"An indelible mark" the response to participation in euthanasia and physician-assisted suicide among doctors: A review of research findings.

INTRODUCTION: The debate regarding euthanasia and physician-assisted suicide (E/PAS) raises key issues about the role of the doctor, and the professional, ethical, and clinical dimensions of the doctor-patient relationship. This review aimed to examine the published evidence regarding the response of doctors who have participated in E/PAS. METHODS: Original research papers were identified reporting either qualitative or qualitative data published in peer-reviewed literature between 1980 and March 2018, with a specific focus on the impact on, or response from, physicians to their participation in E/PAS. PRISMA and CASP guidelines were followed. RESULTS: Nine relevant papers met selection criteria. Given the limited published data, a descriptive synthesis of quantitative and qualitative findings was performed. Quantitative surveys were limited in scope but identified a mixed set of responses. Where studies measured psychological impact, 30-50% of doctors described emotional burden or discomfort about participation, while findings also identified a comfort or satisfaction in believing the request of the patient was met. Significant, ongoing adverse personal impact was reported between 15% to 20%. A minority of doctors sought personal support, generally from family or friends, rather than colleagues. The themes identified from the qualitative studies were summarized as: 1) coping with a request; 2) understanding the patient; 3) the doctor's role and agency in the death of a patient; 4) the personal impact on the doctor; and 5) professional guidance and support. SIGNIFICANCE OF RESULTS: Participation in E/PAS can have a significant emotional impact on participating clinicians. For some doctors, participation can contrast with perception of professional roles, responsibilities, and personal expectations. Despite the importance of this issue to medical practice, this is a largely neglected area of empirical research. The limited studies to date highlight the need to address the responses and impact on clinicians, and the support for clinicians as they navigate this challenging area.

La eutanasia, tendencias y opiniones en España / Euthanasia: trends and opinions in Spain

OBJETIVO: Conocer la evolución de la opinión pública y de los médicos sobre la eutanasia entre 1995 y 2019 y su influencia en el momento actual. MATERIAL Y MÉTODO: Análisis bibliográfico de publicaciones de mayor relevancia y calidad en plataformas de acceso abierto y de acceso académico. Revisión de los principales sondeos de instituciones públicas y privadas. Revisión de los diarios de sesiones del Congreso y el Senado. RESULTADOS: Encuestas recientes muestran al colectivo médico favorable a la regulación de la eutanasia, una posición que concuerda con lo que opina la población en general y que, de manera sostenida, ha ido creciendo su respaldo en las últimas décadas. DISCUSIÓN: El apoyo social y clínico a la regulación han sido elementos importantes. Una lectura que también ha sido realizada por los partidos políticos, que en las últimas dos décadas han ido virando sus posiciones, generando una ventana de oportunidad a la regulación

OBJECTIVE: Analyse the evolution of opinions about euthanasia by the general public and clinical physicians from 1995 to 2019 and their influence at the present time. MATERIAL AND METHOD: Bibliographical review based on relevance and quality of publications in open access and academic access platforms. Main surveys review of public and private institutions. Congress and Senate Official Journal Sessions. RESULTS: Recent surveys show that clinicians support the regulation of euthanasia. This position matches the general public's belief, which has grown steadily in recent decades. DISCUSSION: Social and clinical support for the regulation of euthanasia has been fundamental. In the last two decades political parties have changed their positions, thus creating a window of opportunity

Factors associated with requesting and receiving euthanasia: a nationwide mortality follow-back study with a focus on patients with psychiatric disorders, dementia, or an accumulation of health problems related to old age.

