title: Does legal physician-assisted dying impede development of palliative care? The Belgian and Benelux experience.
abstract: BACKGROUND
  In 2002, physician-assisted dying was legally regulated in the Netherlands and Belgium, followed in 2009 by Luxembourg. An internationally frequently expressed concern is that such legislation could stunt the development of palliative care (PC) and erode its culture. To study this, we describe changes in PC development 2005-2012 in the permissive Benelux countries and compare them with non-permissive countries.
  
  
  METHODS
  Focusing on the seven European countries with the highest development of PC, which include the three euthanasia-permissive and four non-permissive countries, we compared the structural service indicators for 2005 and 2012 from successive editions of the European Atlas of Palliative Care. As an indicator for output delivery of services to patients, we collected the amounts of governmental funding of PC 2002-2011 in Belgium, the only country where we could find these data.
  
  
  RESULTS
  The rate of increase in the number of structural PC provisions among the compared countries was the highest in the Netherlands and Luxembourg, while Belgium stayed on a par with the UK, the benchmark country. Belgian government expenditure for PC doubled between 2002 and 2011. Basic PC expanded much more than endowment-restricted specialised PC.
  
  
  CONCLUSIONS
  The hypothesis that legal regulation of physician-assisted dying slows development of PC is not supported by the Benelux experience. On the contrary, regulation appears to have promoted the expansion of PC. Continued monitoring of both permissive and non-permissive countries, preferably also including indicators of quantity and quality of delivered care, is needed to evaluate longer-term effects.
authors: End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
authors: Kenneth
authors: K
authors: Chambaere
authors: End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
authors: Jan L
authors: JL
authors: Bernheim
mesh_terms: D001291:Attitude of Health Personnel; D001530:Belgium / Q000453:epidemiology; D033161:Government Regulation; D006801:Humans; D009426:Netherlands / Q000453:epidemiology; D010166:Palliative Care / Q000941:ethics / Q000331:legislation & jurisprudence* / Q000639:trends; D010819:Physician's Role / Q000523:psychology; D010817:Physician-Patient Relations / Q000941:ethics; D010818:Practice Patterns, Physicians' / Q000941:ethics* / Q000331:legislation & jurisprudence; D015397:Program Evaluation; D012017:Referral and Consultation / Q000331:legislation & jurisprudence; D012297:Right to Die / Q000941:ethics / Q000331:legislation & jurisprudence*; D017236:Suicide, Assisted / Q000941:ethics / Q000331:legislation & jurisprudence* / Q000523:psychology; D019452:Terminally Ill / Q000331:legislation & jurisprudence / Q000523:psychology*
keywords: Euthanasia; Palliative Care