Judgment of unbearable suffering and willingness to grant a euthanasia request by Dutch general practitioners

Tol, Donald van; Rietjens, Judith; Heide, Agnes van der

doi:10.1016/j.healthpol.2010.04.007

Cited by 76 publications

(40 citation statements)

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“…This finding suggests that physician assistance in dying for people with psychological issues, in the absence of a serious physical illness, is difficult for the medical teams of the clinic just as it is for general medical practitioners and Dutch society. Euthanasia and physician-assisted suicide are controversial in the pared with physical conditions, physicians are less likely to regard psychosocial conditions as unbearable 22 ; in those cases, one of the legal due care criteria is not met. A more detailed study of decision making in such cases is warranted.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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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 MAIN OUTCOMES AND MEASURESA request could be granted, rejected, or withdrawn or the patient could have died before a final decision was reached.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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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“…Age did not predict physician's attitudes towards assisted dying (Ryynänen et al, 2002;van Tol et al, 2009van Tol et al, , 2010, but Ryynänen et al (2002) found that younger nurses held significantly more permissive views towards euthanasia. With regard to public opinion, Williams et al (2007) identified a trend towards younger people holding more favourable attitudes on assisted dying, but this was not a significant relationship.…”

Section: Factors Associated With Attitudesmentioning

confidence: 98%

“…This effect was found for the public (Cicirelli, 1998), nurses (Ryynänen et al, 2002) and for people with dementia (Koenig et al, 1996). However, no association was found in physicians (Ryynänen et al, 2002;van Tol et al, 2009van Tol et al, , 2010. The other reviewed studies had an underrepresentation of men in the sample, and this association was not explored.…”

Section: Factors Associated With Attitudesmentioning

confidence: 98%

Assisted dying in dementia: a systematic review of the international literature on the attitudes of health professionals, patients, carers and the public, and the factors associated with these

Tomlinson

Stott

2014

Int J Geriat Psychiatry

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“…There might also be a lack of recognition of all types of suffering in healthcare, where physicians prefer to see physical suffering as a more legitimate form of intolerable suffering [7][8][9]. According to a Norwegian study, physicians were observed to use strategies to readdress their patients' concerns into a medical context, while their existential meanings were removed and neglected [37].…”

Section: Discussionmentioning

confidence: 99%

“…However, there are no clear definitions of what constitutes intolerable suffering [6], which makes its assessment by physicians subjective. Previous studies in the Netherlands have shown that physicians vary in their assessment of suffering, and that there seems to be a preference for judging physical suffering as intolerable rather than suffering from other dimensions [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Suffering and euthanasia: a qualitative study of dying cancer patients’ perspectives

Karlsson

Milberg

Strang

2011

Support Care Cancer

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Dying cancer patients draw varying conclusions from suffering: suffering can, but does not necessarily, lead to advocations of euthanasia. Patients experiencing meaning and trust, and who find strategies to handle suffering, oppose euthanasia. In contrast, patients with anticipatory fears of multi-dimensional meaningless suffering and with lack of belief in the continuing availability of help, advocate euthanasia. This indicates a need for healthcare staff to address issues of trust, meaning, and anticipatory fears.

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Judgment of unbearable suffering and willingness to grant a euthanasia request by Dutch general practitioners

Cited by 76 publications

References 7 publications

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

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

Assisted dying in dementia: a systematic review of the international literature on the attitudes of health professionals, patients, carers and the public, and the factors associated with these

Suffering and euthanasia: a qualitative study of dying cancer patients’ perspectives

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