title: Euthanasia in patients dying at home in Belgium: interview study on adherence to legal safeguards.
abstract: 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.
authors.affiliation: End-of-Life Care Research Group, and Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium. tinne.smets@vub.ac.be
authors.forename: Tinne
authors.initials: T
authors.lastname: Smets
authors.forename: Johan
authors.initials: J
authors.lastname: Bilsen
authors.forename: Lieve
authors.initials: L
authors.lastname: Van den Block
authors.forename: Joachim
authors.initials: J
authors.lastname: Cohen
authors.forename: Viviane
authors.initials: V
authors.lastname: Van Casteren
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
mesh_terms: 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
chemical_list: D001463:Barbiturates; D009294:Narcotics; D009467:Neuromuscular Depolarizing Agents