BACKGROUND: Recently, euthanasia and assisted suicide (EAS) in patients with psychiatric disorders, dementia, or an accumulation of health problems has taken a prominent place in the public debate. However, limited is known about this practice. The purpose of this study was threefold: to estimate the frequency of requesting and receiving EAS among people with (also) a psychiatric disorder, dementia, or an accumulation of health problems; to explore reasons for physicians to grant or refuse a request; and to describe differences in characteristics, including the presence of psychiatric disorders, dementia, and accumulation of health problems, between patients who did and did not request EAS and between patients whose request was or was not granted. METHODS: A nationwide cross-sectional survey study was performed. A stratified sample of death certificates of patients who died between 1 August and 1 December 2015 was drawn from the central death registry of Statistics Netherlands. Questionnaires were sent to the certifying physician (n = 9351, response 78%). Only deceased patients aged ≥ 17 years and who died a non-sudden death were included in the analyses (n = 5361). RESULTS: The frequency of euthanasia requests among deceased people who died non-suddenly and with (also) a psychiatric disorder (11.4%), dementia (2.1%), or an accumulation of health problems (8.0%) varied. Factors positively associated with requesting euthanasia were age (< 80 years), ethnicity (Dutch/Western), cause of death (cancer), attending physician (general practitioner), and involvement of a pain specialist or psychiatrist. Cause of death (neurological disorders, another cause) and attending physician (general practitioner) were also positively associated with receiving euthanasia. Psychiatric disorders, dementia, and/or an accumulation of health problems were negatively associated with both requesting and receiving euthanasia. CONCLUSIONS: EAS in deceased patients with psychiatric disorders, dementia, and/or an accumulation of health problems is relatively rare. Partly, this can be explained by the belief that the due care criteria cannot be met. Another explanation is that patients with these conditions are less likely to request EAS.

Causas de morte e razões para eutanásia em gatos na Região Central do Rio Grande do Sul (1964-2013) / Causes of death and reason for euthanasia in cats in the central region of Rio Grande do Sul, Brazil (1964-2013)

Este trabalho tem por objetivo determinar a prevalência das doenças que causam a morte ou levam à eutanásia de gatos da região central do Rio Grande do Sul. Para isto, foram revisados os arquivos do Laboratório de Patologia Veterinária (LPV) da Universidade Federal de Santa Maria (UFSM) entre 1964 a 2013, e foram encontrados um total de 1.247 protocolos de necropsias de gatos. Em 878 protocolos (70,4%) a causa da morte e/ou razão para eutanásia foi estabelecida e em 369 casos (29,6%) não foi possível estabelecer uma causa definitiva. Os diagnósticos encontrados foram avaliados e distribuídos em diferentes categorias. Os grupos responsáveis pelo maior número de causas de morte ou razão para eutanásia em gatos foram os distúrbios causados por agentes físicos (15,6%), seguidos das doenças infecciosas e parasitárias (13,2%) e dos tumores (10,50%). Intoxicações e toxi-infecções (5,3%), doenças degenerativas (4,8%), distúrbios iatrogênicos (3,8%), doenças metabólicas e endocrinológicas (2,7%) foram categorias comuns. Doenças imunomediadas (2,1%), doenças nutricionais (1,6%), eutanásia por conveniência (1,4%) e distúrbios congênitos (1%) foram categorias incomuns. Outros distúrbios perfizeram 8,34% dos casos, As doenças mais importantes também foram avaliadas com relação à idade e os resultados obtidos demonstram que os adultos são mais acometidos pelo distúrbio do trato urinário inferior dos felinos, por traumas e por distúrbios iatrogênicos. Os gatos idosos são mais afetados por tumores e por doenças degenerativas, como a insuficiência renal crônica. Nos filhotes a principal doença que causa a morte ou eutanásia é a peritonite infecciosa feline.(AU)

The objective of this study was to determine the main diseases that cause death or euthanasia in cats in the central region of Rio Grande do Sul, Brazil. The Veterinary Pathology Laboratory (LPV-UFSM) files were reviewed from 1964 to 2013 and a total of 1,247 cat necropsies protocols were found. In 878 (70.40%) protocols the cause of death and/or reason for euthanasia has been established while in 369 (29.59%) cases it was not possible to be determined and these were classified as inconclusive. The final diagnosis were evaluated and classified into different categories. The category which includes the largest number of causes of death or reason for euthanasia in cats are disorders due to physical agents (15.63%), followed by infectious and parasitic diseases (13.15%), tumors (10.50%), other disorders (8.34%), poisoning and toxinfections (5.29%), degenerative diseases (4.81%), iatrogenic disorders (3.76%), metabolic and endocrinological diseases (2.72%), immune-mediated diseases (2.08%), nutritional diseases (1.60), convenience euthanasia (1.44%) and congenital disorders (1.04%). The most important diseases were also evaluated according to age and the results demonstrated that adult cats are most affected by lower urinary tract disease, trauma and iatrogenic disorders. Elderly cats are most affected by tumors and chronic renal failure. However, in young cats, feline infections peritonitis were found to be the most important cause of death or euthanasia.(AU)

Death on demand? An analysis of physician-administered euthanasia in The Netherlands.

