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Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
Br J Gen Pract. 2010 April 1; 60(573): e163–e170.
PMCID: PMC2845507

Euthanasia in patients dying at home in Belgium: interview study on adherence to legal safeguards

Tinne Smets, MA, Junior Researcher and Johan Bilsen, RN, PhD, Professor of Nursing Sciences
End-of-Life Care Research Group, and Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
Lieve Van den Block, PhD, Senior Researcher and Professor of Communication and Education in General Practice
End-of-Life Care Research Group and Department of General Practice, Vrije Universiteit Brussel, Brussels, Belgium
Joachim Cohen, PhD, Senior Researcher
End-of-Life Care Research Group, and Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
Viviane Van Casteren, MD, Senior Researcher
Scientific Institute of Public Health, Department of Epidemiology, Brussels, Belgium
Luc Deliens, PhD, Professor of Public Health and Palliative Care



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.


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.

Design of study

Large scale, retrospective study.


General practice in Belgium.


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.


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.


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.

Keywords: euthanasia, health policy, terminal care

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners