End-of-life decisions in medical practice in Flanders, Belgium: a nationwide survey

Background Our study is a repeat of the Dutch death-certificate study on en d-of-life decisions (ELDs). The main objective was to estimate the frequenc y of euthanasia (the administration of lethal drugs with the explicit inten tion of shortening the patient's life at the patient's explicit request), p hysician-assisted suicide (PAS), and other ELDs in medical practice in Flan ders, Belgium. Methods A 20% random sample of 3999 deaths was selected from all deaths rec orded between Jan 1 and April 30, 1998. The physicians who signed the corre sponding death certificates received one questionnaire by post per death. Findings The physicians' response rate was 1355 (52%). 1925 deaths were des cribed. The results were corrected for non-response bias, and extrapolated to estimated annual rates after seasonal adjustment for death causes, and w e estimate that 705 (1.3%, 95% CI 1.0-1.6) deaths resulted from euthanasia or PAS. In 1796 (3.2%, 2.7-3.8) cases, lethal drugs were given without the explicit request of the patient. Alleviation of pain and symptoms with opio ids in doses with a potential life-shortening effect preceded death in 10 4 16 (18.5%, 17.3-19.7) cases and non-treatment decisions in 9218 (16.4%, 15. 3-17.5) cases, of which 3261 (5.8%, 5.1-6.5) with the explicit intention of ending the patient's life. Interpretation ELDs are prominent in medical practice in Flanders. The freq uency of deaths preceded by an ELD is similar to that in the Netherlands, b ut lower than that in Australia. However, in Flanders the rate of administr ation of lethal drugs to patients without their explicit request is similar to Australia, and significantly higher than that in the Netherlands.