Attitudes and practices of physicians regarding physician-assisted dying in minors.
OBJECTIVE
To investigate attitudes towards physician-assisted death in minors among all physicians involved in the treatment of children dying in Flanders, Belgium over an 18-month period, and how these are related to actual medical end-of-life practices.


METHODS
Anonymous population-based postmortem physician survey.


METHODS
Flanders, Belgium.


METHODS
Physicians signing death certificates of all patients aged 1-17 years who died between June 2007 and November 2008.


METHODS
Attitudes towards physician-assisted death in minors and actual end-of-life practices in the deaths concerned.


RESULTS
124 physicians for 70.5% of eligible cases (N=149) responded. 69% favour an extension of the Belgian law on euthanasia to include minors, 26.6% think this should be done by establishing clear age limits and 61% think parental consent is required before taking life-shortening decisions. Cluster analysis yielded a cluster (67.7% of physicians) accepting of, and a cluster (32.2% of physicians) reluctant towards physician-assisted death in minors. Controlling for physician specialty and patient characteristics, acceptant physicians were more likely to engage in practices with the intention of shortening a patient's life than were reluctant physicians.


CONCLUSIONS
A majority of surveyed Flemish physicians appear to accept physician-assisted dying in children under certain circumstances and favour an amendment to the euthanasia law to include minors. The approach favoured is one of assessing decision-making capacity rather than setting arbitrary age limits. These stances, and their connection with actual end-of-life practices, may encourage policy-makers to develop guidelines for medical end-of-life practices in minors that address specific challenges arising in this patient group.
Pousset
Geert
G
Bioethics Institute Ghent, Ghent University, Ghent, Belgium. geert.pousset@ugent.be
Mortier
Freddy
F
Bilsen
Johan
J
Cohen
Joachim
J
Deliens
Luc
L
D000293:Adolescent; D001291:Attitude of Health Personnel; D001530:Belgium; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D004992:Ethics, Medical; D028601:Euthanasia, Active / Q000941:ethics / Q000331:legislation & jurisprudence / Q000523:psychology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016743:Mental Competency; D033242:Minors; D033282:Parental Consent; D010358:Patient Participation; D011364:Professional Practice / Q000706:statistics & numerical data; D013727:Terminal Care / Q000941:ethics / Q000331:legislation & jurisprudence / Q000523:psychology