Changes in medical end-of-life practices during the legalization process of euthanasia in Belgium

The medical practice of euthanasia in Belgium and The Netherlands: Legal notification, control and evaluation procedures

“…The legalisation process in Belgium was finalised quite quickly and without broad consensus among the medical profession. As a result the Belgian euthanasia law, including its procedures for societal control, was largely based on the Dutch model [17,18].…”

Policy statements and practice guidelines for medical end-of-life decisions in Dutch health care institutions: Developments in the past decade

“…However, practice guidelines for intensified alleviation of symptoms with possible life-shortening effect can be very useful in institutions, since it is a common medical end-of-life decision [15]. In this practice guideline, attention should be paid to the role of nurses, since they are often involved in this medical end-of-life decision, but their role is often unclear [4,5]. Furthermore, it should include information about the lifeshortening effects of pain medication, since there is still uncertainty about this among physicians [19].…”

“…Guidelines can also be relevant because of the ethical and legal aspects of medical decision-making, and this applies in particular to medical end-of-life decisionmaking. Most important professionals regarding medical end-of-life decision making in institutions are physicians and nurses [3][4][5][6] and practice guidelines therefore should be useful and available for them.…”

Letters

“…6 It is also important to know that similarly detailed and thoughtful studies in Belgium, which explored many aspects of physician behaviour in this context, found increased carefulness in decision making and that endof-life decisions were discussed more often with patients, relatives and nurses. 7 These accounts show how the consensus impasse can be transformed and how permissive legislation actually improved end-of-life decision making. May the South African Law Commission's nine-year-old contribution to such legislation be revived and the advance of the disciplines and practice of modern palliative care be prioritised, especially because of the prevalence of HIV/Aids.…”