Background: Physician-administered euthanasia (PAE) was legalized, along with physician-assisted suicide (PAS), in The Netherlands in 2001. Sources of data: Annual reports of the Dutch Regional Euthanasia Review Committees, the committees' 2015 published Code of Practice and research studies. Areas of agreement: There is a general openness about the practice of PAE/PAS in The Netherlands and an avoidance of misleading euphemisms. The 2001 law also includes arrangements for post-event review of PAE/PAS decisions. Areas of controversy: Rising numbers of annually reported deaths from PAE and uncertainty over actual numbers. Movement away from the principle that euthanasia must take place within an established doctor-patient relationship. Increasing extension of the 2001 law to people with mental health conditions, dementia and multiple co-morbidities. Nature of the post-event scrutiny applied to reported cases. Growing points: The predominance of PAE over PAS where both are legalized raises questions over how these two acts are perceived and whether there are implications for such laws. Areas for timely research: Are the criteria for PAE/PAS in the 2001 law appropriate for a law of this nature? What should be the respective roles of the second-opinion doctors and the review committees?

Discussing euthanasia in two German states: scientific terminology and public discourse in the German Democratic Republic and the Federal Republic of Germany.

Discussions on euthanasia ("Sterbehilfe") that took place in the German Democratic Republic (GDR) have remained widely unnoticed by the historical sciences. By referring to various publications dating from the 1950s until today, this paper presents the basic ideas of the debate on euthanasia in the GDR and compares them-partly synchronically, partly diachronically-with the situation in the Federal Republic of Germany (FRG). A special focus is placed on positions and terminology related to medical ethics at the end of life in the former two German states. The methodical approach of the paper allows a transparent analysis of the question of whether the GDR debates on euthanasia are significant and independent, and whether they are relevant to current ethical debates on end-of-life practices in Germany.

Euthanasia for people with psychiatric disorders or dementia in Belgium: analysis of officially reported cases.

BACKGROUND: Euthanasia for people who are not terminally ill, such as those suffering from psychiatric disorders or dementia, is legal in Belgium under strict conditions but remains a controversial practice. As yet, the prevalence of euthanasia for people with psychiatric disorders or dementia has not been studied and little is known about the characteristics of the practice. This study aims to report on the trends in prevalence and number of euthanasia cases with a psychiatric disorder or dementia diagnosis in Belgium and demographic, clinical and decision-making characteristics of these cases. METHODS: We analysed the anonymous databases of euthanasia cases reported to the Federal Control and Evaluation Committee Euthanasia from the implementation of the euthanasia law in Belgium in 2002 until the end of 2013. The databases we received provided the information on all euthanasia cases as registered by the Committee from the official registration forms. Only those with one or more psychiatric disorders or dementia and no physical disease were included in the analysis. RESULTS: We identified 179 reported euthanasia cases with a psychiatric disorder or dementia as the sole diagnosis. These consisted of mood disorders (N = 83), dementia (N = 62), other psychiatric disorders (N = 22) and mood disorders accompanied by another psychiatric disorder (N = 12). The proportion of euthanasia cases with a psychiatric disorder or dementia diagnosis was 0.5% of all cases reported in the period 2002-2007, increasing from 2008 onwards to 3.0% of all cases reported in 2013. The increase in the absolute number of cases is particularly evident in cases with a mood disorder diagnosis. The majority of cases concerned women (58.1% in dementia to 77.1% in mood disorders). All cases were judged to have met the legal requirements by the Committee. CONCLUSIONS: While euthanasia on the grounds of unbearable suffering caused by a psychiatric disorder or dementia remains a comparatively limited practice in Belgium, its prevalence has risen since 2008. If, as this study suggests, people with psychiatric conditions or dementia are increasingly seeking access to euthanasia, the development of practice guidelines is all the more desirable if physicians are to respond adequately to these highly delicate requests.

The Evolution of Spina Bifida Treatment Through a Biomedical Ethics Lens.

Spina bifida is a neurodevelopmental disorder that results in a broad range of disability. Over the last few decades, there have been significant advances in diagnosis and treatment of this condition, which have raised concerns regarding how clinicians prognosticate the extent of disability, determine quality of life, and use that information to make treatment recommendations. From the selective treatment of neonates in the 1970s, to the advent of maternal-fetal surgery today, the issues that have been raised surrounding spina bifida intervention invoke principles of medical bioethics such as beneficence and nonmaleficence, while also highlighting how quality of life judgments may drive care decisions. Such changes in treatment norms are also illustrative of how disability is viewed both within the medical community and by society at large. An examination of the changes in spina bifida treatment provides a model through which to understand how ethically complex decisions regarding care for children with disabilities has evolved, and the challenges faced when medical information is combined with value-based judgments to guide medical decision making.

