Belgium’s euthanasia law, adopted on May 28, 2002, lets a physician intentionally end a patient’s life at that patient’s explicit written request without criminal liability, provided a set of strict conditions is met. It covers both physical and mental suffering, applies to legally competent adults and, since 2014, to certain terminally ill minors, and puts every case under review by a federal commission. In 2024, physicians reported 3,991 cases to that commission, or 3.6% of all deaths in Belgium.
Who Can Request Euthanasia
The core requirements sit with the patient, the condition, and the request itself. A patient must be a legally competent adult experiencing constant and unbearable suffering that no available treatment can relieve. The suffering must come from a serious and incurable medical condition, whether from a progressive illness or an accident.
Suffering does not have to be physical. Psychiatric disorders can qualify, but the bar is high. The attending physician must consult two independent physicians, one of whom must be a psychiatrist; the suffering must be constant and without prospect of improvement; and a one-month waiting period applies. Psychiatric cases stay rare in practice, about 1.4% of all reported cases in 2024.
Whatever the diagnosis, the physician has to verify that the request is voluntary, well-considered, repeated over time, and free from outside pressure. The patient’s file needs to show how the specific condition produces the suffering the patient describes. That link between diagnosis and subjective suffering has to be clinically demonstrable, not just asserted, and it is where many requests stall.
Terminal Versus Non-Terminal Patients
The law treats these two situations very differently. For a patient expected to die in the near future, the attending physician consults one independent colleague, and no fixed waiting period applies; the timing follows medical judgment.
For a patient who is not expected to die soon, two independent physicians must be consulted, and at least one of them must be a psychiatrist or a specialist in the patient’s condition. A waiting period of at least one month must pass between the written request and the procedure. That cooling-off period is there to confirm the decision is durable rather than a reaction to a crisis.
Minors
A 2014 amendment removed age limits, making Belgium the first country to allow euthanasia for minors of any age. The conditions are narrower than for adults. A minor must be terminally ill and near death, and the suffering must be constant, unbearable, and physical. Mental suffering alone does not qualify a minor.
The safeguards stack. A pediatric psychiatrist or psychologist must interview the child and certify in writing that the child has the “capacity of discernment”: that they genuinely understand what they are asking for. The treating physician also consults an independent doctor for a second opinion. The child’s request and the written agreement of the parents or legal representatives both go on file. Psychological support is offered to the child and family throughout.
The Written Request
Every request must be in writing, signed and dated by the patient. If the patient physically cannot write, someone they designate can draft and sign it for them, but only in a physician’s presence. Without this written document, no physician can lawfully proceed.
The physician has to talk the request through with the patient in depth, covering remaining treatment options and palliative care. If the patient names a trusted person, that person is included in those conversations. Every consultation, discussion, and evaluation goes into the file, and that file is what the commission later reviews.
Advance Directives
An adult can file an advance directive in case they later become permanently unconscious and unable to communicate. It must be written, dated, and co-signed by two adult witnesses, at least one of whom has no material interest in the person’s death. The person filing it can also name one or more trusted individuals to advocate for them if it is ever activated.
Since a legislative amendment on March 15, 2020, advance directives stay valid indefinitely. Under the earlier rules, they expired after five years and had to be renewed. Now a directive remains active until the person explicitly revokes or changes it.
Registering the directive with the local municipal administration is strongly recommended. Registration adds it to the Federal Public Health Service’s database, which physicians can access electronically. That matters most in emergencies, when a doctor who does not know the patient needs to check quickly whether a directive exists. Keeping a copy in the primary medical file is a useful backup.
When a Physician Refuses
No physician can be forced to perform euthanasia, and no one else can be forced to assist. The conscience protection is written into the 2002 Act and applies without qualification. A refusal does not need a medical justification; personal or moral objections are enough.
A refusing physician still has duties. They must tell the patient (and any trusted person) of the refusal in a timely way and explain the reasons. If the patient or the trusted person asks, the physician must transfer the medical records to another physician the patient designates. The law does not require the refusing doctor to find a willing replacement, but the record-transfer duty keeps the patient from being cut off.
Oversight After the Procedure
Within four working days of performing euthanasia, the physician sends a registration document to the Federal Commission for the Control and Evaluation of Euthanasia. It has a sealed section protecting the identities of those involved and an open section with the medical details and procedural steps for the commission to review.
If the commission decides the legal conditions were not met, the case goes to a vote. At least two-thirds of voting members must agree before it is referred to the public prosecutor. That threshold is deliberately high; the system is designed as post-hoc review, not prior authorization. Once a case is referred, the general provisions of the Criminal Code apply. The euthanasia law itself contains no penalty provisions, so a physician who acts outside its framework faces prosecution for homicide. The only criminal trial involving euthanasia in Belgium, which ended in acquittal, proceeded on charges of murder by poisoning.
Cost
Since November 1, 2025, euthanasia is fully reimbursed by Belgium’s mandatory health insurance. Patients and their families pay nothing out of pocket. Coverage includes the procedure, the necessary materials, confirmation of death, and completion of the official documents. Before this change, costs were handled inconsistently and could fall partly on patients or families depending on the setting and the physician.
Non-Residents
The 2002 Act does not require Belgian residency or citizenship. On its face, a foreign national can access euthanasia under the same conditions as a Belgian citizen. The practical barrier is finding a Belgian physician willing to take the case. The law’s emphasis on a well-considered, repeated request and thorough dialogue between doctor and patient makes it hard to satisfy the procedural requirements without an established therapeutic relationship. Non-residents meet the same eligibility criteria, documentation requirements, and consultation obligations as residents, and no expedited path exists.
How Often It Happens
Reported cases have risen steadily. In 2024 the commission received 3,991 registration documents, a 16.6% increase over 2023. Cancer was the underlying condition in 54% of cases. Patients with multiple serious conditions, or polypathologies, made up 26.8%, and serious neurological disorders 8.1%. Cardiovascular and respiratory conditions each accounted for roughly 2.5–3%. Psychiatric conditions and cognitive disorders were about 1.4% each. The rising share of polypathology cases tracks an aging population living with combinations of serious conditions rather than a single terminal diagnosis.