Intended for healthcare professionals


Development of palliative care and legalisation of euthanasia: antagonism or synergy?

BMJ 2008; 336 doi: (Published 17 April 2008) Cite this as: BMJ 2008;336:864
  1. Jan L Bernheim, medical oncologist 12,
  2. Reginald Deschepper, anthropologist 1,
  3. Wim Distelmans, palliative care specialist 13,
  4. Arsène Mullie, palliative care specialist 4,
  5. Johan Bilsen, health scientist 1,
  6. Luc Deliens, medical sociologist 15
  1. 1End of Life Care Research Group, Department of Medical Sociology and Health Sciences, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
  2. 2Department of Human Ecology, Vrije Universiteit Brussel
  3. 3Department of Palliative Care, Oncological Centre, AZ, Vrije Universiteit Brussel
  4. 4Federation Palliative Care Flanders, Wemmel, Belgium
  5. 5Department of Public and Occupational Health, EMGO Institute, VU University Medical Centre Amsterdam, Netherlands
  1. Correspondence to: J L Bernheim jan.bernheim{at}
  • Accepted 3 January 2008

Debates about euthanasia often polarise opinion, but Jan Bernheim and colleagues describe how in Belgium the two camps grew up side by side to mutual benefit

Although palliative care and legalised euthanasia are both based on the medical and ethical values of patient autonomy and caregiver beneficence and non-maleficence,1 they are often viewed as antagonistic causes. A popular perception, for instance, is that palliative care is the province of religiously motivated people and the advocacy of euthanasia that of agnostics or atheists.2 3 The European Association for Palliative Care has voiced concerns that legalising euthanasia would be the start of a slippery slope resulting in harm to vulnerable patients such as elderly and disabled people and that it would impede the development of palliative care by appearing as an alternative.4 Data from the Netherlands and Belgium, where euthanasia is legal, do not provide any evidence of a slippery slope.5 6 Here, we focus on the effect of the process of legalisation of euthanasia on palliative care and vice versa by reviewing the published historical, regulatory, and epidemiological evidence in Belgium.


Detailed accounts of the development of euthanasia and palliative care in Belgium are available elsewhere,7 8 9 but table 1 gives the main milestones. Palliative care started developing in the early 1980s, at the same time as the drive for the legalisation of euthanasia. By 1999 in Europe, Belgium was second only to the United Kingdom in per capita number of beds for palliative care,10 in 2007 it ranked third of 52 countries in palliative care resources after Iceland and the UK and in 2002 Belgium became the second country to legalise euthanasia.11 12 13

View this table:
Table 1

 Milestones in the development of palliative care and the legalisation of euthanasia in Belgium

Although the societal …

View Full Text

Log in

Log in through your institution


* For online subscription