End-of-Life Decisions of Physicians in the City of Hasselt (Flanders, Belgium): A Report From Belgium

Abstract

Objectives: The objective of this study is to estimate the proportion of different types of end-of-life decisions (ELDs) of physicians in the city of Hasselt (Flanders, Belgium). The question is addressed to what degree these ELD meet legal constraints and the ethical requirements for prudent practice. Methodology: All physicians of the city of Hasselt who signed at least one death certificate in 1996 (N=166) received an anonymous self-administered mail questionnaire per death case (max. 5/doctor). Results: The response rate was 55% (N=269). In 37.3% of all cases at least one ELD was made (16.5% non-treatment decisions; 16% potential life-shortening by intensifying the treatment of pain and symptoms; 4.8% administration, supply or prescription of lethal drugs). In 59.5% of the cases where an ELD was made that decision was legally questionnable. Patient characteristics were clearly related to the type of ELD. There was no influence of physician characteristics, except for commitment to life-stance. In 71.3% of the cases the ELD was in no way discussed with the patient. 8.1% of the ELD-cases were in response to a direct request from the patient. Conclusions: The incidences of ELDs in Hasselt are consistent with earlier findings. The study shows that religious commitment influences the behaviour of physicians at the end of their patients' life. The patient's and her family's entitlements to participation in the decision making process were rather poorly respected.