Belgium’s experiment with euthanasia has expanded its scope continually over the past 19 years with deaths by legal euthanasia increasing more than elevenfold from 235 in 2003 to 2,699 in 2021. The increase just from 2020 to 2021 was 10.4%.
Of deaths by euthanasia in 2021 some 15.9% (430 cases) involved people whose deaths were not expected in the foreseeable future.
In 2021, 24 people with psychiatric disorders and 26 with cognitive disorders were killed by euthanasia.
And in 2016 and 2017 three children (ages 9, 11 and 17) were euthanased. A fourth child was euthanased in 2019.
Every two years the Belgium Federal Commission on the Control and Evaluation of Euthanasia presents a report detailing statistics and developments in the practice of euthanasia in Belgium.
The most recent report for 2018 and 2019 is available in French.
Overall the impression is that euthanasia practice in Belgium continues on the path of normalising euthanasia as the go-to response to an ever increasing range of circumstances including children with disabilities, uncompleted suicides and victims of child abuse.
Increase in numbers
Deaths by legal euthanasia increased more than elevenfold from 235 in 2003 to 2,699 in 2021. The increase just from 2020 to 2021 was 10.4%.
Officially reported euthanasia accounted for 2.6% of all deaths in Belgium in 2021.
The 2018-2019 report notes that 18 people who were euthanased donated their organs. These people suffered either from a disease of the nervous system or from a mental and behavioural disorder. The majority of them were Dutch speakers, in the age group 50 to 69, female and death was not expected soon.
Death not expected in the foreseeable future
In 2021 there were 430 cases of reported euthanasia of people whose deaths were not expected in the foreseeable future. This represents 15.9% of all cases of reported euthanasia.
Of these 191 (7% of all cases) were for polypathology where death was not expected in the foreseeable future; 24 were for cognitive disorders; 24 for psychiatric disorders; and, the remaining cases were for a range of physical non-terminal conditions, including arthritis (11), eye and ear disorders (2), chromosomal and congenital abnormalities (4) and injuries from external causes (14).
In 2021 there were 478 cases (17.7% of all cases) of reported euthanasia for “polypathology”, that is two or more conditions none of which in itself is sufficient ground for euthanasia.
No physical suffering
In 2021, 56 (2.1%) 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”.
Four 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.
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
A total of 201 people with psychiatric disorders were killed by euthanasia in Belgium between 2014 and 2017 including for mood disorders such as depression, bipolar disorder (73 cases); organic mental disorders, including dementia and Alzheimer's (60 cases); personality and behavioural disorders (23 cases); neurotic disorders, and disorders related to stressors including posttraumatic stress disorder (16 cases); schizophrenia and psychotic disorders (11 cases); organic mental disorders, including autism (10 cases) and complex cases involving a combination of several categories (8 cases).
Between 2014 and 2017 there were 60 cases of people killed by euthanasia for dementia. Of these cases death was only expected in the short term for 9 cases.
Of these 201 cases there were 25 cases of people under 40 being killed by euthanasia.
In relation to these troubled young people the Commission observes “In the group of patients under 40, it is mainly personality and behavioral disorders. All these patients have been treated for many years, both outpatient and residential. There has always been talk of intractable suffering. For this type of disorder, serious psychological trauma at a very young age has been mentioned several times, such as domestic violence, psychological neglect or sexual abuse.”
Belgium is treating the victims of child abuse by domestic violence, neglect and sexual abuse by killing them.
In 2018 and 2019 there were 48 cases of euthanasia for psychiatric conditions, including depression/bipolar disorder (17), personality disorders (26), post-traumatic stress (4), schizophrenia (7) or autism (3).
Euthanasia by advanced directive
27 people were killed by euthanasia in 2019 while "irreversibly unconscious" pursuant to an advanced directive. 17 people were killed by euthanasia in 2021 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).
The place of residence is only required to be reported in the second part of a euthanasia report filed by the doctor performing euthanasia. This part only gets open when questions arise. However, in 2016 and 2017 doctors did refer in the first part of the report to people who were foreigners who came to Belgium to seek euthanasia. There were 23 such cases reported in this way but there may be many more. Of the 23 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.
The 19 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.