Study: More Than 1,000 Deaths “Hastened without Patient’s Explicit Request” in Belgium

Genevieve Plaster, M.A.  

In 2011, doctors gave then-22-year-old Matt Davis a 10 percent chance of ever waking up from his coma. After suffering a severe traumatic brain injury from a motorcycle accident, the doctors advised his wife of only seven months, Danielle Josey Davis, to end his life support. “They said if it was them, they’d pull the plug. That’s what they’d want their family to do,” Danielle Davis told ABC News this week. Three months later, her husband awoke from the coma. “I wasn’t going to give up,” she wrote on their GoFundMe page.


The hopeful outcome for the Davis family stands in stark contrast to a troubling new report on end-of-life practices in Belgium, where euthanasia has been legal since 2002. According to the report published last month in the New England Journal of Medicine (NEJM), potentially more than one thousand deaths in Belgium were “hastened [by a doctor] without an explicit request from the patient.” A similar study by the same primary author showed that in 70% of the cases in which doctors decided to hasten death without consent, the patient was comatose.

Hospital room denmark public domain

The new report, entitled “Recent Trends in Euthanasia and Other End-of-Life Practices in Belgium,” was published in the March 19 issue of the NEJM. It was conducted by sending a four-page questionnaire to 6,188 physicians who certified a death certificate in Flanders, the northern Dutch-speaking region of Belgium, for the first half of 2013. Nearly 4,000 doctors participated, yielding a 60.6% response rate. This same survey has been conducted over the years in Belgium beginning in 1998, then again in 2001 and 2007.


One horrific finding was that 1.7% of the deaths were brought about by the doctor without an explicit request from the patient. Since there were 61,621 total reported deaths in Flanders in 2013, possibly more than one thousand people, who did not request euthanasia, died after being given drugs intended to end their lives.


The study defined the 1.7% to include cases “where a patient request was not judged as explicit by the physician, where the request came from the family or where the physician acted out of compassion.”


Though the circumstances of the patients who died this way are not available for the 2013 data, a previous, similar survey conducted in 2007 by the same primary author contains valuable insight. According to the study by Dr. Kenneth Chambaere, published by the Canadian Medical Association Journal (CMAJ) in 2010:


In cases where the decision had not been discussed with the patient, the physician specified as reason(s) that the patient was comatose (70.1% of cases) or had dementia (21.1%); in 40.4% of cases, the physician indicated that the patient had previously expressed a wish for ending life (not equivalent to an explicit request for euthanasia). Physicians specified that the decision had not been discussed with the patient because the decision was in the patient’s best interest (17.0%) or because discussion would have been harmful (8.2%). (Emphasis added.)


The study also noted that while doctors did not discuss the decision to use life-ending drugs with the patient himself, they did discuss it with the patient’s family. The study states:


Compared with euthanasia or assisted suicide, the use of life-ending drugs without an explicit patient request was discussed less often with other caregivers, but as often with the patient’s family… [F]amily burden and the consideration that life was not to be needlessly prolonged were more often reasons for using life-ending drugs without explicit patient request.” (Emphasis added.)


The language of “needlessly prolonging life” reflects a rather cold, utilitarian view that a person’s value is based on what he or she can contribute or what needs he or she can fulfill. It’s telling that most of the patients who were given life-ending drugs without requesting them were 80 years or older, according to the same study.


That these doctors were able to decide whether one should live versus have their death deliberately hastened (not simply allowed to die) is a clear abuse of an already problematic law, and yet it’s not wholly unexpected.


As University of Cambridge law and medical ethics professor John Keown said in 1989: “Once a doctor is prepared to make such a judgment in the case of [a] patient capable of requesting death, the judgment can, logically, equally be made in the case of a patient incapable of requesting death.” Keown continues, “If a doctor thinks death would benefit the patient, why should the doctor deny the patient that benefit merely because the patient is incapable of asking for it?… The logical “slippery slope” argument is unanswerable.”


The American Medical Association acknowledges the slippery slope argument, and strongly opposes euthanasia and physician-assisted suicide for this and many other reasons. Its official statement reads: “Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.”


Though the case of Matt and Danielle Davis doesn’t directly involve euthanasia and assisted suicide, it does send a timely and important message as so-called “death with dignity” laws are being considered in many states. Life has inherent value regardless of one’s state of ability or dependency, and so should be protected.


Genevieve Plaster is a research assistant for the Charlotte Lozier Institute.


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