Physician‐assisted dying for children is conceivable for most Dutch paediatricians, irrespective of the patient's age or competence to decide

Abstract

Most Dutch paediatricians felt PAD was conceivable, even under the age of 12 if requested by the parents. They seemed driven by a sense of duty to relieve suffering.

The involvement of family in the Dutch practice of euthanasia and physician assisted suicide: a systematic mixed studies review

“…Furthermore, in a study investigating physicians’ opinions about EAS for children, GPs and medical specialists less often agreed with the idea of granting EAS for a child without parental consent than pediatricians [ 85 ]. Diverging opinions among pediatricians on the extent to which parents should be involved in EAS decision-making for children were found in other studies as well [ 73 , 86 ].…”

“… death certificate study and questionnaires Death certificates, attending physicians (n = 6860) Buiting et al [ 76 ] 2011 To investigate how good SCEN consultations differ from less satisfactory SCEN consultations questionnaires and qualitative interviews questionnaires: euthanasia consultants ( n = 594) Interviews: euthanasia consultants (n = 14), physicians who had requested an euthanasia consultation (n = 12), relatives (n = 10) De Boer et al [ 71 ] 2011 To gain insight into how ADs for euthanasia affect resident care in nursing homes questionnaires and in-depth interviews questionnaires: elderly care physicians ( n = 434) Interviews: elderly care physicians (n = 11) and relatives (n = 8) of deceased dementia patients with euthanasia AD Van Delden et al [ 42 ] 2011 To investigate knowledge, opinions and experiences regarding euthanasia, palliative sedation and ADs among health care professionals and members of the general public. questionnaires and in-depth interviews questionnaires: members of the general public ( n = 1960), physicians ( n = 793), nurses ( n = 1243) Interviews: physicians ( n = 49), nurses (n = 18), members of the general public ( n = 16) Van der Heide et al [ 47 ] 2012 To examine the practice of medical decisions at the end of life after 10 years of the Euthanasia Act, how the regulations of the Euthanasia Act are applied and which problems occur questionnaires and in-depth interviews questionnaires: physicians ( n = 2000) interviews : physicians (n = 30, 22/30 GPs), relatives of patients who died of EAS ( n = 25) Onwuteaka-Philipsen et al [ 7 ] 2017 To determine whether the Euthanasia Act reaches its aims survey and in-depth interviews questionnaires: physicians ( n = 2500), members of the general public ( n = 2500) interviews : psychiatrists ( n = 17) Bolt et al [ 73 ] 2017 To explore the situations in which pediatricians found PAD conceivable and to describe the roles of the patient and parents, the patient’s age and their life expectancy survey and in-depth interviews pediatricians ( n = 276 and n = 8) ...…”

“…Two studies found that advance euthanasia directives were rarely carried out for various reasons, such as nursing home policies [ 70 , 71 ], doubts about the presence of unbearable suffering or the applicability of the advance directive in that situation [ 71 ], and opinions of NHPs about the acceptability of euthanasia for patients with dementia or the validity of a request based on an advance directives [ 70 ]. Quantitative studies about end-of-life decisions for children indicate that 25 to 50% of pediatricians at some time receive an explicit request for physician assisted dying for children between the age of 1 and 17, and that in the majority of cases the request comes from parents [ 72 , 73 ]. The actual performance of physician assisted dying in children was rare according to a study of death certificates (2.7% of deaths in children), but in the few cases that were found, it was mostly at the explicit request of the parents (2.0 out of 2.7%) [ 72 ].…”

“…For others, euthanasia was seen as a possibility to organize care and to have a fixed end point of care responsibilities [ 35 ]. In various other studies, healthcare professionals -- both physicians and others -- describe exhausted family members, emotionally burdened by the course of events at the deathbed [ 9 , 34 , 38 , 73 ]. According to healthcare professionals, families’ exhaustion was sometimes projected onto the patient [ 9 , 34 ] and an appeal for EAS could be just a call for support and clarity [ 34 ].…”

“…The discussion could foster mutual bonds between patient, family and physician, if there was clear communication and respect for all involved [ 35 , 64 ]. In contrast, other studies mention how family members had great difficulties with the indecisiveness or conflicting messages of physicians about a request for EAS, and how they could feel powerless and not taken seriously as a patient’s representative [ 34 , 47 , 73 ]. Family members were also found to struggle with acting upon a euthanasia advanced directive, which could cause disagreement about whether the state of unbearable suffering had been reached and about who should make the final decision to act upon it [ 39 , 71 ].…”