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Author: Jacques Wels, Principal Investigator, Unit for Lifelong Health & Ageing, UCL
Original article: https://theconversation.com/belgiums-euthanasia-trends-dispute-slippery-slope-argument-new-study-252323
Euthanasia has been legal in Belgium since mid-2002, and in the past two decades, the number of reported cases has risen sharply. In 2003, only 236 cases were recorded, but by 2023, this had increased to 3,423. This means that euthanasia now accounts for around 3% of all deaths. But what explains this increase? And does it suggest a worrying trend, as some critics fear?
In a new study published in Jama Network Open, my colleagues and I analysed trends in all reported euthanasia cases between 2002 and 2023. Our findings show that the rise in euthanasia cases can be attributed to two factors: “regulatory onset” (the time required for both the medical community to adapt its practices and protocols to the new law, and for the public to become informed about its availability and implications) and demographic change, including population ageing.
We saw a sharp rise in cases during the 15 years following the law being introduced, followed by a period of stabilisation. About one-third of the increase can be explained by demographic changes – mainly population ageing. Euthanasia is indeed most common among people in their 70s and 80s, who often suffer from terminal cancer or several conditions. The number of people in those age categories has steadily increased.
A common point of contention in the euthanasia debate is the inclusion of psychiatric disorders as a valid reason. In Belgium, euthanasia for psychiatric conditions has been permitted since the law was first introduced. However, despite concerns that this might lead to a rapid expansion of cases, our study finds that psychiatric euthanasia remains extremely rare.
Between 2002 and 2023, psychiatric conditions accounted for just 1.3% of all euthanasia cases, and this figure has remained stable over time. The strict criteria mean that these cases typically involve long-standing conditions where all treatment options failed. In all cases, the person seeking to end their life underwent an extensive assessment before euthanasia was approved.
Euthanasia for dementia, however, has increased slightly in recent years. While cases remain low – under 1% of total euthanasia cases – there has been a gradual rise, partially reflecting the ageing of Belgium’s population.
There are also regional differences. Historically, euthanasia rates have been higher in the Flemish region than in French-speaking Wallonia and Brussels. However, our study shows that this gap has narrowed in recent years. This may reflect shifting cultural attitudes or changes in access to end-of-life care, but, overall, the trend points to a growing alignment in practices across the country.
One of the biggest concerns around euthanasia laws is the so-called slippery slope argument – the idea that legalisation could lead to a broadening of criteria, eventually allowing euthanasia for non-terminal conditions, mental health issues or even socioeconomic reasons. However, our study finds no evidence to support this claim.
The increase in euthanasia cases has largely followed demographic trends and legislation implementation, rather than any broadening of legal criteria or changes in medical practice. Over time, both the regional and gender gaps have decreased, showing a more consistent pattern across the population rather than diverging trends.
Belgium’s approach differs significantly from the assisted dying bill currently being debated in the UK. With assisted dying, the patient ends their own life but a doctor prescribes the life-ending medication. With euthanasia, a doctor administers the life-ending medication. The proposed UK legislation would allow assisted dying only for terminally ill patients with a short life expectancy, whereas Belgium’s law permits euthanasia even when death is not expected in the near future.
This is particularly relevant for patients with psychiatric disorders or dementia, who may suffer unbearably for years before meeting the UK’s proposed eligibility criteria. Another key distinction is decision-making: in Belgium, the final decision is made by doctors, whereas the UK is mooting judicial oversight.
Data gaps
One thing that countries allowing assisted dying need to think about is how to track and collect euthanasia data. Belgium has a national system for reporting, but there are still gaps – especially in connecting euthanasia data with people’s social and economic backgrounds. It’s important to understand who asks for euthanasia and why, to assess the long-term effects of the law.
As more countries consider assisted dying laws, Belgium’s experience offers valuable lessons – not only on regulation but also on the importance of robust data monitoring from the outset.
Jacques Wels receives funding from the Belgian National Scientific Fund (FNRS) and the European Research Council (ERC).
Natasia Hamarat reports participating in the Federal Commission for the Control and Evaluation of Euthanasia (FCCEE).
