A Study of the First Year of the End-of-Life Clinic for Physician-Assisted Dying in the Netherlands

Abstract

IMPORTANCE Right to Die NL, an organization in the Netherlands that advocates for the option of euthanasia, founded the End-of-Life Clinic in 2012 to provide euthanasia or physician-assisted suicide for patients who meet all legal requirements but whose regular physicians rejected their request. Many patients whose requests are rejected have less common situations, such as a psychiatric or psychological condition, dementia, or being tired of living.OBJECTIVE To study outcomes of requests for euthanasia or physician-assisted suicide received by the clinic and factors associated with granting or rejecting requests.DESIGN Analysis of application forms and registration files from March 1, 2012, to March 1, 2013, the clinic's first year of operation, for 645 patients who applied to the clinic with a request for euthanasia or physician-assisted suicide and whose cases were concluded during the study period. MAIN OUTCOMES AND MEASURESA request could be granted, rejected, or withdrawn or the patient could have died before a final decision was reached. We analyzed bivariate and multivariate associations with medical conditions, type of suffering, and sociodemographic variables. RESULTSOf the 645 requests made by patients, 162 requests (25.1%) were granted, 300 requests (46.5%) were refused, 124 patients (19.2%) died before the request could be assessed, and 59 patients (9.1%) withdrew their requests. Patients with a somatic condition (113 of 344 [32.8%]) or with cognitive decline (21 of 56 [37.5%]) had the highest percentage of granted requests. Patients with a psychological condition had the smallest percentage of granted requests. Six (5.0%) of 121 requests from patients with a psychological condition were granted, as were 11 (27.5%) of 40 requests from patients who were tired of living.CONCLUSIONS AND RELEVANCE Physicians in the Netherlands have more reservations about less common reasons that patients request euthanasia and physician-assisted suicide, such as psychological conditions and being tired of living, than the medical staff working for the End-of-Life Clinic. The physicians and nurses employed by the clinic, however, often confirmed the assessment of the physician who previously cared for the patient; they rejected nearly half of the requests for euthanasia and physician-assisted suicide, possibly because the legal due care criteria had not been met.

Trajectories to seeking demedicalised assistance in suicide: a qualitative in-depth interview study

“…This uncertainty regarding the availability of PAD is especially the case for psychiatric patients and patients suffering from dementia or a ‘completed life’. Initiatives that clarify the possibilities falling within the scope of the current law on PAD are helpful, for example, initiatives like The End of Life Clinic which provides PAD to patients who meet all legal requirements but whose requests are rejected by their regular physician 28. On the other hand, there will always be people falling outside the scope of the law on PAD, for example, when it concerns anticipating possible prospective suffering or people who fall in the trajectory that values self-determination above everything else.…”

Cost analysis of medical assistance in dying in Canada

“…In addition, there will be patients who request medical assistance in dying and incur the 2 assessment fees but do not complete the process, either being denied, retracting their request or dying from their disease. In the Netherlands, data from a single centre suggests 25% of requests for medical assistance in dying are ultimately granted, 17 whereas this proportion is more than 75% in Belgium. 18 We chose a conservative estimate that 33% of requests in Canada will be granted, meaning for every patient receiving medical assistance in dying, we added the cost of 2 additional patients who underwent assessment only.…”

On Legalizing Physician‐Assisted Death for Dementia

“…(In the remaining cases, the request was denied or withdrawn before the PAD decision was made.) The researchers named patients’ lack of decision‐making capacity as a probable basis of decisions to reject PAD requests …”

“…The researchers named patients' lack of decision-making capacity as a probable basis of decisions to reject PAD requests. 4 Although PAD is provided to highfunctioning dementia patients in the Netherlands, AEDs rarely lead to PAD. As of 2016, just one case of an assisted death based on an AED had been widely publicized.…”