Belgium (2002- )

Euthanasia became legal in Belgium on 3 September 2002.

Increase in numbers

In Belgium deaths by legal euthanasia increased more than fourteenfold (1456%) from 235 in 2003 – the first full year of legalisation – to 3,423  in 2023. From 2020 to 2021 alone the increase was 10.4%, with further increases of 9.85% from 2021 to 2022 and 15.4% from 2022 to 2023.

Officially reported euthanasia now accounts for one in 33 (3.03%) of all deaths in Belgium in 2023.

Organ donation

There was a total of 64 cases of organ donation with euthanasia in Belgium between 2005 and 2021.

One case involved a 52 year old woman with a mental disorder manifested with the symptom of auto-mutilation – cutting to cause self-harm.  Her consent to euthanasia and organ donation was accepted despite this particular mental illness.

Polypathology

In 2023 there were 793 cases (23.2% of all cases) of euthanasia for polypathology, that is two or more conditions none of which in itself is sufficient ground for euthanasia. 

Death not expected in the foreseeable future

In 2023 there were 713 cases (20.8%) of euthanasia where the person was not expected to die in the foreseeable future. Euthanasia where death was not expected increased by 38.9% from 2022 to 2023 while euthanasia where death was expected only increased by 10.47% over the same period.

This included 372 (10.9% of all cases) for polypathology;35 for cognitive disorders; 48 for psychiatric disorders (double the number for 2022); and a range of physical non-terminal conditions, including arthritis (18), eye disorders (8), chromosomal and congenital abnormalities (3) and injuries from external causes (9).

No physical suffering

In 2023, 56 (1.9%) cases involved no physical suffering at all. This includes, for example, some cancer patients “whose physical suffering is alleviated by painkillers” but who “may suffer psychologically from the loss of dignity or a loss of autonomy”.

Five children

Five children have so far been killed under the Belgian law. Three children were killed by euthanasia in 2016/2017. These were a 17-year-old child who was suffering from muscular dystrophy; a nine year old child, who had a brain tumour, and an 11 year old child, who was suffering from cystic fibrosis.

Luc Proot a member of the Belgium’s Federal Euthanasia Evaluation and Control Commission, commented to Charles Lane of the Washington Post that he “saw mental and physical suffering so overwhelming that I thought we did a good thing”. As Lane points out he is referring to the Committee approving the cases after the fact based on reports from the doctors who carried out the killing. It is curious that Proot refers to “mental and physical suffering” when the Belgian law specifically refers only to “unbearable physical suffering” in relation to children in contrast to a reference to “unbearable physical or psychological suffering” for adults. This comment raises a doubt in relation to each of these three cases of child euthanasia as to whether there was “unbearable physical suffering” that could not be alleviated.

Good palliative care can relieve the various forms of physical suffering associated with end-stage brain tumours.

Life expectancy for people with cystic fibrosis (CF) is increasing significantly in response to developments in treatment regimes. In the United States the median predicted age of survival for people with CF has now increased to 47 years. It is by no means clear that the 11 year old child euthanased in Belgium in 2016 or 2017 was facing imminent death. He or she may have had years to live. Depression is also a particular issue with CF. The “mental suffering” mentioned by Luc Proot may have been relievable through appropriate treatment.

The 17 year old child had Duchenne muscular dystrophy (DMD). “Until relatively recently, boys with DMD usually did not survive much beyond their teen years. Thanks to advances in cardiac and respiratory care, life expectancy is increasing and many young adults with DMD attend college, have careers, get married and have children. Survival into the early 30s is becoming more common, and there are cases of men living into their 40s and 50s.” On the available information it is not clear whether in this case the child was both imminently dying and experiencing unbearable physical suffering that could not be alleviated.

A fourth child was killed by euthanasia in 2019; and a fifth child was killed in 2023.

Euthanasia to complete failed suicide attempts

Between 2014 and 2017 two patients who were in an irreversible coma after a suicide attempt were euthanased based on an advance directive 5 months and 35 months respectively before the suicide attempt.

Euthanasia for psychiatric conditions and dementia

In 2023 there were 41 cases of euthanasia for cognitive disorders (including Alzheimer’s and other dementias) as well as 48 cases of euthanasia for psychiatric conditions.

In 2022 there were 42 cases of euthanasia for cognitive disorders (including Alzheimer’s and other dementias) as well as 26 cases of euthanasia for psychiatric conditions.

Between 2018 and 2021, there were 97 cases of euthanasia for cognitive disorders (including Alzheimer’s and other dementias) as well as 102 cases of euthanasia for psychiatric conditions and  including  depression/bipolar disorder (36), personality disorders (35), anxiety/stress disorders (10), schizophrenia (10), autism (6), and anorexia (2). 

Extraordinarily, one person was euthanased in 2018 for “Commonly occurring behavioral and emotional disturbances during childhood and adolescence (such as attachment disorder)” and one person in 2020 for “Mental and behavioral disorders related to the use of psychoactive substances”.

The Commission reports that:

In young patients, the unbearable and persistent nature of the suffering was frequently associated with experiences from the past. In this regard, it was a question of sexual abuse, neglect as a child, rejection by parents, self-destructive behavior and suicide attempts. In addition, failed suicide attempts have made those affected aware that there is also another, more dignified way to end their life.

Euthanasia by advanced directive

19 people were killed by euthanasia in 2023 while unable to give consent, pursuant to an advanced directive.

A case of euthanasia without request

One case reported in 2016/2017 concerned an interruptive act of life without request from the patient.

In this complex case where the patient had not made an explicit request, some members of the Commission felt that the law on euthanasia had been violated and that the file should be sent to the public prosecutor. Indeed, demand is one of the essential legal conditions. However, other members considered that a referral to the prosecution was not appropriate. The two-thirds majority, legally required for referral to the King's Attorney (see Article 8 of the law) was not reached (9 for referral to the King's public prosecutor, 7 against).

This high threshold of two-thirds majority of the Commission for referral to the public prosecutor helps explain why only one case has ever been referred (in 2015).

Euthanasia tourism

The place of residence is only required to be reported in the first part of a euthanasia report filed by the doctor performing euthanasia. This part only gets open when questions arise. However, in 2020 and 2021 doctors did refer in the second part of the report to people who were foreigners who came to Belgium to seek euthanasia. There were 79 such cases reported in this way (up from 45 reported in 2016 and 2017) but there may be many more. Of the 79 reported cases “More than half of the deaths were expected in the near future” meaning several were cases where death was not expected in the short term. 

There were 110 cases of euthanasia tourism in 2023. Of these 44 (40%) were cases where death was not expected in the foreseeable future.

Conclusion

The 22-year experiment with euthanasia in Belgium is fatally flawed. It has resulted in the abandonment of the disabled, the mentally ill, the suicidal and the victims of child abuse to hopelessness and State sanctioned death by lethal injection. 

Download a summary on Belgium