Belgium's Euthanasia Trends Counter 'Slippery Slope' Concerns with New Research

Euthanasia has been legal in Belgium since 2002, with reported cases increasing markedly over the past two decades. Initially, in 2003, only 236 cases were documented, but by 2023, this number surged to 3,423, accounting for approximately 3% of all deaths in the country. This rise prompts examination of the factors behind the trend and whether it signals a troubling expansion of euthanasia practices.

A recent study published in JAMA Network Open analyzed euthanasia data from 2002 to 2023. The researchers identified two main contributors to the increasing numbers: the 'regulatory onset'—the period required for the medical community and public to adapt to the law—and demographic shifts, particularly aging populations. The initial 15 years saw a sharp increase in cases as procedures became integrated into standard medical practice, followed by a period of stabilization. Notably, about one-third of the rise correlates with demographic changes, especially the growth of elderly individuals with terminal illnesses.

One area of debate concerns euthanasia for psychiatric conditions. Belgium has permitted euthanasia for mental health disorders since legalization, but despite fears that such cases might proliferate, they remain very rare—constituting just 1.3% of all cases from 2002 to 2023. These cases typically involve extensive assessments and long-standing conditions unresponsive to treatments. Conversely, euthanasia requests related to dementia have seen a modest increase, reflecting the aging demographic, yet still comprise less than 1% of total euthanasia cases.

Regional differences historically showed higher euthanasia rates in Flanders compared to Wallonia and Brussels, but recent data indicate this gap is narrowing. This trend may result from shifting cultural attitudes and better access to end-of-life care, leading to more uniform practices nationwide.

A key concern in euthanasia debates is the 'slippery slope' argument—that legalization could lead to broader criteria, including non-terminal conditions or socioeconomic factors. However, the study found no evidence supporting this worry. The rise in cases aligns with demographic trends and the implementation of laws, not a relaxation of criteria. Over time, disparities based on region and gender have decreased, suggesting a more consistent application of euthanasia practices.

Differences between Belgium's laws and the assisted dying legislation under review in the UK are significant. Belgium permits euthanasia where death is not imminent, often involving elderly patients with chronic illnesses or psychiatric conditions, with doctors making the final decision. In contrast, the UK considers assisted dying primarily for terminal illnesses with short life expectancy, involving patient-driven actions with oversight from legal authorities.

Despite Belgium's established reporting system, gaps exist in data collection, especially regarding social and economic factors influencing euthanasia requests. Monitoring these aspects is crucial for assessing long-term impacts and guiding future legislation. As other countries explore assisted-dying laws, Belgium's experience underscores the importance of comprehensive data collection and regulation to ensure ethical practices.

Source: https://medicalxpress.com/news/2025-04-belgium-euthanasia-trends-dispute-slippery.html