Euthanasia and other end-of-life decisions: a mortality follow-back study in Belgium

• Published in: BMC public health 2009-03, Vol.9 (1), p.79-79, Article 79
• Main Authors: Van den Block, Lieve, Deschepper, Reginald, Bilsen, Johan, Bossuyt, Nathalie, Van Casteren, Viviane, Deliens, Luc
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Advance Directives - statistics & numerical data; Aged; Aged, 80 and over; Attitude to Death; Belgium; Cause of Death; Central service department; Child; Child, Preschool; Confidence Intervals; Cross-Sectional Studies; Decision Making; Demographic aspects; Distribution; Euthanasia; Euthanasia - statistics & numerical data; Euthanasia - trends; Euthanasia, Active - statistics & numerical data; Euthanasia, Active - trends; Family Practice - standards; Family Practice - trends; Female; Forecasts and trends; Geography; Home care services; Home care services industry; Hospitals; Humans; Infant; Laws, regulations and rules; Male; Middle Aged; Mortality; Mortality - trends; Odds Ratio; Physician-Patient Relations; Prevalence; Probability; Registries; Risk Factors; Statistics; Terminal care; Terminal Care - standards; Terminal Care - trends; Young Adult
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/1471-2458-9-79

This study compares prevalence and types of medical end-of-life decisions between the Dutch-speaking and French-speaking communities of Belgium. This is the first nationwide study that can make these comparisons and the first measurement after implementation of the euthanasia law (2002). We performed a mortality follow-back study in 2005-2006. Data were collected via the nationwide Sentinel Network of General Practitioners, an epidemiological surveillance system representative of all Belgian GPs.Weekly, all GPs reported the medical end-of-life decisions among all non-sudden deaths of patients in their practice. We compared the northern Dutch-speaking (60%) and southern French-speaking communities (40%) controlling for population differences. We analysed 1690 non-sudden deaths. An end-of-life decision with possible life-shortening effect was made in 50% of patients in the Dutch-speaking community and 41% of patients in the French-speaking community (OR 1.4; 95%CI, 1.2 to 1.8). Continuous deep sedation until death occurred in 8% and 15% respectively (OR 0.5; 95%CI, 0.4 to 0.7). Community differences regarding the prevalence of euthanasia or physician-assisted suicide were not significant.Community differences were more present among home/care home than among hospital deaths: non-treatment decisions with explicit life-shortening intention were made more often in the Dutch-speaking than in the French-speaking community settings (OR 2.2; 95%CI, 1.2 to 3.9); while continuous deep sedation occurred less often in the Dutch-speaking community settings (OR 0.5; 95%CI, 0.3 to 0.9). Even though legal and general healthcare systems are the same for the whole country, there are considerable variations between the communities in type and prevalence of certain end-of-life decisions, even after controlling for population differences.