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In Belgium, palliative care is provided in a variety of settings (hospital, home, nursing home) in response to the demand of many patients to be able to choose where they receive this specific care. However, reports published by the Federal Centre of Expertise for Health Care (KCE) in recent years show that provision still does not meet patients' needs, due to a lack of resources.
In its latest report on palliative care in Belgium, published on 16 January 2025, the KCE recommends setting up a palliative middle care service to complement existing provision. This intermediate care would be situated between routine and non-urgent care on the one hand, and the hospital on the other, particularly for patients who do not require care in a hospital or palliative care unit and who cannot be cared for at home or in a nursing home. The KCE stresses the importance of diversifying palliative care provision and levels of care (generalist and specialist) to better meet the needs of all patients, needs that are not solely linked to advanced age or life expectancy. This is in line with the new focus of palliative care, which since 2016 has been aimed not only at patients at the end of life, but also at anyone suffering from a serious, life-threatening illness.
Palliative care is thus facing a twofold increase in needs, linked on the one hand to the ageing of the population and on the other to the extension of palliative care to new groups. In 2024, the French palliative care federation warned of the lack of resources for palliative care, highlighting in particular the shortage of beds dedicated to this service in hospitals (only 400 are available for the whole of Belgium).
Can euthanasia and palliative care coexist?
The question of the impact of euthanasia on palliative care provision is a major one in Belgium, where palliative care coexists with the possibility of euthanasia. In November 2024, the Anscombe Bioethics Centre published a report as part of the examination of the bill to decriminalise euthanasia in the United Kingdom (Assisted Dying Bill). Entitled Evidence of Harm: Assessing the Impact of Assisted Dying / Assisted Suicide on Palliative Care, the report sheds interesting light on the impact of euthanasia or assisted suicide on palliative care in countries that have decriminalised these practices.
Based on data available in Belgium, Switzerland, the Netherlands and Luxembourg between 2012 and 2019, the author of the report notes that, in these countries, palliative care provision has increased by only 7.9%, compared with 25% in 20 Western European countries where euthanasia remains prohibited. The same observation was made in the United States, where palliative care teams in hospitals increased by only 3.2% in the American states that offer euthanasia or assisted suicide, compared with 9.4% in the other states. Euthanasia would appear to have a negative impact on palliative care, which is not only progressing at a slower rate, but is also deteriorating, due in particular to the pressure exerted on palliative care staff when euthanasia or assisted suicide is introduced.
According to the report by the Anscombe Bioethics Centre, respondents in Flanders noted that ‘euthanasia receives a great deal of attention from the public and the media, which is not the case for palliative care’. Against this backdrop, there is a very real risk that palliative care in Belgium will never meet the needs of patients who, in the absence of appropriate care or information about the existence of this type of care, could more easily turn to euthanasia.