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


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Van den Block
Lieve
L
Vrije Universiteit Brussel, End-of-Life Care Research Group, Laarbeeklaan 103, 1090 Brussels, Belgium. lvdblock@vub.ac.be
Deschepper
Reginald
R
Bilsen
Johan
J
Bossuyt
Nathalie
N
Van Casteren
Viviane
V
Deliens
Luc
L
D000293:Adolescent; D000328:Adult; D016223:Advance Directives / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D001530:Belgium; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003657:Decision Making; D005065:Euthanasia / Q000706:statistics & numerical data* / Q000639:trends; D028601:Euthanasia, Active / Q000706:statistics & numerical data / Q000639:trends; D005194:Family Practice / Q000592:standards / Q000639:trends; D005260:Female; D005843:Geography; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D016017:Odds Ratio; D010817:Physician-Patient Relations; D015995:Prevalence; D011336:Probability; D012042:Registries; D012307:Risk Factors; D013727:Terminal Care / Q000592:standards / Q000639:trends; D055815:Young Adult