Changing the law on euthanasia to include dementia, or not?
Since 2002, Belgium has a law that legalises euthanasia. It does not exclude persons with dementia, but it requires the person requesting euthanasia to have ‘capacity to consent’. As a result, persons with dementia can still request euthanasia after formal diagnosis, as long as medical staff makes the assessment that there is ‘capacity to consent’. The law however did not provide details on how to make (and document!) such an assessment. An advance directive requiring euthanasia is only possible in situations of irreversible coma.
Over the past years, several well-known persons with dementia requested and received euthanasia. This resulted in opponents of a change of law to describe these situations as ‘they had to die too soon’. If the law would accept an advance directive in situations of dementia and loss of ‘capacity to consent’, they could have lived months and years longer.
When a new Belgian government was formed early 2024, the coalition agreement stipulated that they would look into changing the law to make these advance directives applicable in cases of dementia. Earlier, there was never a coalition between political parties that would have accepted such change of law.
For several years, the Belgian Advisory Committee on Bioethics worked on euthanasia based on an advance directive for conscious persons whose ability to decide for themselves and to express their will is irreversibly impaired. It was published December 2025 and is available in English[JS1] . Within the committee, there was broad consensus to change the law to include advance directives in situations when there was no longer ‘capacity to consent’. There was however dissent among the members of this committee on how to balance the ‘then self’ with the ‘now self’. What if the person had an advanced directive indicating a wish for euthanasia if and when he didn’t recognize his children anymore, but seems happy with the current situation, mixing up names or even not remembering them anymore?
The Flemish Council of Older Persons also published a proposal early 2026 supporting expanding the law on euthanasia. Currently, there have not yet been proposals in Belgian parliament to actually initiate discussions.
Early February 2026, the Flemish Expertise Centre on Dementia Care in cooperation with the Flemish Council of Older Persons and the Flemish Centre on Palliative Care organised a conference on dignified end of life, including euthanasia. As expected, the key elements of discussion were the lack of clarity in the assessment of ‘capacity to consent’ and the balance between the ‘then self’ and the ‘now self’. If somebody was a lifetime vegetarian but dementia resulted in him/her asking for a steak with pepper sauce, would you deny this referring to the ‘then self’ vegetarian person??
More info: jan.steyaert@dementie.be