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Great support among psychiatrists in Belgium to retain euthanasia as option in psychiatric suffering

On Tuesday the 11th of August, the End-of-life Care Research Group (VUB-UGent) published a study about the willingness among psychiatrists to take a concrete, active role in euthanasia procedures when it comes to psychiatric suffering. The results are ambiguous.

Motivation for the study
In Belgium, patients suffering from a psychiatric illness can, under certain circumstances, end their life through euthanasia. Nevertheless, in recent years there has been an increasingly louder call for the current euthanasia law to be scaled back or tightened. Dutch research has shown that psychiatrists tend to be more cautious and rarely honor euthanasia requests from this patient group. But how do psychiatrists in Flanders view the Belgian euthanasia law and practice in this patient group? To what extent are they willing to take a concrete, active role in such euthanasia procedures? And if so, which role? And to what extent have they been confronted with such euthanasia requests and procedures during their careers?

The study
The study was a cross-sectional survey study, that was performed between November 2018 and April 2019. The survey was sent to a sample of 499 eligible psychiatrists affiliated to the Flemish Association for Psychiatry, a professional association that aims to unite and represent all psychiatrists working in Flanders, the Dutch-speaking, northern part of Belgium. The Association’s members comprise an estimated 80–90% of all psychiatrists active in Flanders. Only psychiatrists working with adults with psychiatric conditions (83% of the association’s total membership) were included.

Three-quarters of the psychiatrists were in favor of retaining euthanasia as a legal end-of-life option for patients suffering from serious psychiatric illness. The vast majority of psychiatrists are convinced that the suffering of these patients can be unbearable (95%) and medically hopeless (84%). But there is less willingness to actively work with these euthanasia requests. Yet only a minority of psychiatrists are willing to take on the formal arrangement of an explicit euthanasia request (39 percent) or to provide formal advice (30 percent). Less than 10 percent of psychiatrists envisioned an executive physician role. The majority would refer a psychiatric patient with such a request to a colleague for further regulation. Finally, 80 percent also indicate that they have already been confronted with such a request. All the results of this survey are published (open acces) in BMC Psychiatry.

Belgian practice
The findings reveal that the Belgian euthanasia practice concerning adults with psychiatric disorders is not a peripheral one, as a large proportion of psychiatrists has been confronted with and engaged in such euthanasia requests and procedures. However, psychiatrists’ engagement is often limited to the role of referring these patients to a colleague-physician for the further clarification and/or performance of these patients’ euthanasia request. These referrals are mostly due to the legal assessment criteria that are difficult to apply in this specific patient group and difficult to reconcile in therapeutic consultations. The main motives for psychiatrists to engage in euthanasia are the patient’s fundamental right in Belgian law to ask for euthanasia and the psychiatrist’s duty to work with it. However, results also reveal psychiatrists’ perception of some colleague’s inadequate (perfunctory) euthanasia assessment and the fear of risking juridical persecution. Less than 10% of the responding psychiatrists has refused to engage in such assessment procedures, due to e.g. conscientious objections.

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