The Belgian model on comprehensive end-oflife care: palliative care and legal euthanasia as complementing, non-antagonistic developments I. Historical, epidemiological and regulatory evidence

Palliative care (PC) and legal euthanasia are
widely considered as antagonistic societal developments
and causes, originating in fundamentally
different philosophies and conceptions of care.
Pragmatically, the opponents of legal euthanasia
fear: 1. "slippery slope" effects which would endanger
vulnerable patients and 2. that legalisation
would impede the development of PC. Belgium,
the second country to legalise euthanasia (2002),
had by then developed one of the best PC systems.
The first PC initiatives were taken by advocates
of legal euthanasia, who prominently contributed
to the development of the PC system. Vice
versa, adequate PC made the legalisation of
euthanasia ethically and politically acceptable.
According to all epidemiological data in Belgium,
life-abbreviating medical decisions at the end of
life are more frequent in PC settings than in standard
care. This is partly due to a selection of PC
in cases with a heavier uncontrollable symptom
burden, but at any rate it shows that euthanasia is
part and parcel of PC. So far, there are no epidemiological
data in Belgium suggesting any "slippery
slope" phenomena since the legalisation of
euthanasia. On the contrary, there is an increased
carefulness when taking end-of-life decisions.The
development of PC and the process of legalisation
of euthanasia can be mutually reinforcing. The Belgian
model is best encapsulated as "Integral Endof-
Life Care".

Publication year:2012

Keywords:Euthanasia, palliative care, end-of-life decisions, legalisation