State of Palliative Care Development in European Countries with and without Legally Regulated Physician-Assisted Dying

Abstract

In 2002 physician-assisted dying was legally regulated in the Netherlands and Belgium. Besides fundamental and ethical objections to physician-assisted dying, one of the frequently expressed pragmatic concerns is that legal regulation of physician-assisted dying, as implemented in the Netherlands and Belgium, could stunt the development of palliative care and erode its culture of competent and compassionate care. We here review these controversies and test the hypothesis that legal physician-assisted dying impeded the development of palliative care in the Netherlands and Belgium. We collected the data over time on the funding of palliative care in Belgium. Next, using the data of the European Association for Palliative Cares 2007 Atlas of Palliative Care, we compared the state of development of palliative care in Western-European countries with and without legally regulated physician-assisted dying. In Belgium, government expenditure for palliative care grew consistently by a yearly average of 10% over the 5 years fol- lowing legal regulation of physician-assisted dying. As assessed in 2005, palliative care development in the Netherlands and Belgium did not lag behind Western-European countries without legally regulated physician-assisted dying, and was close to on a par with the UK, the benchmark country. In conclusion, the hypothesis that legal regulation of physician-assisted dying stunts the development of palliative care is not supported by the Belgian and Dutch experience of the first several years. Continued monitoring of both permissive and non-permissive countries is needed to assess possible longer-term effects.