+16,6% : why does the number of euthanasia cases continue to increase in Belgium?

Two factors emerge from the Commission's report with figures, published a few days ago:

• Firstly, there has been a jump in euthanasia among Dutch-speaking patients (+25%), compared with a slight decrease among French-speaking patients.
• Secondly, there has been a notable increase in euthanasia for ‘multiple pathologies’.

As the Commission indicates, multiple pathologies refer to ‘a combination of suffering caused by several chronic conditions that are progressing towards an end stage’. In practice, these conditions may include terminal heart failure, hemiplegia due to a stroke, but also loss of vision or hearing, polyarthritis or incontinence.

These ‘multiple pathologies’ now account for more than a quarter (27%) of reported euthanasia cases. It should be noted that these cases accounted for only 5% of euthanasia cases in 2013, while already raising questions about the evolution of the justifications accepted for euthanasia: The report at the time highlighted a divergence of opinion within the Commission regarding the justification of euthanasia for multiple conditions, for these non-terminal and ‘normal’ conditions related to the patient's age.

This is, in the Commission's words, the most marked increase in 2024. This reality also influences the increase in euthanasia for patients whose death was not expected in the short term (932 cases in 2024, compared to 713 in 2023), because patients with multiple pathologies are often not at the end of their life.

On the other hand, the press release informs us that 82.3% of patients suffered both physically and psychologically (compared to 76.2% in 2023). According to the Commission, this psychological suffering may be linked to a physical illness, which generates, for example, a ‘loss of autonomy or dignity due to advanced cancer’, ‘while the physical suffering is alleviated by painkillers’.

Finally, there are some interesting details to note about the doctors concerned. Since the lifting of anonymity in euthanasia declarations imposed by the law of 27 March 2024, the Commission has been aware of and has been keeping a record of the qualification of the declaring doctor, i.e. the doctor who performed the euthanasia: in 72% of cases, this is a general practitioner and in 28% of cases, a specialist doctor. The doctor consulted on a mandatory basis is a specialist in the disease in only 33% of cases.

No case file has been forwarded to the Public Prosecutor's Office because the Commission considers that ‘the registration documents received met the essential conditions of the law’. Since 2024, in fact, violation of the formal or procedural conditions surrounding euthanasia no longer constitutes grounds for prosecution of the doctor.

Critical analysis:

Two priorities emerge from a reading of this data:

• Psychological suffering is increasingly present in people resorting to euthanasia (82%), regardless of the pathologies involved. This suffering tends to persist even when the pain is relieved. This results in an urgent need to supplement the care provided to the patient on a psychological, social and - where appropriate - spiritual level, according to the comprehensive approach to care favoured by palliative care.

• The considerable and continuous increase in euthanasia for ‘multiple pathologies’ has given rise to an urgent need to analyse in greater depth this phenomenon of euthanasia for ageing people. In particular, this data should be cross-referenced with the increase in euthanasia on the Dutch-speaking side.

*It can be assumed that the declarations written in Dutch by doctors concern Dutch-speaking patients, although this is undoubtedly not automatically the case.