Euthanasia in the case of dementia: a survey among Flemish GPs

Abstract

BackgroundIn Belgium law prohibits euthanasia at the end stage of dementia when patients are no longer able to formulate their will. The number of applications for euthanasia based on dementia is low, but patients and their relatives are searching for access to euthanasia.AimThis study assessed the opinions of GPs facing requests for euthanasia in patients with dementia.Design & settingA cross-sectional survey was performed in general practice. Flemish GPs were invited by email to participate in the study.MethodGPs were reached through the regional GP association and the online survey was open for 4 weeks. The data were then anonymised, analysed, and interpreted. The outcome of interest addresses opinions of Flemish GPs regarding euthanasia in patients with dementia.ResultsA total of 113/308 doctors participated. It was found that 69% agreed that euthanasia in patients without dementia is more acceptable than in patients with dementia. When patients with dementia had concomitant diseases, 59% stated that euthanasia was more acceptable than when patients were ‘healthy’. It was also found that 56% agreed the euthanasia law needs adjustments towards patients with dementia. Legal adjustments were supported more by GPs of a younger generation. Non-religious doctors were twice as likely to be in favour of legal adjustments than their religious colleagues; 51% believed that the ability of patients to repeat their will is essential; while 72% of GPs feared pressure from relatives to follow the declaration of will.ConclusionThe Belgian GP has an open attitude towards euthanasia for patients with dementia. There was a willingness to perform euthanasia as the stage of dementia worsened and in cases of terminal conditions. Debate, education, and experience will influence opinion and the legislation process.

Intégration des personnes atteintes de troubles neurocognitifs dans la recherche sur l’aide médicale à mourir : l’apport unique du travail social

“…Ce sont effectivement les soignants, les proches et la population générale qui sont les plus souvent considérés dans les devis de recherche sur l'AMM en contexte de demandes anticipées. De vastes études ont été menées au Québec et en Europe sur cette question (Bravo et al, 2017(Bravo et al, , 2018Cleemput et Schoenmakers, 2019;Daveson et al, 2013;De Vleminck et al, 2015). Dans ces sondages et enquêtes citoyennes, la voix des personnes avec troubles neurocognitifs se confond à celle de la population.…”

Euthanasia in Dementia: A Narrative Review of Legislation and Practices in the Netherlands and Belgium

“…Fifty-six percent of Flemish general practitioners, especially the younger and non-religious physicians, agreed that the Act needed to be adjusted for patients with dementia. The general practitioners who disagreed with legalization of euthanasia in advanced dementia argued that quality of life cannot be judged reliably in this stage and that patients cannot repeat their will just before euthanasia is carried out ( 50 ).…”

The ethics of euthanasia in dementia: A qualitative content analysis of case summaries (2012–2020)

“…Studies describe (i) empirical characteristics of patients and practices involved, 3 , 4 (ii) competence issues and advance directives, 5 , 6 , 7 , 8 , 9 (iii) the way RTEs apply legal criteria, 10 , 11 (iv) the role of physicians and how euthanasia affects them. 12 , 13 , 14 , 15 , 16 , 17 , 18 …”

“…Studies describe (i) empirical characteristics of patients and practices involved, 3,4 (ii) competence issues and advance directives, [5][6][7][8][9] (iii) the way RTEs apply legal criteria, 10,11 (iv) the role of physicians and how euthanasia affects them. [12][13][14][15][16][17][18] Ethical questions have also been addressed, often at the level of individual cases. They revolve around (i) patient autonomy 19 and voluntariness, 20,21 (ii) suffering and the capriciousness of dementia, 20,22,23 (iii) timing and problems with anticipatory choices, 20,23 (iv) happiness, dignity and life's intrinsic value, 19,20 (v) doctors' involvement, 20 (vi) the ethical importance of cultural and medical (e.g., palliative care) developments.…”