Regional variation in the practice of euthanasia and physician-assisted suicide in the Netherlands.

BACKGROUND: The practice of euthanasia and physicianassisted suicide has been compared between countries, but it has not been compared between regions within the Netherlands. This study assesses differences in the frequencies, characteristics, and trends of euthanasia and physician-assisted suicide between five regions in the Netherlands and tries to explain the differences by demographic, socioeconomic, and health-related differences between these regions. METHODS: Data on the frequencies, characteristics, and trends of euthanasia and physician-assisted suicide for each region and each year from 2002 through 2014 were derived from the annual reports of the Regional Review Committees. Averages and trends were determined using a regression model with the regions and years as independent variables. Demographic, socioeconomic, and health-related variables for each region and each year were derived from the Central Bureau for Statistics and added to the model as covariates. RESULTS: The frequencies, characteristics, and trends of euthanasia and physician-assisted suicide differed between the regions, whereas the frequencies of non-assisted suicide did not differ. Euthanasia and physician-assisted suicide were most frequent and were performed most often by general practitioners, in patients with cancer, in the patient's home, in North Holland. The regional differences remained after adjustment for demographic, socioeconomic, and health-related differences between the regions. CONCLUSION: More detailed research is needed to specify how and why the practice of euthanasia and physicianassisted suicide differs between regions in the Netherlands and to what extent these differences reflect a deficiency in the quality of care, such as other forms of regional variation in health care practice.

End-of-life, euthanasia, and assisted suicide: An update on the situation in France.

On February 2, 2016, the French parliament adopted legislation creating new rights for the terminally ill. The text modifies and reinforces the rights of patients to end-of-life care and strengthens the status of surrogate decision makers. Under the new regulations, advance directives become legally binding though not unenforceable. Two types of advance directives are distinguished depending on whether the person is suffering or not from a serious illness when drafting them. The attending physician must abide by the patient's advance directives except in three situations: there is a life-threatening emergency; the directives are manifestly inappropriate; the directives are not compatible with the patient's medical condition. There is no time limit on the validity of advance directives. They are to be written in concordance with a model elaborated by the French superior health authority. This model takes into account the person's knowledge (or not) of having a serious illness when drafting his/her advance directives. In all likelihood, physicians will be called upon to help patients elaborate their advance directives. The law also has a provision for a national registry - potentially the shared medical file - to be designed as a reference source to facilitate storage, accessibility and safety of advance directives. The law introduces the right to continuous deep sedation until death in three specific situations: (i) at the patient's request when the short-term prognosis is death and continuous deep sedation is the only alternative for relieving the patient's suffering or one or more otherwise uncontrollable symptoms; (ii) at the patient's request when the patient chooses to withdraw artificial life-sustaining treatment and such withdrawal would be rapidly life-shortening and susceptible to cause unbearable suffering; (iii) when the patient is unable to express his/her wishes and the collegiate medical decision is to withdraw aggressive futile life-sustaining treatment; continuous deep sedation is mandatory when the patient presents signs of suffering or when the patient's suffering cannot be evaluated due to the patient's cerebral or cognitive state. The law stipulates prior control of such practices, implying the development of a new type of collegiate procedure for medical decision-making. Satisfactory application of this new law will depend greatly on the implementing decrees. It will also depend on the implementation of a genuine policy for the development of palliative care. Professional guidelines will be needed. Several issues relevant to the field of neurology remain unresolved or are introduced by the new regulations. Further in-depth reflection and research are need.

International changes in end-of-life practices over time: a systematic review.

