Recent Trends in Euthanasia and Other End-of-Life Practices in Belgium

Recent Trends in Euthanasia and Other End-of-Life Practices in BelgiumTo the Editor: In Belgium, where euthanasia was legalized in 2002, large-scale repeat surveys have monitored the evolution of medical end-oflife practices since 1998, with subsequent surveys conducted in 2001 and 2007 1,2 and the latest in 2013.As was done in previous surveys, 2 we sent questionnaires to 6188 physicians certifying death certificates from the first half of 2013 in Flanders, the Dutch-speaking half of Belgium, with approximately 6 million inhabitants and 58,000 deaths annually (see the Supplementary Appendix, available with the full text of this letter at NEJM.org).The response rate was 60.6%.The response sample was weighted to be representative of all the deaths that occurred in the first half of 2013.After a large increase between 2001 and 2007, the total percentage of deaths preceded by one or more possibly life-shortening end-of-life practices remained stable at 47.8% in 2013 (Table 1).The intensified alleviation of pain and other symptoms with the use of drugs, with possible shortening of life taken into account (24.2% of deaths), and the withholding or withdrawing of life-prolonging treatment (17.2%) remained the most prevalent end-of-life practices.The rate of euthanasia increased significantly