title: Trends in medical end-of-life decision making in Flanders, Belgium 1998-2001-2007.
abstract: In 2002, Belgium saw the enactment of 3 laws concerning euthanasia, palliative care, and patient rights that are likely to affect end-of-life decision making. This report examines trends in the occurrence and decision-making process of end-of-life practices in different patient groups since these legal changes. A large-scale retrospective survey in Flanders, Belgium, previously conducted in 1998 and 2001, was repeated in 2007. Questionnaires regarding end-of-life practices and the preceding decision-making process were mailed to physicians who certified a representative sample (N = 6927) of death certificates. The 2007 response rate was 58.4%. In patient groups in which the prevalence of life-ending drug use without explicit patient request has dropped, performance of euthanasia and assisted suicide has increased. The consistent increase in intensified pain and symptom alleviation was found in all patient groups except cancer patients. In 2007, competent patients were slightly more often involved in the discussion of end-of-life practices than in previous years. Over the years, involvement of the patient in decision making was consistently more likely among younger patients, cancer patients, and those dying at home. Physicians consulted their colleagues more often than in previous years for euthanasia and nontreatment decisions. The euthanasia law and emerging palliative care culture have substantially affected the occurrence and decision making for end-of-life practices in Belgium. Efforts are still needed to encourage shared end-of-life decision making, as some patients would benefit from advance care planning.
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium (KC, JB, JC, LD)
authors.forename: Kenneth
authors.initials: K
authors.lastname: Chambaere
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium (KC, JB, JC, LD)|Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium (JB)
authors.forename: Johan
authors.initials: J
authors.lastname: Bilsen
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium (KC, JB, JC, LD)
authors.forename: Joachim
authors.initials: J
authors.lastname: Cohen
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, the Netherlands (BDOP, LD)
authors.forename: Bregje D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
authors.affiliation: Bioethics Institute Ghent, Ghent University, Ghent, Belgium (FM)
authors.forename: Freddy
authors.initials: F
authors.lastname: Mortier
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium (KC, JB, JC, LD)|Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, the Netherlands (BDOP, LD)
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D003657:Decision Making; D019538:Health Care Surveys; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D005791:Patient Care / Q000941:ethics; D028701:Patient Rights / Q000941:ethics*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000941:ethics* / Q000379:methods; D028761:Withholding Treatment / Q000941:ethics*