Euthanasia in patients dying at home in Belgium: interview study on adherence to legal safeguards.
BACKGROUND
Euthanasia became legal in Belgium in 2002. Physicians must adhere to legal due care requirements when performing euthanasia; for example, consulting a second physician and reporting each euthanasia case to the Federal Review Committee.


OBJECTIVE
To study the adherence and non-adherence of GPs to legal due care requirements for euthanasia among patients dying at home in Belgium and to explore possible reasons for non-adherence.


METHODS
Large scale, retrospective study.


METHODS
General practice in Belgium.


METHODS
A retrospective mortality study was performed in 2005-2006 using the nationwide Belgian Sentinel Network of General Practitioners. Each week GPs reported medical end-of-life decisions taken in all non-sudden deaths of patients in their practice. GP interviews were conducted for each euthanasia case occurring at home.


RESULTS
Interviews were conducted for nine of the 11 identified euthanasia cases. Requirements concerning the patient's medical condition were met in all cases. Procedural requirements such as consultation of a second physician were sometimes ignored. Euthanasia cases were least often reported (n = 4) when the physician did not regard the decision as euthanasia, when only opioids were used to perform euthanasia, or when no second physician was consulted. Factors that may contribute to explaining non-adherence to the euthanasia law included: being unaware of which practices are considered to be euthanasia; insufficient knowledge of the euthanasia law; and the fact that certain procedures are deemed burdensome.


CONCLUSIONS
Substantive legal due care requirements for euthanasia concerning the patient's request for euthanasia and medical situation were almost always met by GPs in euthanasia cases. Procedural consultation and reporting requirements were not always met.
Smets
Tinne
T
End-of-Life Care Research Group, and Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium. tinne.smets@vub.ac.be
Bilsen
Johan
J
Van den Block
Lieve
L
Cohen
Joachim
J
Van Casteren
Viviane
V
Deliens
Luc
L
D000293:Adolescent; D000328:Adult; D016223:Advance Directives; D000368:Aged; D001463:Barbiturates / Q000506:poisoning; D001530:Belgium; D005065:Euthanasia / Q000331:legislation & jurisprudence*; D005260:Female; D058006:General Practice / Q000331:legislation & jurisprudence* / Q000592:standards; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000506:poisoning; D009467:Neuromuscular Depolarizing Agents / Q000506:poisoning; D017410:Practice Guidelines as Topic; D011364:Professional Practice / Q000331:legislation & jurisprudence* / Q000592:standards; D012189:Retrospective Studies; D055815:Young Adult
D001463:Barbiturates; D009294:Narcotics; D009467:Neuromuscular Depolarizing Agents