A new study published in CMAJ Open may dispel serious misunderstandings about assisted death and palliative care in Belgium, according to authors Drs. Kenneth Chambaere, Jan L Bernheim, James Downar and Luc Deliens. They say that most Belgian cases of "non-voluntary euthanasia" are incorrectly labelled.
The study, "Characteristics of Belgian "life-ending acts without explicit patient request": a large-scale death certificate survey revisited", looked at the 66 cases of life-ending acts without explicit request identified in a large anonymous survey from 2007 that was first published in CMAJ in 2010. These cases were widely interpreted as examples of non-voluntary ending of life.
However, the detailed re-examination of the cases described in the CMAJ Open paper indicates that a large majority (68%) would not fit this label. In many cases, the medications reported by physicians that were used to end the patient's life would not have hastened death, and were actually similar to those given for symptom relief as part of appropriate palliative care.
In other cases, the patient had made a request for their life to be ended, albeit one that did not meet the legal criteria set out in the legislation. Physicians themselves described most cases of life-ending acts without explicit request as symptom treatment (88%). Mislabeling was probably due to misconceptions that are still common among physicians about the effect of opioid medication, the authors suggest.
"Although life-ending acts without explicit request cases can raise questions about the intent of the physician, most should not be thought of as "non-voluntary euthanasia"," state the authors. "A more nuanced view of life-ending acts without explicit request is recommended in the debates on physician-assisted dying."
In another recent paper from the End-of-Life Care Research Group of the Vrije Universiteit Brussel and Ghent University, "Questions and Answers on the Belgian Model of Integral End-of-Life Care: Experiment? Prototype?", published by the Journal of Bioethical Inquiry, palliative-care doctors Jan L. Bernheim, Wim Distelmans, Arsène Mullie and Michael A. Ashby purport to allay several other widespread concerns. From their review of the data they conclude that legalization of physician-assisted death in Belgium was associated with strongly expanded palliative care, greater public confidence in the healthcare system, and no increased risk to the vulnerable. The Belgian model of so-called integral end-of-life care continues to evolve, they say, with constant scrutiny of practice, improvements of its procedures and gradual remediation of its remaining imperfections.
These data should contribute to a better-informed international debate about end-of-life issues.