A recent study in the Journal of Medical Ethics has found that in Belgium decisions to withdraw artificial nutrition and hydration (ANH) rarely involve patient consent. The study, conducted by researchers from Brussels University and the University of Ghent, examined the circumstances of 6927 deaths in the country (about 12% of deaths in the year 2007).

Researchers found that in 81% of cases where artificial nutrition and hydration had been removed there had been no patient consultation. The reasons give for this were that the patient was demented (40%), unconscious (35%) or that the decision ‘was in the best interest of the patient’(8%). In lieu of patient consent the patient’s family was consulted and/or other physicians.

The researchers argue that patient consent is vital, and that a process of advanced consultation is necessary:

“The significance of these decisions calls for a model of decision making involving ideally the consent of the patient or at least of the family in the context of advance care planning, which can still be improved in Belgium.”

This will aid doctors in cautious and informed ethical decision making, the authors said. 

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