Objective To investigate the emotional feelings reported by physicians in the Netherlands after having performed euthanasia or other medical end‐of‐life decisions. Design Nationwide interview study in the Netherlands, November 1995 through February 1996. Participants and setting A random sample of 405 physicians (general practitioners, nursing home physicians, and clinical specialists). Main outcome measures Subsequent feelings of physicians about their most recent cases (if any) of euthanasia, assisted suicide, life‐ending without an explicit request from the patient, and alleviation of pain and other symptoms with high doses of opioids. Results The response rate was 89%. In 52% of all cases of hastening death, physicians had feelings of comfort afterwards, which included feelings of satisfaction in 44% and of relief in 13%. Feelings of discomfort were reported in 42%, most frequently referred to as emotional (28%) or burdensome (25%). Feelings of discomfort were highest for euthanasia (75%; P < 0.000). 95% of physicians were willing to perform euthanasia or assisted suicide again in similar situations. Afterwards, 5% had doubts, but none had regrets, about performing euthanasia. Conclusions Hastening the death of a patient evokes different feelings among physicians. Although performing euthanasia is often experienced as burdensome and emotional, granting the ultimate wish of a competent patient may also give physicians a feeling of having contributed to the quality of the dying process.

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The objective of this paper is to describe the ethics and incidence of euthanasia and physician-assisted suicide (EAS) with special regard to old age. It is based on an assumption that if and when a practice of euthanasia and EAS is allowed, several vulnerable groups, including the elderly, may become a 'population at risk'. We describe some of these claims, and make an inventory of the arguments against a permissive policy concerning euthanasia and EAS which emphasise inherent dangers for the elderly. We then give an overview of the results of empirical studies about incidence of (request for) euthanasia and assisted suicide in the Netherlands, Australia, the UK, the US, Denmark and Norway. These results confirm that practitioners do receive requests for EAS and that EAS is performed in all these countries. However, there are large differences between these countries with regard to the numbers of requests and performances. Dutch findings concerning the age distribution of patients who received euthanasia or assisted suicide indicate that these procedures are rare in the elderly and in nursing homes. We conclude that, although euthanasia and assisted suicide are illegal, there is evidence that these practices occur in all countries studied. Most surveys on the incidence of euthanasia show lower figures than those in the Netherlands. Dutch studies do not provide any evidence for the elderly being in danger of becoming 'victims' of euthanasia or assisted suicide.

ObjectiveTo investigate how often physicians act as a consultant in the review of intended euthanasia and assisted suicide (EAS), by whom physicians are asked to act as a consultant, and the consultant's reasons for not agreeing with the intended performance of EAS. DesignA retrospective descriptive study. SettingThe Netherlands. ParticipantsA stratified random sample of 405 Dutch physicians. Main outcome measuresNumber of times the physician has been a consultant; how often a physician had previously been asked to be a consultant by the same treating physician; why consultants advised against EAS. Results42% of interviewed physicians had acted as a consultant for EAS and 11 % had been a consultant more than three times. Half the physicians who acted as a consultant more than once were invited to do so by the same attending physician, and 41% of consultants had previously consulted the attending physician. The main reasons consultants advised against EAS were because treatment options were still available, the patient's request was not well‐considered or persistent, and the patient's suffering was not unbearable and hopeless. ConclusionsMany physicians have at some time been a consultant in a case of intended EAS, but only very few have been able to gain experience in consultancy. To guarantee high standards of consultation, it may be advisable to appoint and train specific consultants for EAS.