BACKGROUND: End-of-life policies are hotly debated in many countries, with international evidence frequently used to support or oppose legal reforms. Existing reviews are limited by their focus on specific practices or selected jurisdictions. The objective is to review international time trends in end-of-life practices. METHODS: We conducted a systematic review of empirical studies on medical end-of-life practices, including treatment withdrawal, the use of drugs for symptom management, and the intentional use of lethal drugs. A search strategy was conducted in MEDLINE, EMBASE, Web of Science, Sociological Abstracts, PAIS International, Worldwide Political Science Abstracts, International Bibliography of the Social Sciences and CINAHL. We included studies that described physicians' actual practices and estimated annual frequency at the jurisdictional level. End-of-life practice frequencies were analyzed for variations over time, using logit regression. RESULTS: Among 8183 references, 39 jurisdiction-wide surveys conducted between 1990 and 2010 were identified. Of those, 22 surveys used sufficiently similar research methods to allow further statistical analysis. Significant differences were found across surveys in the frequency of treatment withdrawal, use of opiates or sedatives and the intentional use of lethal drugs (X 2 > 1000, p < 0.001 for all). Regression analyses showed increased use of opiates and sedatives over time (p < 0.001), which could reflect more intense symptom management at the end of life, or increase in these drugs to intentionally cause patients' death. CONCLUSION: The use of opiates and sedatives appears to have significantly increased over time between 1990 and 2010. Better distinction between practices with different legal status is required to properly interpret the policy significance of these changes. Research on the effects of public policies should take a comprehensive look at trends in end-of-life practice patterns and their associations with policy changes.

Opinión de los profesionales de una unidad de cuidados intensivos sobre la limitación del esfuerzo terapéutico / Opinion of professionals in an intensive care unit on the limitations of therapeutic effort

Objetivo. Conocer la opinión que tienen los profesionales de una unidad de cuidados intensivos sobre el proceso de limitación del esfuerzo terapéutico (LET) con el fin de mejorar los aspectos básicos que influyen en la calidad asistencial. Material y métodos. Estudio descriptivo prospectivo, llevado a cabo en la Unidad de Cuidados Intensivos de un hospital universitario público de tercer nivel. Cuestionario confeccionado con cuestiones de perfil sociodemográfico y cuestiones para conocer la valoración ética, así como el conocimiento y la información que de la LET tenía el personal encuestado. Análisis descriptivo de la muestra. Estadística comparativa utilizando el test estadístico de chi-cuadrado. Resultados. De una muestra de conveniencia de 70 profesionales se obtuvieron 65 encuestas válidas. El 98% de ellos se mostró a favor de la LET. Hasta en un 28% de las respuestas se consideró la LET como algún tipo de eutanasia (activa o pasiva). Un 77% tenían la creencia de que no era lo mismo no iniciar un nuevo tratamiento que retirar un tratamiento ya instaurado. Para el 52% de los encuestados, el factor que más peso debiera tener a la hora de considerar una LET sería el pronóstico de la enfermedad actual, y para el 46%, la calidad de vida futura del paciente. El coste económico del tratamiento a aplicar no fue considerado en ningún caso. Conclusiones. La LET es una práctica aprobada por los profesionales de nuestra Unidad de Cuidados Intensivos de forma mayoritaria. No obstante, un porcentaje no desdeñable lo entiende como alguna forma de eutanasia (AU)

Objective. To determine the opinion held by professionals in an intensive care unit on the limitation of therapeutic effort process at the end-of-life (LTE). To collect this information, and then use it to improve the basic aspects that the LTE have on the quality of care by intensive care unit staff. Material and methods. A prospective descriptive study was carried out in the Intensive Care Unit of a third level public university hospital. A questionnaire was prepared that included questions on their demographic profile and others to provide an ethical valuation profile, as well as to find out the knowledge and information that the professional had on the LTE. Descriptive study of the sample and comparative statistics were performed using the chi-squared statistical test. Results. A total of 65 valid questionnaires were obtained from a convenience sample of 70 professionals. Almost all of them (98%) were in favour of the limitation of therapeutic effort. The LTE was considered as some kind of euthanasia (active or passive) in up to 28% of the replies, valuations by professional categories is shown in. More than three-quarters (77%) had the belief that not to start treatment was not the same as withdrawing an already established treatment. Just over half (52%) of the respondents believe the value that should have more weight when considering LET would be the prognosis of the current illness of the patient, and 46% the future quality of life of the patient. The economic cost of treatment to be applied was not considered in any case. Conclusions. The LTE is approved by the majority of professionals in our Intensive Care Unit. Although a non-negligible percentage understood it as a form of euthanasia (AU)

Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the United States, Canada, and Europe.

