End-of-Life Practices in the Netherlands under the Euthanasia Act

Heide, Agnes van der; Onwuteaka‐Philipsen, Bregje D.; Rürup, Matthias; Buiting, Hilde M; Delden, J.J.M. van; Wolf, Johanna E. Hanssen-de; Janssen, Anke G. J. M.; Pasman, H. Roeline W.; Rietjens, Judith; Prins, C. J. M.; Deerenberg, I. M.; Gevers, J. K. M.; Maas, P.J. van der; Wal, Gerrit van der

doi:10.1056/nejmsa071143

Cited by 378 publications

(265 citation statements)

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“…32 In The Netherlands, representativeness was reached for age and gender. However, nursing home deaths were underrepresented (n ¼ 9965) 33 (analyses not shown). The characteristics of the study population are presented in Table 1.…”

Section: Resultsmentioning

confidence: 98%

Advance Care Planning in Belgium and The Netherlands: A Nationwide Retrospective Study Via Sentinel Networks of General Practitioners

Meeussen

Block

Echteld

et al. 2011

Journal of Pain and Symptom Management

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Context. Advance care planning (ACP) is an important part of patient-centered palliative care. There have been few nationwide studies of ACP, especially in Europe.Objectives. To investigate the prevalence and characteristics of ACP in two European countries and identify the associated factors.Methods. A mortality follow-back study was undertaken in 2007 via representative nationwide Sentinel Networks of general practitioners (GPs) in Belgium and The Netherlands using similar standardized procedures. All GPs reported on each non-suddenly deceased patient in their practice. Our main outcome measure was whether or not ACP, that is, an agreement for medical treatment and/or medical decisions in the last phase of life in the case of the patient losing competence, was present.Results. Among 1072 non-sudden deaths, ACP was done with 34% of patients and most often related to the forgoing of potential life-prolonging treatments in general (24%). In 8% of cases, ACP was made in consultation with the patient and in writing. In 23% of cases, care was planned with the patient's family only. Multivariate analysis revealed that ACP was more often made with patients if they were capable of decision making during the last three days of life (odds ratio [OR] 3.86; 95% confidence interval [CI] 2.4e6.1), received treatment aimed at palliation in the last week (OR 2.57; 95% CI 1.6e4.2), had contact with a GP in the last week (OR 2.71; 95% CI 1.7e4.1), died of cancer (OR 1.46; 95% CI 1.1e2.0), or died at home (OR 2.16; 95% CI 1.5e3.0).

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Section: Resultsmentioning

confidence: 98%

Advance Care Planning in Belgium and The Netherlands: A Nationwide Retrospective Study Via Sentinel Networks of General Practitioners

Meeussen

Block

Echteld

et al. 2011

Journal of Pain and Symptom Management

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“…In most countries, it is currently illegal for physicians to grant such requests. In The Netherlands, where EAS is allowed under certain circumstances, 1.8% of all deaths in 2005 were the result of EAS [13]. Public perception is that EAS is more frequently associated with cancer, as this is far commoner.…”

Section: Introductionmentioning

confidence: 99%

“…Public perception is that EAS is more frequently associated with cancer, as this is far commoner. Of all cancer patients who died in The Netherlands, EAS was performed in 5% [13], compared with 20% of ALS patient deaths [16] and 0.5% of heart failure patient deaths [15].…”

Section: Introductionmentioning

confidence: 99%

Requests for euthanasia: origin of suffering in ALS, heart failure, and cancer patients

et al. 2010

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In The Netherlands, relatively more patients (20%) with amyotrophic lateral sclerosis (ALS) die due to euthanasia or physician-assisted suicide (EAS) compared with patients with cancer (5%) or heart failure (0.5%). We wanted to gain insight into the reasons for ALS patients requesting EAS and compare these with the reasons of cancer and heart failure patients. Knowing disease-specific reasons for requesting EAS may improve palliative care in these vulnerable patients. The data used in the present study were derived from the Support and Consultation in Euthanasia in The Netherlands (SCEN) evaluation study. This study provided consultation reports and questionnaires filled out by the attending physicians from 3,337 consultations conducted by SCEN physicians in situations where a patient requested EAS. For this study we selected data on all ALS patients (n = 51), all heart failure patients (n = 61), and a random sample of 73 cancer patients. The most frequently reported reasons for unbearable suffering were: fear of suffocation (45%) and dependency (29%) in ALS patients, pain (46%) and fatigue (28%) in cancer patients, and dyspnea (52%) and dependency (37%) in heart failure patients. Somatic complaints were reported more frequently as a reason for EAS by cancer patients [odds ratio (OR) 0.20, 95% confidence interval (CI) 0.09-0.46] and heart failure patients [OR 0.16, 95% CI 0.05-0.46] than by ALS patients. ALS patients should be helped in a timely fashion to cope with psychosocial symptoms, e.g., by informing them about the low risk of suffocation in the terminal phase and the possible means of preventing this.

