Table 1 Due care criteria for euthanasia for psychological suffering (Belgian Law on Euthanasia 2002)

Substantive criteria

Euthanasia for psychological suffering is allowed if the patient:

1. is an adult (> 18 years old) or emancipated minor;

2. is legally competent and conscious at the moment of the euthanasia request;

3. has made a voluntary, well-considered, and repeated request, that is not the result of any external pressure; and

4. is in a medical situation, without prospect of improvement, of constant and unbearable psychological suffering

a) that cannot be alleviated; and b) that results from a serious and incurable condition caused by accident or illness

Procedural criteria

Administrative requirements

1. The patient’s request must be in writing and drawn up, dated and signed by the patient. If the patient is not physically capable of doing so, the document should be drawn up by an adult designated by the patient and without material interest in the death of the patient. In such case, the request is drafted in the presence of a physician whose name is recorded in the document

2. At least one month should proceed between the patient’s written request and the performance of euthanasia

3. The patient may revoke the euthanasia request at any time, in which case the document is removed from the medical record and returned to the patient

4. All the requests formulated by the patient, as well as any actions by the attending physician and their results, including the reports of the consulted physicians, are noted in the patient’s medical record

5. Within four working days after performing the euthanasia, the attending physician is required to complete the registration form and to deliver this document to the Federal Control and Evaluation Commission for Euthanasia, so as to allow the Commission to determine whether the euthanasia was performed in accordance with the legal due care criteria

Decision-making procedure

The attending physician must:

1. inform the patient about her health condition and life expectancy;

2. discuss with the patient her euthanasia request and any therapeutic and palliative options still remaining and their consequences;

3. be certain that all substantive criteria have been met, including the patient’s constant and unbearable suffering that cannot be alleviated and the durable nature of the request, and to this end;

A. have several conversations with the patient, spread out over a reasonable period of time, taking into account the progress of the patient’s condition;

B. consult a second physician,

i. who must be independent and competent to give an opinion on the condition concerned;

ii. who must review the medical record and examine the patient; and

iii. who must ascertain the patient’s constant and unbearable suffering that cannot be alleviated;

C. consult a third physician,

i. who must be independent and a psychiatrist;

ii. who must review the medical record and examine the patient; and

iii. who must ascertain the constant and unbearable suffering that cannot be alleviated, and the voluntary, well-considered, and repeated nature of the euthanasia request;

d. if there is a nursing team that has regular contact with the patient, discuss the request with that team or with members of that team;

e. if the patient so desires, discuss the request with the relatives appointed by the patient; and

f. ascertain that the patient has had the opportunity to discuss the request with the persons whom she designates