IMPORTANCE: The increasing legalization of euthanasia and physician-assisted suicide worldwide makes it important to understand related attitudes and practices. OBJECTIVE: To review the legal status of euthanasia and physician-assisted suicide and the available data on attitudes and practices. EVIDENCE REVIEW: Polling data and published surveys of the public and physicians, official state and country databases, interview studies with physicians, and death certificate studies (the Netherlands and Belgium) were reviewed for the period 1947 to 2016. FINDINGS: Currently, euthanasia or physician-assisted suicide can be legally practiced in the Netherlands, Belgium, Luxembourg, Colombia, and Canada (Quebec since 2014, nationally as of June 2016). Physician-assisted suicide, excluding euthanasia, is legal in 5 US states (Oregon, Washington, Montana, Vermont, and California) and Switzerland. Public support for euthanasia and physician-assisted suicide in the United States has plateaued since the 1990s (range, 47%-69%). In Western Europe, an increasing and strong public support for euthanasia and physician-assisted suicide has been reported; in Central and Eastern Europe, support is decreasing. In the United States, less than 20% of physicians report having received requests for euthanasia or physician-assisted suicide, and 5% or less have complied. In Oregon and Washington state, less than 1% of licensed physicians write prescriptions for physician-assisted suicide per year. In the Netherlands and Belgium, about half or more of physicians reported ever having received a request; 60% of Dutch physicians have ever granted such requests. Between 0.3% to 4.6% of all deaths are reported as euthanasia or physician-assisted suicide in jurisdictions where they are legal. The frequency of these deaths increased after legalization. More than 70% of cases involved patients with cancer. Typical patients are older, white, and well-educated. Pain is mostly not reported as the primary motivation. A large portion of patients receiving physician-assisted suicide in Oregon and Washington reported being enrolled in hospice or palliative care, as did patients in Belgium. In no jurisdiction was there evidence that vulnerable patients have been receiving euthanasia or physician-assisted suicide at rates higher than those in the general population. CONCLUSIONS AND RELEVANCE: Euthanasia and physician-assisted suicide are increasingly being legalized, remain relatively rare, and primarily involve patients with cancer. Existing data do not indicate widespread abuse of these practices.

Medical end-of-life decisions in Switzerland 2001 and 2013: Who is involved and how does the decision-making capacity of the patient impact?

QUESTIONS UNDER STUDY: In Switzerland, the prevalence of medical end-of-life practices had been assessed on a population level only once - in 2001 - until in 2013/14 an identical study was conducted. We aimed to compare the results of the 2001 and 2013 studies with a special focus on shared decision-making and patients' decision-making capacity. METHODS: Our study encompassed a 21.3% sample of deaths among residents of the German-speaking part of Switzerland aged 1 year or older. From 4998 mailed questionnaires, 3173 (63.5%) were returned. All data were weighted to adjust for age- and sex-specific differences in response rates. RESULTS: Cases with at least one reported end-of-life practice significantly increased from 74.5% (2001) to 82.3% (2013) of all deaths eligible for an end-of-life decision (p <0.001). In 51.2% there was a combination of at least two different end-of-life decisions in one case. In relation to discussion with patients or relatives and otherwise expressed preferences of the patient, 76.5% (74.5-78.4%) of all cases with reported medical end-of-life practice in 2013 (2001: 74.4%) relied on shared decision-making, varying from 79.8% (76.5-82.7%) among not at all capable patients to 87.8% (85.0-90.2%) among fully capable patients. In contrast to a generally increasing trend, the prevalence of end-of-life practices discussed with fully capable patients decreased from 79.0% (75.3-82.3%) in 2001 to 73.2% (69.6-76.0%) in 2013 (p = 0.037). CONCLUSIONS: Despite a generally high incidence of end-of-life practices in Switzerland, there remains potential for further improvement in shared decision-making. Efforts to motivate physicians to involve patients and relatives may be a win-win situation.

[Euthanasia 2002-2014: The situation in Belgium]. / Euthanasie 2002­2014 : état de la situation en Belgique.

INTRODUCTION: Since 2002, Belgian law has authorized the practice of euthanasia under certain clear conditions. All cases have to be reported to the Assessment and Control Commission (ACC). To date, more than 9000 cases have been reported. AIM: To make a statement about the Belgian experience requires consideration of several different essential points: detailed data and information from the ACC reports, their analysis, consequences on medical practice, problems experienced, legal and medical perspectives, criticism and attacks. The concept of individual and institutional conscience is also considered. Euthanasia for minors has been permitted since March 2014 but, to date, no case has been reported. In the light of what has happened in Belgium, we propose to analyse the legal situation in France. MAIN POINTS AND CONCLUSIONS: The Belgian experience is much more than an example and shows that, in difficult and painful situations, it is possible to meet the expectations of patients experiencing intolerable suffering with great respect and without imposing dogmatically something they do not wish.