Belgium’s relationship with death looks, at first glance, like a ledger of rules and registers. Laws that define the right to refuse treatment, a national policy guaranteeing access to palliative care, and one of the world’s most developed frameworks for euthanasia.
But the country’s practices are braided with memory and ritual too. From chrysanthemums crowding cemetery paths on All Saints’ and All Souls’ days to the quiet rise of cremation. This has reshaped how families say goodbye.
These strands sit together uneasily and, at times, productively.
A History
Two decades ago, Belgium rewrote its social contract at the bedside. It passed, in quick succession, three cornerstone statutes. The Law on Patients’ Rights (2002), the Palliative Care Law (2002), and the Euthanasia Act (2002). Taken together, they codified autonomy near life’s end. They also put palliative care on a rights footing and decriminalized physician-performed euthanasia under strict conditions.
The euthanasia law established substantive and procedural rules, creating a federal review commission to examine each case after the fact. They have the authority to ask questions and, in rare instances, refer matters to prosecutors.
In 2014, parliament ended the age threshold for euthanasia, a world first that made headlines and remains controversial. Minors can, in exceptional circumstances, request euthanasia if they are terminally ill or in constant and unbearable suffering.
Supporters insisted that the law did not widen access so much as acknowledge an ethically fraught reality already present in pediatric palliative care. Critics warned of slippery slopes. Whatever one’s view, Belgium’s reform sits within a broader European reassessment of the end of life.
Normalization without Trivialization
Reported euthanasia rose from a few hundred cases after 2002 to well over a thousand a decade later. This continues to represent a small but visible share of deaths. The trend line tracks with more open public attitudes and places euthanasia within a continuum of last-resort responses to refractory suffering.
If euthanasia dominates headlines, the quieter backbone is palliative care.
Belgium’s law recognizes a right to palliative care. They finance a mixed system of hospital teams, dedicated units, and home-based networks. There are dozens of regional networks that knit together home nursing, general practitioners, social workers, and volunteers. Policy reviews over the past two years have urged investment earlier in the disease trajectory. And better public understanding of what palliative care is and is not.
“Right care, right moment, right place” has become both a slogan and a way of life (and death).
Traditions and Changes
In this historically Catholic country, All Saints’ and All Souls’ remain powerful cultural markers; families still visit graves and cover them with chrysanthemums as the year tilts toward winter.
At the same time, cremation has steadily become the norm, especially in Flanders. This is because of its low cost, flexibility, and secularization. Recent figures show cremation far outpacing burial in the Dutch-speaking region, and national tallies confirm the shift.
Pluralism complicates these practices and makes them more humane. Muslim communities, for example, have pressed municipalities to ensure speedy burials facing Mecca. There is now more space for Islamic sections in public cemeteries.
And then there is the frontier that sits uneasily between medicine and meaning: psychedelics. Belgium’s drug law, rooted in a 1921 statute and updated through royal decrees including a comprehensive 2017 schedule, classifies classic psychedelics such as psilocybin and DMT as controlled substances.
Manufacturing, possession, and sale are illegal.
There is no medical exemption, and human trials with these substances have largely been constrained by that framework. The ayahuasca landscape is particularly murky: while the constituent plants are not scheduled, authorities treat the brewed decoction as a preparation containing DMT and therefore illicit.
This outdated position has limited ceremonial use.
Yet Belgian clinicians and researchers often collaborate across borders. A Europe-wide palliative-care consortium recently secured EU funding to study psilocybin for existential distress in serious illness. This is an unmistakable sign that end-of-life care is paying attention, even if Belgian law has not shifted.
Attitudes toward psychedelics among Belgians mirror broader European mindsets: a blend of scientific curiosity, public-health caution, and a wary eye on commercialization. The cultural current here is pragmatic; Belgium is not a hub of psychedelic spirituality, and the dominant end-of-life conversation still focuses on pain control, quality medical care, and family presence.
That pragmatism is also visible in how the system treats advance directives. Belgians can formalize refusals of treatment and, uniquely, record a prior wish for euthanasia should they later become irreversibly unconscious; formalities matter, witnesses are required, and the document must be renewed periodically to remain valid.
Law, Ritual, Research
What does a good death look like in Belgium? For some, it is still a Mass and a burial beside grandparents with chrysanthemums blooming.
For others, it is a pared-down ceremony at a crematorium, ashes scattered in a favorite forest. A minority will ask, after months or years of unrelieved suffering and in conversation with their doctors, for a death on a chosen afternoon, at home.
And perhaps, in carefully designed trials, a few will swallow a measured capsule and find, for a few hours, a vantage point from which fear loosens its grip.
Belgium is not a utopia at the end of life. Access to palliative services still varies by region, public understanding lags, and clinicians work inside under-resourced systems.
But the country has done something rare: it has allowed death to be governed by norms that acknowledge suffering without pretending every pain can be cured. Its cemeteries and crematoria, its legal registers and clinical networks, and even its guarded curiosity about altered states are parts of the same project.
In a small, multilingual nation, the work of dying well is done in many tongues, but the promise is the same: when medicine runs out of roads, people should still be able to find their way home.
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