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“…Increasingly, death derives not only from the natural course of a deadly disease, but also from a number of medical decisions, such as the assignment of treatments that prolong the life of critical patients or the suspension of those treatments (life-saving technology can sometimes only delay the process of death) and the relief of severe symptoms by the use of drugs which can cause, as possible side effects, acceleration of death. This scenario can create difficult situations such as when patients feel hopeless, after realising that their suffering is unbearable, and ask the doctor to help them to end their lives [2][3][4][5] .…”

mentioning

confidence: 99%

“…The assignment or suspension of treatments and the relief of severe symptoms are generally considered common medical practice 7 . Still, in most countries, doctors are not allowed to accept a request for euthanasia (death resulting from the administration of drugs by a physician, with the explicit intention to hasten death) 2 , although this is a topic which is being increasingly debated [2][3][4]8 .…”

mentioning

confidence: 99%

Caso belga de eutanásia em crianças: solução ou problema?

Silva

Nunes

2015

Rev. Bioét.

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By extending its euthanasia law to minors in 2014, Belgium has fuelled the international debate on this issue. In fact, Medicine does not always have something to offer when it comes to a child's serious disease. Nevertheless, should euthanasia be considered a viable solution? Keeping in mind the Belgian reality, this article analyses the relevance of the new law, considering, on one hand, children's growing self-determination capacity and, on the other hand, their lack of "life experience". Let's not forget, in addition, classical arguments against euthanasia, such as the disrespect for the value of human life and the eventual approaching of the slippery slope. An obvious solution for this problem is the implementation of a proper palliative care system. However, evidence about the quality of pediatric end-of-life care is scarce. Therefore, additional investigation is necessary in order to formulate and propose an appropriate public policy on the matter. Keywords: Euthanasia. Child. Belgium. Palliative care. Resumo Caso belga de eutanásia em crianças: solução ou problema?A aprovação da extensão da prática da eutanásia a menores de idade em 2014, pela Bélgica, reacendeu o debate internacional sobre as decisões médicas em fim de vida em crianças. De fato, a medicina nem sempre tem resposta para a doença grave de uma criança. No entanto, será a eutanásia uma solução equacionável? Partindo da realidade belga, este artigo analisa a premência da nova legislação, considerando, por um lado, a capacidade crescente de autodeterminação das crianças e, por outro, a sua falta de "experiência de vida", não esquecendo argumentos clássicos que contrariam a prática da eutanásia, como o desrespeito pelo valor da vida humana e a eventual concretização do argumento da ladeira escorregadia. Uma solução óbvia passa pela realização de cuidados paliativos apropriados. Todavia, sendo escassa a evidência sobre a qualidade dos cuidados pediátricos em fim de vida, é necessária investigação adicional para que se possam formular e propor políticas públicas adequadas a respeito da matéria. Palavras-chave: Eutanásia. Criança. Bélgica. Cuidados paliativos. Resumen Caso belga de la eutanasia en niños, ¿solución o problema?La aprobación de la práctica de la extensión de la eutanasia a menores en 2014 por Bélgica ha reavivado el debate internacional sobre las decisiones médicas en el fin de la vida de los niños. De hecho, la medicina no siempre ha de responder a la enfermedad grave de un hijo. Sin embargo, ¿debería considerarse la eutanasia como una solución viable? Partiendo de la realidad belga, este artículo analiza la emergencia de la nueva ley: considerando, por un lado, la creciente capacidad de autodeterminación de los niños y, en segundo lugar, su falta de "experiencia de vida", sin olvidar los clásicos argumentos que contradicen la práctica de la eutanasia, como el desprecio por el valor de la vida humana y la eventual realización de "rampa de deslizamiento". Una solución obvia es implementar los cuidados paliativos adecuados. Si...

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End-of-Life Practices in the Netherlands under the Euthanasia Act

Abstract: The Dutch Euthanasia Act was followed by a modest decrease in the rates of euthanasia and physician-assisted suicide. The decrease may have resulted from the increased application of other end-of-life care interventions, such as palliative sedation.

Cited by 378 publications

References 21 publications

Advance Care Planning in Belgium and The Netherlands: A Nationwide Retrospective Study Via Sentinel Networks of General Practitioners

Advance Care Planning in Belgium and The Netherlands: A Nationwide Retrospective Study Via Sentinel Networks of General Practitioners

Requests for euthanasia: origin of suffering in ALS, heart failure, and cancer patients

Caso belga de eutanásia em crianças: solução ou problema?

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