How do hospitals deal with euthanasia requests in Flanders (Belgium)?: A content analysis of policy documents
Introduction
In Europe, public debate about the acceptability and regulation of euthanasia and other medical end-of-life decisions continues to grow [1], [2], [3], [4], [5]. In 2002, Belgium became the second country after the Netherlands to enact a law that allows euthanasia only under strict conditions and to be performed only by physicians [6]. In Belgium and the Netherlands, 1.2% [7] and 1.7% [8] of all deaths, respectively, resulted from euthanasia. Between January 2004 and December 2005, 54% (195 cases in 2004 and 203 cases in 2005) of all registered euthanasia cases in Belgium were performed in hospitals [9].
Since the enactment of the euthanasia law, the debate on how to deal with euthanasia requests within Belgian hospitals has intensified. Clinical–ethical decision-making surrounding euthanasia requests is complex, and physicians [10], [11], [12] and nurses [13] need more support and guidance. Written institutional ethics policies on euthanasia represent one way to provide this support. Such policies also clarify hospitals’ stance on handling euthanasia requests for caregivers, patients, and relatives [14].
Thus far, research about written euthanasia policies in hospitals has only been performed in the Netherlands [15] and in Flanders (Belgium) [16], [17]. A 1994 survey revealed that 69% of Dutch hospitals had a euthanasia policy [15]. In 2005–2006, we surveyed all Flemish hospitals and found that 63% had a euthanasia policy [17]. The Belgian Act on Euthanasia and centrally developed guidelines of professional organizations frequently mentioned reasons for and sources used in developing hospital euthanasia policies. Up to one-third of the hospitals developed policies upon request from physicians or nurses, or after being confronted with a euthanasia request. Clinicians, ethics committees, and hospital administrators were involved in policy development. Most hospitals took the initiative to communicate the policy to their physicians and nurses [17]. Although our survey mapped out euthanasia policy development in Flemish hospitals, the data were based on self-reports from hospital administrators and the questionnaire obtained limited information about euthanasia policy content.
The aim of the current study, therefore, was to describe systematically the form and content of ethics policies on euthanasia from Flemish hospitals. This was achieved through content analysis of policy documents. A second aim was to describe the possible influence of religious affiliation on the content of these policies.
Section snippets
Data collection
Data were collected from 15 November 2005 to 28 February 2006, in Flanders, the Dutch-speaking region of Belgium, where 60% (5.9 million) of the nation's population lives. We surveyed directors of all Flemish hospitals about their written ethics policies on euthanasia (development, communication, and stance on euthanasia) [17] and asked them to provide a copy of their policy.
Definitions
According to Article 2 of the Belgian Euthanasia Act, euthanasia is the intentional termination of life by someone other
Sample description
Our survey had an 88% response rate: of the 81 hospitals invited to participate, directors of 71 completed and returned the questionnaire. Of the 45 hospitals with a euthanasia policy, 42 (93%) provided a copy of their policy (Table 1). The majority of the hospitals were general hospitals for acute care (95%), medium sized (69%), Catholic (69%), and private (64%).
Form of euthanasia policies
The majority of the policies (86%) had an unbound-page format with a mean length of 13 pages (±S.D. 11.2). Fifty-seven percent
Discussion
The euthanasia policies we examined described hospitals’ clear stance on euthanasia in competent terminally ill patients and non-terminally ill patients. The hospitals’ stance on euthanasia in incompetent terminally ill patients, however, was less clear. One-fourth of the policies did not even describe their stance on euthanasia in these patients. Flemish hospitals may have not been prepared to formulate their stance on euthanasia in incompetent terminally ill patients, perhaps because of
Acknowledgements
The authors gratefully thank all hospital directors for participating in this study. The authors wish to acknowledge Luc Anckaert and Marc Lemiengre for reviewing earlier versions of the paper.
Funding: The study was made possible by a grant from the Fonds Voor Wetenschappelijk Onderzoek Vlaanderen.
Researchers were independent from funders.
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