Cohen-Almagor found that life-ending drugs were used with "the intention to shorten life and without explicit request" in 1.7% of all deaths in Belgium in 2013. In 52.7% of the cases, the patients were 80 years of age or older.
More alarming, in 77.9% of these cases, physicians did not discuss the decision to euthanize with their patients at all, saying it was because they were comatose, had dementia, or "because discussion would have been harmful to the patient’s best interest." According to the report, doctors have also said they have resorted to the deliberate shortening of a patient’s life to an average of one week or more in 6.4% of the cases.
The findings indicate that doctors are taking life-ending decisions in their own hands, deciding themselves whether or not a patient has endured enough agony and when that patient’s suffering should end.
Doctors have cited "compassion" in "futile medical situations" as the grounds for involuntary euthanasia, however Cohen-Almagor notes the difficulty in defining when and how a situation is "futile" and estimating how much time a patient has to live.
The Euthanasia Act, which was passed in 2002, legalizes euthanasia under the condition that patients explicitly make the request, and that request must be "voluntary, well-considered, and repeated and…not the result of external pressure."
"At the heart of the legislation is the free will of the patient who asks for euthanasia," Cohen-Almagor wrote. "It is worrying that some physicians take upon themselves the responsibility to deliberately shorten patients’ lives without a clear indication that this is what they would want."
While the numbers of 2013 are alarming, Cohen-Almagor notes that they have decreased significantly and consistently from 1998, when involuntary euthanasia accounted for 3.3% of all deaths in Belgium. This was four years before euthanasia was legalized in the country.
The decrease may be a result of the gained experience in practicing euthanasia after it was legalized which, according to the report, allowed doctors to involve their patients more in the decision-making process.
However, Cohen-Almagor notes that the decrease may not be an accurate reflection of the practice because doctors may not be "well acquainted with the labelling of all the medical practices at the end of life," and often used methods such as terminal sedation that are not reported as euthanasia.
"Deliberately ending the lives of patients without their request is taking place in Belgium more than in all other countries that document such practices, including the Netherlands," Cohen-Almagor said.
