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Attitudes and practices of physicians regarding physician-assisted dying in minors
  1. Geert Pousset1,2,
  2. Freddy Mortier1,
  3. Johan Bilsen2,3,
  4. Joachim Cohen2,
  5. Luc Deliens2,4
  1. 1Bioethics Institute Ghent, Ghent University, Ghent, Belgium
  2. 2End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
  3. 3Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
  4. 4Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Geert Pousset, Department of Medical Sociology, End-of-Life Care Research Group, Laarbeeklaan 103, 1090 Brussels, Belgium; geert.pousset{at}


Objective To investigate attitudes towards physician-assisted death in minors among all physicians involved in the treatment of children dying in Flanders, Belgium over an 18-month period, and how these are related to actual medical end-of-life practices.

Design Anonymous population-based postmortem physician survey.

Setting Flanders, Belgium.

Participants Physicians signing death certificates of all patients aged 1–17 years who died between June 2007 and November 2008.

Main outcome measures Attitudes towards physician-assisted death in minors and actual end-of-life practices in the deaths concerned.

Results 124 physicians for 70.5% of eligible cases (N=149) responded. 69% favour an extension of the Belgian law on euthanasia to include minors, 26.6% think this should be done by establishing clear age limits and 61% think parental consent is required before taking life-shortening decisions. Cluster analysis yielded a cluster (67.7% of physicians) accepting of, and a cluster (32.2% of physicians) reluctant towards physician-assisted death in minors. Controlling for physician specialty and patient characteristics, acceptant physicians were more likely to engage in practices with the intention of shortening a patient's life than were reluctant physicians.

Conclusion A majority of surveyed Flemish physicians appear to accept physician-assisted dying in children under certain circumstances and favour an amendment to the euthanasia law to include minors. The approach favoured is one of assessing decision-making capacity rather than setting arbitrary age limits. These stances, and their connection with actual end-of-life practices, may encourage policy-makers to develop guidelines for medical end-of-life practices in minors that address specific challenges arising in this patient group.

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  • Funding This study was supported by a grant from the Institute for the Promotion of Innovation by Science and Technology in Flanders (Instituut voor de aanmoediging van Innovatie door Wetenschap en Technologie in Vlaanderen) (SBO IWT nr. 050158), Bischoffsheimlaan 25, 1000 Brussels, Belgium.

  • Competing interests None.

  • Ethics approval This study was approved by the Ethical Review Board of the University Hospital of the Vrije Universiteit Brussel, the Ethics Committee of the University Hospital of Ghent University, the Belgian National Disciplinary Board of Physicians and the Belgian Federal Privacy Commission.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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