Key challenges in providing assisted dying in Belgium: a qualitative analysis of health professionals’ experiences

Abstract

Background:

Assisted dying or ‘euthanasia’ has been legal in Belgium since 2002. Extensive research has been conducted which investigates Belgian euthanasia practice, however, the current challenges that health professionals face when providing euthanasia are not well known. This knowledge is important for evaluating the current system, especially in light of recent developments in Belgian euthanasia law and practice including judicial decisions, legislative amendments and research highlighting the complexity of its governing regulatory framework.

Objectives:

This study investigates the key challenges that health professionals experience when providing euthanasia in Belgium.

Design:

A qualitative interview study with reflexive thematic analysis.

Methods:

Twenty interviews were conducted between September 2022 and March 2024 using Microsoft Teams videoconferencing. Eligible participants were physicians and nurses who spoke English or Dutch and who had been involved in the euthanasia assessment of at least two patients in the past year.

Results:

Four themes were generated: (1) the framing of the euthanasia legislation poses challenges; (2) providing euthanasia can place considerable burdens on health professionals; (3) clashing views about euthanasia can hamper opportunities for balanced discussions and (4) euthanasia and processes relating to euthanasia are not always well-understood.

Conclusion:

This study highlights the numerous and varied challenges physicians and nurses experience when providing euthanasia in Belgium, even 20 years after its law passing. This study contributes to a wider understanding of universal challenges associated with providing assisted dying and sheds light on issues specific to Belgium. The results provide an opportunity for policymakers to take action to better support providers to manage these challenges, including through a formal review of the legislation and the broader system.

Plain language summary

What aspects of providing euthanasia in Belgium do health professionals find challenging?

This study investigates the challenges that doctors and nurses experience when they are involved in providing euthanasia in Belgium. Euthanasia is when a person makes a voluntary request to a health practitioner for help to die. Belgium has permitted euthanasia since 2002. Under the law, doctors assess whether patients are eligible to access euthanasia. Nurses assist doctors and have other important roles in caring for patients who access euthanasia. Much research explores Belgian euthanasia practice. However, research has not considered the many challenges doctors and nurses experience when assisting patients to access euthanasia. These findings are an important source of knowledge when euthanasia law and practice is reviewed. Measures can be implemented to address these challenges, improving patients’ and providers’ experiences of the euthanasia system. We conducted interviews with 20 doctors and nurses. They described four main challenges: the framing of the euthanasia legislation poses challenges; providing euthanasia can place considerable burdens on health professionals; clashing views about euthanasia can hamper opportunities for balanced discussions; and euthanasia and processes relating to euthanasia are not always well understood. Doctors and nurses should be supported to manage these challenges. Measures should also be implemented to manage these challenges, including evaluating and, if needed, making changes to the law; implementing mandatory training for doctors and nurses involved in providing euthanasia; and providing community education on euthanasia and the legal process. These findings are also important for other places which are considering legalising euthanasia in the future.