Developments Under Assisted Dying Legislation: The Experience in Belgium and other countries

Background: Legalization of assisted dying (AD), including euthanasia and
physician-assisted suicide, remains a highly contentious issue as more jurisdictions
around the world consider AD laws. Important concerns exist related to legalization
of AD with regard to vulnerable populations and monitoring and reporting systems.
Methods: A selective literature review was performed to explore the developments
under assisted dying laws globally. An array of issues and key publications were
selected based on the authors’ previous research and knowledge.
Results: The experience in Belgium can provide an instructive example about the
evolution of AD laws. Since legalization, AD practice has increased gradually (0.2%
of all deaths in 2002–2003 to 2.4% in 2021), accompanied by a diversification of the
patient groups and by broadening acceptance among physicians and the public.
Fears relating to disregard of regulatory safeguards and thwarted palliative care
development have largely been allayed. Nonetheless, there are important points
that require continued attention, for which ongoing monitoring and research is
essential.
Conclusion: Research in Belgium has not found evidence of suicide contagion,
expansion to minors, or an increase in non-voluntary forms of life-ending. AD
legislation should always be accompanied by careful consideration for integration
into the health care system, physician training and support, possible conscientious
objection, availability of palliative care services, clinical guidelines, public education,
and monitoring systems.