A study published this month in the Journal of Medical Ethics examined the “deliberate” euthanasia of patients in Belgium without their explicit, voluntary consent as required by law.

The study’s author, Raphael Cohen-Almagor, a professor of philosophy and ethics at the United Kingdom’s Hull University, found that life-ending drugs were used “with the intention to shorten life and without explicit request” in 1.7 percent of all deaths in Belgium in 2013.

In 52.7 percent of these cases, the patients were 80 years of age or older. The decision to euthanize was not discussed with the patient in 77.9 percent of the cases because he/she was comatose, had dementia, or “because discussion would have been harmful to the patient’s best interest,” according to the study.

Belgium passed the Euthanasia Act in 2002, which states that only voluntary euthanasia is legally permissible.

“At the heart of this legislation is the free will of the patient who asks for euthanasia,” Cohen-Almagor noted. “It is worrying that some physicians take upon themselves the responsibility to deliberately shorten patients’ lives without a clear indication from the patients that this is what they would want.”

According to the law, the patient must request euthanasia, and such a request must be “voluntary, well-considered, and repeated and…not the result of any external pressure.” The patient must also be “an adult or an emancipated minor, capable and conscious at the time of his/her request.”

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