Reporting of euthanasia in medical practice in Flanders, Belgium: cross sectional analysis of reported and unreported cases

• Published in: BMJ 2010-10, Vol.341 (7777), p.819-819
• Main Authors: Smets, Tinne, Bilsen, Johan, Cohen, Joachim, Rurup, Mette L, Mortier, Freddy, Deliens, Luc
• Format: Article
• Language: English
• Subjects: Anesthesia; Assisted Dying; Assisted suicide; Attention deficit disorder; Belgium; Bioethics; Committees; Cross sectional studies; Death; Death Certificates; Decision Making; Doctors; Drugs: Musculoskeletal and Joint Diseases; End of Life Decisions (Ethics); End of Life Decisions (Geriatric Medicine); End of Life Decisions (Palliative Care); Euthanasia; Euthanasia - statistics & numerical data; Family Practice; Hospice; Humans; Labeling; Mandatory Reporting; Medical practice; Medical practices; Medical research; Medical services; Opioids; Physicians; Questionnaires; Research universities; Sedatives; Sociology; Surveys and Questionnaires; Terminal Care
• ISSN: 0959-8138; 0959-535X; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.c5174

Objectives To estimate the rate of reporting of euthanasia cases to the Federal Control and Evaluation Committee and to compare the characteristics of reported and unreported cases of euthanasia.Design Cross sectional analysis.Setting Flanders, Belgium.Participants A stratified at random sample was drawn of people who died between 1 June 2007 and 30 November 2007. The certifying physician of each death was sent a questionnaire on end of life decision making in the death concerned. Main outcome measures The rate of euthanasia cases reported to the Federal Control and Evaluation Committee; physicians’ reasons for not reporting cases of euthanasia; the relation between reporting and non-reporting and the characteristics of the physician and patient; the time by which life was shortened according to the physician; the labelling of the end of life decision by the physician involved; and differences in characteristics of due care between reported and unreported euthanasia cases.Results The survey response rate was 58.4% (3623/6202 eligible cases). The estimated total number of cases of euthanasia in Flanders in 2007 was 1040 (95% CI 970 to 1109), thus the incidence of euthanasia was estimated as 1.9% of all deaths (95% CI 1.6% to 2.3%). Approximately half (549/1040 (52.8%, 95% CI 43.9% to 60.5%)) of all estimated cases of euthanasia were reported to the Federal Control and Evaluation Committee. Physicians who perceived their case as euthanasia reported it in 93.1% (67/72) of cases. Cases of euthanasia were reported less often when the time by which life was shortened was less than one week compared with when the perceived life shortening was greater (37.3% v 74.1%; P