Open Access Highly Accessed Research article

Euthanasia and other end-of-life decisions: a mortality follow-back study in Belgium

Lieve Van den Block12*, Reginald Deschepper1, Johan Bilsen13, Nathalie Bossuyt4, Viviane Van Casteren4 and Luc Deliens15

Author Affiliations

1 Vrije Universiteit Brussel, End-of-Life Care Research Group, Laarbeeklaan 103, 1090 Brussels, Belgium

2 Vrije Universiteit Brussel, Department of General Practice, Laarbeeklaan 103, 1090 Brussels, Belgium

3 Ghent University, Bioethics Institute, Blandijnberg 2, 9000 Ghent, Belgium

4 Scientific Institute of Public Health, Department of Epidemiology, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium

5 Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands

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BMC Public Health 2009, 9:79  doi:10.1186/1471-2458-9-79

Published: 9 March 2009



This study compares prevalence and types of medical end-of-life decisions between the Dutch-speaking and French-speaking communities of Belgium. This is the first nationwide study that can make these comparisons and the first measurement after implementation of the euthanasia law (2002).


We performed a mortality follow-back study in 2005–2006. Data were collected via the nationwide Sentinel Network of General Practitioners, an epidemiological surveillance system representative of all Belgian GPs.

Weekly, all GPs reported the medical end-of-life decisions among all non-sudden deaths of patients in their practice. We compared the northern Dutch-speaking (60%) and southern French-speaking communities (40%) controlling for population differences.


We analysed 1690 non-sudden deaths. An end-of-life decision with possible life-shortening effect was made in 50% of patients in the Dutch-speaking community and 41% of patients in the French-speaking community (OR 1.4; 95%CI, 1.2 to 1.8). Continuous deep sedation until death occurred in 8% and 15% respectively (OR 0.5; 95%CI, 0.4 to 0.7). Community differences regarding the prevalence of euthanasia or physician-assisted suicide were not significant.

Community differences were more present among home/care home than among hospital deaths: non-treatment decisions with explicit life-shortening intention were made more often in the Dutch-speaking than in the French-speaking community settings (OR 2.2; 95%CI, 1.2 to 3.9); while continuous deep sedation occurred less often in the Dutch-speaking community settings (OR 0.5; 95%CI, 0.3 to 0.9).


Even though legal and general healthcare systems are the same for the whole country, there are considerable variations between the communities in type and prevalence of certain end-of-life decisions, even after controlling for population differences.