Trends in assisted dying among patients with psychiatric disorders and dementia in Belgium: A health registry study

TL;DR

This study examines how euthanasia for psychiatric disorders and dementia has changed in Belgium from 2002 to 2023, finding distinct trends for these conditions compared to other cases.

Contribution

The study provides the first detailed analysis of euthanasia trends for non-terminal conditions in a legal context, highlighting differences in growth rates and demographic patterns.

Findings

Euthanasia for psychiatric disorders increased at a similar rate to other euthanasia cases.

Euthanasia for dementia increased faster than for other conditions.

Gender and regional differences in euthanasia rates were observed and evolved over time.

Abstract

Assisted dying and euthanasia (ADE) for patients with psychiatric disorders or dementia have increased in jurisdictions where the practice is legal. In this study, we examine trends in euthanasia cases involving patients with these conditions in Belgium, where the law makes a distinction based on whether a patient’s death is not expected in the foreseeable future (>12 months)—a common situation in cases of dementia or psychiatric disorders.

We use data on all cases of euthanasia reported to the Federal Commission for the Control and Evaluation of Euthanasia from 2002 (when the legislation was introduced) to 2023 (N = 33,592). Psychiatric disorders and dementia represent 1.27% and 0.92% of all cases, respectively. Using time-series zero-inflated negative binomial regression, we model trends by first examining interactions between euthanasia reasons and year, then extending to three-way interactions with patients’ characteristics. The model calculates change in count and is replicated with an offset to account for demographic changes and generate rates. Our results show that euthanasia for psychiatric disorders and dementia showed distinct trends over time. Although slightly increasing, euthanasia for psychiatric disorders followed trends similar to the other types of euthanasia (count = 1.00 [95%CI: 0.98; 1.03]—rate = 1.02 [95%CI: 0.99; 1.04]), while euthanasia cases for dementia increased faster than other types of euthanasia (count = 1.03 [95%CI: 1.00; 1.06]—rate = 1.04 [95%CI: 1.01;1.07]). Trends in euthanasia for dementia and psychiatric disorders coincide with demographic changes. While euthanasia rates for psychiatric disorders were initially higher among women, the rate among men has been increasing over time. Regional trends show higher overall euthanasia rates in the Dutch-speaking population, but with faster increases in the French-speaking population. A key limitation of this study is the lack of information on patients’ socio-economic profiles.

In Belgium, between 2002 and 2023, there are distinct trends for euthanasia for non-terminal illnesses. Euthanasia for psychiatric disorders followed similar trends as euthanasia for terminal illnesses, whereas euthanasia cases involving cognitive conditions increased at a faster rate. Furthermore, there were gender and regional differences, which diminished over time.

Assisted dying and euthanasia (ADE) for people with psychiatric disorders or dementia often raise ethical concerns, especially in countries considering legalisation.

We studied how often euthanasia is performed for these conditions in Belgium, where it has been legal since 2002.

We analysed all reported euthanasia cases in Belgium from 2002 to 2023, focussing on those involving psychiatric disorders or dementia.

These cases made up a small portion of all euthanasia cases—less than 2.5% combined. We found that euthanasia for psychiatric disorders has increased at a similar rate to all euthanasia cases, whereas cases of euthanasia for dementia have increased slightly more. There were gender and regional differences in these trends

Increase of cases of euthanasia for psychiatric disorders have increased in line with the total increase in cases for all other reasons while cases for dementia have increased more than other cases.

A major limitation of the study is the lack of data on patients’ socio-economic status.

In this registry study, Jacques Wels and Natasia Hamarat use data on all cases of euthanasia in Belgium between 2002-2023 to assess trends in assisted dying for patients with psychiatric disorders and dementia.

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