title: Prevalence and content of written ethics policies on euthanasia in Catholic healthcare institutions in Belgium (Flanders).
abstract: BACKGROUND
  Euthanasia is performed worldwide, regardless of the existence of laws governing it. Belgium became the second country in the world to enact a law on euthanasia in 2002. Healthcare institutions bear responsibility for guaranteeing the quality of care for patients at the end of life, and for ensuring support for caregivers involved. Therefore, institutional ethics policies on end-of-life decision-making, especially on euthanasia, may be useful.
  
  
  METHODS
  A cross-sectional mail survey of general directors of Catholic hospitals and nursing homes in Belgium was used to describe the prevalence and content of written ethics policies for competent terminally ill, incompetent terminally ill, and non-terminally ill patients.
  
  
  RESULTS
  Of the 298 targeted institutions, 81% of hospitals and 62% of nursing homes returned complete questionnaires. Of these, 79% of hospitals and 30% of nursing homes had a written ethics policy on euthanasia. Of hospitals 83% and of nursing homes 85% permitted euthanasia for competent terminally ill patients only in exceptional cases in accordance with legal due care criteria and provisions outlined by the palliative filter procedure. Euthanasia for incompetent terminally ill patients was prohibited by 27% of the hospitals and by 60% of the nursing homes. For non-terminally ill patients, these figures were 43 and 64%, respectively.
  
  
  CONCLUSIONS
  Catholic healthcare institutions in Belgium (Flanders) made great efforts to develop written ethics policies on euthanasia. Only a small group of institutions completely prohibited euthanasia. Most of the institutions considered euthanasia to be an option if all possible alternatives (e.g., palliative filter procedure, which contains more rigorous criteria than those in the Belgian Euthanasia Act), have been thoroughly investigated.
authors.affiliation: Katholieke Universiteit Leuven, Centre for Biomedical Ethics and Law, Kapucijnenvoer 35, Leuven 3000, Belgium. Chris.Gastmans@med.kuleuven.be
authors.forename: Chris
authors.initials: C
authors.lastname: Gastmans
authors.forename: Joke
authors.initials: J
authors.lastname: Lemiengre
authors.forename: Gerrit
authors.initials: G
authors.lastname: van der Wal
authors.forename: Paul
authors.initials: P
authors.lastname: Schotsmans
authors.forename: Bernadette
authors.initials: B
authors.lastname: Dierckx de Casterlé
mesh_terms: D001530:Belgium; D002410:Catholicism; D003430:Cross-Sectional Studies; D003625:Data Collection; D005065:Euthanasia / Q000941:ethics*; D006268:Health Facilities; D006801:Humans; D016134:Organizational Policy