The doctor argued that the doses of morphine were too low to cause death and had been intended only to alleviate pain. The deaths, though they followed shortly after the treatments, were a result of the patients’ conditions and not the pain medication, the defence said.

In Belgium, euthanasia is legal provided the subject has a serious or incurable condition which leads to intolerable physical or psychological suffering. Most importantly, the patient needs to express the clear desire to bring an end to his or her life. In the case of patients suffering from dementia, that condition is impossible to fulfil.

The families of the patients supported the doctor and argued that their relatives were approaching death in any case, and that the doctor was doing a minimum necessary to prevent further suffering, even if the effect of pain control might be to shorten the time before death.

The case is being seen as an important precedent and a sign that doctors may continue to use pain control on terminal patients even if the treatments may shorten the lives of the patients. According to some estimates, one in four deaths in Flanders is accompanied by pain treatment that can shorten life. Wim Distelmans, professor of palliative care at the Free University of Brussels (VUB) and chair of the federal euthanasia commission, called for the government to provide a clear legal framework for terminal care, such as now exists for euthanasia proper, including a commission which could act “as a buffer between the doctor and the prosecutor”.