Belgium study tracks trends in end-of-life decision making

(HealthDay)—In Belgium, between 1998 and 2007, euthanasia was legalized and palliative care was intensified, which led to an increase in end-of-life decisions (ELDs) and fewer life-ending acts without the patient's explicit request, according to research published online March 11 in the Journal of Clinical Oncology.

Koen Pardon, Ph.D., of Ghent University and Vrije Universiteit in Brussels, and colleagues surveyed physicians who had signed 6,927 select death certificates in 2007 to evaluate ELD trends in patients with and without cancer and compare those results to a similar study completed in 1998, before euthanasia was legalized.

From 1998 to 2007, ELDs increased by 6.7 percent for cancer patients and 14.9 percent for patients without cancer, primarily due to an increase in intensified symptom alleviation (53.8 and 31.7 percent for cancer and non-cancer patients). Euthanasia was also more commonly practiced in cancer versus non-cancer patients (6.8 versus 0.9 percent). Overall, 69.7 percent of cancer patients and 83.5 percent of patients without cancer were involved in making ELDs.

"To conclude, the higher ELD incidence in patients with cancer compared with those without is probably related to differences in disease trajectories and access to end-of-life care," the authors write. "Between 1998 and 2007, during which time euthanasia was legalized and palliative care intensified, overall ELDs increased, including those caused by acts of symptom alleviation and euthanasia, with a decrease in life-ending without explicit request."

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