A new study published by the Canadian Medical Association Journal examines trends in Belgian euthanasia cases from 2003 to 2013.

According to the study, there has been a significant increase in euthanasia cases in Belgium since the law went into effect in 2002. Euthanasia accounted for 1.7% of all deaths in Belgium in 2013, compared to only 0.2% 10 years earlier. 

Between January 1, 2003 and December 31, 2013, a total of 8,752 cases were reported by the Federal Control and Evaluation Commission. The number of euthanasia cases has remained consistently highest among patients diagnosed with terminal cancer (68.7%) and those younger than 80 years of age (65%). 

However, there was a notable increase in the number of cases involving non-terminal patients. In 2003, non-terminal illness accounted for 8.1% of deaths by euthanasia. In 2013, it increased to 14.7%.

The CMAJ, also found “An increasing proportion of reported cases involved people with diagnosis of a neuropsychiatric dis­order (such as Alzheimer's disease, Huntington's disease, dementia, and treatment-resistant depression)”.

So, why the increase?

“Our findings showed an increase in euthanasia among older persons and patients without terminal disease in the most recent years, whereas such cases were relatively rare in the first years of the euthanasia law. These findings might suggest an increase in the number of requests from these groups as they increasingly became aware of the legal possibility to request euthanasia. These findings might also reflect a decrease in reluctance to provide euthanasia within these groups as physicians became more experienced and the wider society became more familiar with these types of cases.”
We deem it less plausible that the trends indicate more vulnerable groups feeling increasingly forced to choose euthanasia.
— "Euthanasia in Belgium: trends in reported cases between 2003 and 2013" Canadian Medical Association Journal

Is there a slippery slope?

The CMA study found no evidence indicating that more vulnerable groups are being coerced into euthanasia. Under Belgian law doctors are obligated to report all euthanasia cases to the Federal Control and Evaluation Commission. The commission is comprised of 16 members (plus 16 alternates) who meet once monthly to review cases. If the Commission finds that a euthanasia was not carried out in accordance with the law, the case is turned over to the public prosecutor. So far only one case, in almost 10,000 since the law was passed, has been submitted for judicial review. A mandatory report is published every two years, most recent being 2012 - 2013.

The Commission has been accused of conflict of interest and lack of oversight. “In spite of all precautions, it is surprising that almost half the voting members of the Commission are collaborators or members of the Association for the Right to Die in Dignity, an association which openly fights in favour of euthanasia and the expansion of legal conditions.” (European Institute of Bioethics)

Another cause for concern is the Commission’s capacity to keep up with the number of cases as they increase: “It can be assumed that overburdening of the Belgian review committee may pose a problem, now or in the future”. One member of the commission, oncologist Claire Nouwynck, resigned late last year due to the increased time commitment. Initially she was told there will only be a few dozen cases a month to review. In reality, its up to an average of 200 cases.

The Commission saw several resignations in 2015. News quickly spread of its failure to fill vacancies. An article published in Le Soir stated that "the job is not valued". Members receive 20 Euros per review session for their participation

Conclusion

The CMAJ authors concluded by stating, "Given differences in developments between jurisdictions and even within Belgium, it is clear that societal and cultural contexts play a key role in how euthanasia practice has been adopted after legalization. Our analysis has shown the importance of detailed monitoring of euthanasia practice, provides relevant insights for evaluation of the practice and can inform the debate about euthanasia worldwide."

The Canadian government recently came under scrutiny for its 'lack of public disclosure'. Andre Picard (Globe and Mail) found it 'troubling' that to date there is no official system in place to access statistical data on assisted dying in Canada.

In its backgrounder on Bill C-14, the Justice department acknowledges the need for "a pan-Canadian monitoring system to collect and analyze data on the provision of medical assistance in dying across Canada, to monitor trends and provide information to the public on the implementation of the new law [in order] to foster transparency and public trust in the system".

The only known data on medical assistance in dying has been reported via CBC News. According to a recent CBC News survey there have been 118 reported cases of doctor-assisted deaths, and only 1 in 10 requests are granted. It should be noted, however, only Alberta, British Columbia, Ontario, and Saskatchewan provided data for this survey. The remaining provinces and territories did not, either because of the lack of cases or to honour patients' privacy. 

Even though, its only been three months since Bill C-14 received royal assent, it would be wise of the Justice Department to honour its intentions and heed Picard's call to "let the data speak – for the dead, the living and those who wish to die with dignity."

Background

The Belgian Act on Euthanasia came into effect in 2002, legalizing the intentional termination of a patient’s life by a physician, at his/her explicit request.

To be eligible the patient must be legally competent and conscious at the moment of making the request, and in a state of “constant and unbearable physical or mental suffering that cannot be alleviated, resulting from a serious and incurable disorder caused by illness or accident”.