0.003) and alternative treatments (palliative: 48 %/13%, p<0.001; curative: 28%/5%, p=0.002) significantly more often with the attending physician.

CONCLUSIONS: Changes in peer consultation practice and its quality among LEIF consultants likely reflect changes in assisted dying practice in general, as well as changes in LEIF consultations on more complex cases for which LEIF consultants' expertise is required.

Original languageEnglish
Pages (from-to)E1234-E1244
Number of pages11
JournalBMJ Supportive and Palliative Care
Issue numbere1
Early online date29 Jun 2022
Publication statusPublished - 1 May 2024

Bibliographical note

Funding Information:
This study was supported by funding from the Vrije Universiteit Brussel Funds ‘Wetenschappelijk Steunfonds’ and ‘Zorg aan het Levenseinde’ and the Federal Public Service for Public Health, Food Chain Safety and Environment of Belgium. SD is a Postdoctoral Fellow of the Research Foundation—Flanders (FWO).

Publisher Copyright:
© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.


  • Clinical decisions
  • Education and training
  • End of life care
  • Ethics
  • Service evaluation
  • Terminal care


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