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Letters Assisted dying debate

Missed opportunity to advance debate on assisted dying

BMJ 2011; 343 doi: (Published 05 July 2011) Cite this as: BMJ 2011;343:d4221
  1. Jan L Bernheim, professor emeritus of medicine1
  1. 1Vrije Universiteit Brussel, Brussels, Belgium
  1. jan.bernheim{at}

In his review of Terry Pratchett’s documentary on assisted dying O’Neill focused on caregivers’ feelings.1 From experience, I can confirm that caregivers and loved ones often try to dissuade patients from euthanasia. However, I submit that caregivers’ feelings are a secondary concern because patients’ feelings should count for more than caregivers’. As for families, evidence from the Netherlands is reassuring: on average, bereavements are more serene after euthanasia than after other deaths.2

Andrew died sadly on the cold sofa of Dignitas in Zurich. Had this occurred in Belgium, the Netherlands, or Luxembourg, he would likely have died at home, warmly and less prematurely. Recently I assisted in the euthanasia of a patient with advanced cancer who was in palliative care in Belgium. My patient hugged and kissed her loved ones and died smiling, her son holding her arm, his head on her shoulder, her mother embracing her. Her other relatives and friends stood in a semi-circle holding hands.

The ensuing BBC2 debate concentrated on whether assisted dying (a) endangers vulnerable people and (b) impedes palliative care. The debaters ignored abundant empirical evidence on these two points—for example:

  • (a) Where assisted dying is allowed by law vulnerable people are under-represented among those who choose this option.3 4 In Belgium legalisation shifted assisted dying not at patients’ request to assisted dying at patients’ request and increased carefulness about end of life decisions.4 Over this time Belgians’ confidence in their healthcare system has risen—from 87% in 1999 to 92% in 2008.

  • (b) In the three Benelux countries, palliative care greatly expanded after assisted dying was legalised. In Belgium about half the cases of euthanasia occur at the end of a multidisciplinary palliative care pathway.5 Palliative care and assisted dying are not necessarily incompatible; they can mutually reinforce each other.6


Cite this as: BMJ 2011;343:d4221


  • JLB cofounded the first palliative care service in Belgium in 1979.

  • Competing interests: None declared.


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