Physician-assisted deaths under the euthanasia law in Belgium: a population-based survey

Kenneth Chambaere; Johan Bilsen; Joachim Cohen; Bregje D. Onwuteaka-Philipsen; Freddy Mortier; Luc Deliens

doi:10.1503/cmaj.091876

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Hints that legalisation protects the vulnerable?
Ilana R Levene

Posted on: 17 June 2010

Posted on: (17 June 2010)
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Hints that legalisation protects the vulnerable?
Ilana R Levene, Keble College, Oxford, UK
Your article described a fall in the rate of ‘life-ending acts without explicit request’ (LAWER) with a rise in the rate of euthanasia since legalization of euthanasia in Belgium. Given this coincidental rise and fall, I propose the hypothesis that legalisation has converted cases that would previously have been LAWER into euthanasia. Instead of performing LAWER whilst believing that their patients wanted euthanasia, I p...
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Your article described a fall in the rate of ‘life-ending acts without explicit request’ (LAWER) with a rise in the rate of euthanasia since legalization of euthanasia in Belgium. Given this coincidental rise and fall, I propose the hypothesis that legalisation has converted cases that would previously have been LAWER into euthanasia. Instead of performing LAWER whilst believing that their patients wanted euthanasia, I propose that doctors now feel able to explicitly discuss these issues without fear of prosecution.
The data presented in the paper give support to this hypothesis. As the authors mention, the characteristics of the LAWER cases in 2007 are dissimilar to those of the euthanasia cases - LAWER patients are older (53% over the age of 80), nearer the end of their lives and less likely to be suffering from cancer (34% with a cancer diagnosis). This relationship is also found in large scale Dutch data.[2] However data collected on LAWER patients in 2001, before legalisation, did not show this clear separation of ‘LAWER-type’ from ‘euthanasia-type’ but instead showed intermediate characteristics – for example only 24% of LAWER cases were over age 80 and 52% had cancer.[1] This supports the idea that before legalisation, some patients who may have wanted euthanasia were receiving LAWER because communication between doctor and patient was not explicit. If this were true, it would be an example of a protective function of regulation.
[1] Rietjens JA, Bilsen J, Fischer S, et al. Using drugs to end life without an explicit request of the patient. Death Stud 2007;31(3):205-21.
Conflict of Interest:
None declared
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Competing Interests: None declared.