Commonalities and differences in legal euthanasia and physician-assisted suicide in three countries: a population-level comparison

Sigrid Dierickx, Bregje Onwuteaka-Philipsen, Yolanda Penders, Joachim Cohen, Agnes van der Heide, Milo A. Puhan, Sarah Ziegler, Georg Bosshard, Luc Deliens, Kenneth Chambaere

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24 Citations (Scopus)


Objectives: To describe and compare euthanasia and physician-assisted suicide (EAS) practice in Flanders, Belgium (BE), the Netherlands (NL) and Switzerland (CH). Methods: Mortality follow-back surveys among attending physicians of a random sample of death certificates. Results: We studied 349 EAS deaths in BE (4.6% of all deaths), 851 in NL (4.6% of all deaths) and 65 in CH (1.4% of all deaths). People who died by EAS were mostly aged 65 or older (BE: 81%, NL: 77% and CH: 71%) and were mostly diagnosed with cancer (BE: 57% and NL: 66%). Home was the most common place of death in NL (79%), while in BE and CH, more variation was found regarding to place of death. The decision to perform EAS was more frequently discussed with a colleague physician in BE (93%) and NL (90%) than in CH (60%). Conclusions: EAS practice characteristics vary considerably in the studied countries with legal EAS. In addition to the legal context, cultural factors as well as the manner in which legislation is implemented play a role in how EAS legislation translates into practice.
Original languageEnglish
Pages (from-to)65-73
Number of pages9
JournalInternational journal of public health
Issue number1
Early online date11 Jul 2019
Publication statusPublished - 1 Jan 2020


  • Belgium
  • End-of-life decision-making
  • Euthanasia
  • Physician-assisted suicide
  • Switzerland
  • The Netherlands

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