Ethical and societal control over the practice of euthanasia in Belgium.10th World Congress of Bioethics. Singapore, 28-31 July 2010.

Background
Euthanasia is a topic of great debate. The debate often centers on the possibility of efficient societal and ethical control over euthanasia. Belgium is one of the few countries where euthanasia is legalized. Physicians may under strict circumstances administer life-ending drugs at the explicit request of a patient. To provide control over the euthanasia practice, physicians must report each euthanasia case to the Federal Review Committee, which determines whether the physician has acted carefully in compliance with the due care requirements of the euthanasia law.

Aim This study estimates the rate of reporting euthanasia cases in Flanders, Belgium, to the Federal Review Committee, and compares reported and unreported euthanasia cases.

Methods
We performed a death certificate study in Flanders, Belgium. A stratified random sample of persons deceased was drawn in 2007. Every certifying physician was sent a questionnaire on end-of-life decisions taken. We classified a case as euthanasia if death was, according to the physician, the result of drugs given at the explicit request of the patient with the explicit goal of hastening death.

Results Of all 137 euthanasia cases 52.8% were reported. Physicians who perceived their act as euthanasia reported it in 93.1% of the cases. Cases were less often reported when the estimated life-shortening effect of the euthanasia was less than one week than when the life-shortening effect was larger (37.3% versus 74.1%, p
Conclusion
Half of all actual euthanasia cases is reported to and reviewed by the Federal Review Committee. Unreported euthanasia cases were often not regarded as euthanasia by the physician and were generally dealt with less carefully; especially procedural requirements, such as consulting a second physician or putting the euthanasia request in writing, were less often met in unreported cases. Legalization of euthanasia does not seem sufficient to reach transparency and to guarantee the careful practice of euthanasia; it seems warranted that countries debating legalization of euthanasia, simultaneously consider developing a policy facilitating the physicians' careful acting and report obligation.

Funding: IWT Flanders (SBO IWT nr. 050158)

Presenting author email address: [email protected]