DHMC's Byock Says Caution Needed In Interpreting Results of Belgian Assisted Dying Study

Ira Byock, M.D.

According to a study published recently by Belgian researchers in BMJ (a publication of the British Medical Association), assisted dying laws do not mean that fewer people use palliative care, and further concludes that patients who receive spiritual care are more likely to request euthanasia or physician-assisted dying.

Dr. Lieve Van den Block and colleagues from the End-of-Life Care Research Group in Brussels, found that far from opposing each other, life shortening and palliative care complemented one another and often worked in unison. Previous studies have revealed that death is often preceded by medical end-of-life decisions that had a life shortening effect, such as the use of lethal drugs, continuous sedation, or intensifying drugs to alleviate symptoms that also had the effect of hastening death. However, this is the first large-scale study exploring the relationship between end-of-life decisions and end-of-life care.

In the accompanying editorial, Ira Byock, M.D., Director of Palliative Medicine at Dartmouth-Hitchcock Medical Center, and Professor of Anesthesiology and of Community and Family Medicine at Dartmouth Medical School, says that while Van den Block’s research provides " a valuable contribution to understanding the context of dying in Belgium," he is concerned about some of the conclusions being extrapolated from the study.

Byock says the data show that assisted dying is rarely performed in Belgium and " it would be a mistake to suggest that these findings dispel concerns about euthanasia or that they support including euthanasia within palliative care."

Dr. Van den Block and his team investigated almost 2,000 non-sudden deaths that took place in Belgium from 2005 –2006. Belgium is particularly suited to this study because it has well developed integrated palliative care provision as well legalized euthanasia. In the study, 32 percent of patients were 85 or older, 50 percent were male and cancer was the cause of death for 43 percent of cases. Assisted dying, intensified prescribing and continuous deep sedation without food/fluid administration were more commonly decided for patients with cancer.

The authors found that in Belgium the use of specialist multidisciplinary palliative care was often associated with medical decisions to shorten life and that end of life decisions and palliative care do not contradict, but worked together.

The complete study and Dr. Byock’s editorial can be found in the July 31 edition of BMJ, available online at www.bmj.com/.