Trends in decision-making and performance characteristics of reported euthanasia cases in Belgium, 2003–2013*
| Characteristic | Year; % of euthanasia cases | Average annual change, % | p value† | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2003 (n =235) | 2004 (n =349) | 2005 (n =393) | 2006 (n =429) | 2007 (n =495) | 2008 (n =704) | 2009 (n =822) | 2010 (n =953) | 2011 (n =1133) | 2012 (n =1432) | 2013 (n =1807) | |||
| Type of request for euthanasia | |||||||||||||
| Current request | 99.6 | 98.6 | 98.0 | 96.0 | 98.2 | 98.0 | 97.2 | 97.5 | 97.8 | 96.9 | 98.7 | −0.1 | > 0.9 |
| Advance directive‡ | 0.4 | 1.4 | 2.0 | 4.0 | 1.8 | 2.0 | 2.8 | 2.5 | 2.2 | 3.1 | 1.3 | +0.1 | > 0.9 |
| Specialty of second physician§ | |||||||||||||
| Specialist palliative care physician | 19.1 | 15.5 | 10.7 | 10.0 | 8.7 | 10.1 | 10.4 | 10.2 | 9.6 | 13.8 | 11.0 | −0.8 | 0.3 |
| General practitioner | 34.9 | 41.7 | 42.5 | 44.4 | 48.4 | 46.3 | 51.2 | 49.8 | 50.7 | 50.1 | 52.4 | 1.8 | < 0.001 |
| Disease or organ specialist | 46.0 | 42.9 | 46.8 | 45.6 | 42.9 | 43.6 | 38.4 | 40.0 | 39.6 | 36.1 | 36.6 | −0.9 | < 0.001 |
| Specialty of third physician, if required¶ (n = 867) | |||||||||||||
| Psychiatrist | 68.4 | 41.7 | 66.7 | 57.7 | 67.9 | 77.6 | 62.7 | 68.8 | 67.9 | 74.3 | 68.9 | 0.1 | 0.06 |
| Disease or organ specialist | 31.6 | 58.3 | 33.3 | 42.3 | 32.1 | 22.4 | 37.3 | 31.3 | 32.1 | 25.7 | 31.1 | −0.1 | 0.06 |
| Consultations beyond legal requirements | |||||||||||||
| Additional physician or palliative care team | 80.3 | 55.3 | 53.9 | 50.6 | 59.2 | 55.5 | 56.0 | 52.4 | 52.3 | 53.3 | 50.7 | −3.0 | < 0.001 |
| Additional physician | 37.9 | 38.1 | 34.1 | 28.0 | 34.5 | 33.2 | 29.9 | 26.8 | 26.5 | 26.4 | 25.0 | −1.3 | < 0.001 |
| Palliative care team**†† | 33.9 | 33.8 | 31.3 | 32.4 | 39.4 | 38.1 | 41.1 | 40.6 | 38.0 | 39.9 | 39.3 | 0.5 | 0.001 |
| Drugs used** | |||||||||||||
| Barbiturate IV, with or without neuromuscular relaxant | 80.0 | 85.1 | 92.1 | 94.2 | 96.0 | 98.2 | 98.2 | 99.2 | 98.8 | 99.1 | 98.7 | 1.9 | < 0.001 |
| Barbiturate per os, with or without neuromuscular relaxant | 1.8 | 1.7 | 1.0 | 2.8 | 2.4 | 1.0 | 0.9 | 0.3 | 0.8 | 0.4 | 1.0 | −0.1 | < 0.001 |
| Other or unclear from registration form‡‡ | 18.2 | 13.2 | 6.9 | 3.0 | 1.6 | 0.9 | 1.0 | 0.5 | 0.4 | 0.5 | 0.3 | −1.8 | < 0.001 |
Note: IV = intravenous.
↵* Data for 2002 were excluded from analysis because the euthanasia law came into force on Sept. 23, 2002,15 and data for 2002 thus represent less than an entire year. A total of 24 cases were reported from Sept. 23 to Dec. 31, 2002.
↵† Based on χ2 linear-by-linear association statistics.
↵‡ Euthanasia based on an advance euthanasia directive is allowed only if the person is in an irreversible coma.
↵§ The attending physician must consult a second, independent physician about the serious and incurable character of the disorder. Information about this aspect is ascertained by an open-ended question on the registration form.
↵¶ Belgian law distinguishes between persons who are expected to die in the foreseeable future and those who are not expected to die in the foreseeable future. For the latter, a third physician must be consulted. The third physician should be either a psychiatrist or a specialist in the patient’s illness.
↵** Data on whether palliative care teams were consulted and on the drugs used to perform euthanasia were available for only 56 of the 235 cases in 2003.
↵†† Palliative care consultation is not legally required; however, palliative care teams may be consulted about euthanasia requests, beyond the legal requirements to do so.
↵‡‡ Other drugs included midazolam, morphine and other drugs used to induce unconsciousness.