Reporting of euthanasia and physician-assisted suicide in the Netherlands: descriptive study

Abstract

BackgroundAn important principle underlying the Dutch Euthanasia Act is physicians' responsibility to alleviate patients' suffering. The Dutch Act states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These criteria concern the patient's request, the patient's suffering (unbearable and hopeless), the information provided to the patient, the presence of reasonable alternatives, consultation of another physician and the applied method of ending life. To demonstrate their compliance, the Act requires physicians to report euthanasia to a review committee. We studied which arguments Dutch physicians use to substantiate their adherence to the criteria and which aspects attract review committees' attention.MethodsWe examined 158 files of reported euthanasia and physician-assisted suicide cases that were approved by the review committees. We studied the physicians' reports and the verdicts of the review committees by using a checklist.ResultsPhysicians reported that the patient's request had been well-considered because the patient was clear-headed (65%) and/or had repeated the request several times (23%). Unbearable suffering was often substantiated with physical symptoms (62%), function loss (33%), dependency (28%) or deterioration (15%). In 35%, physicians reported that there had been alternatives to relieve patients' suffering which were refused by the majority. The nature of the relationship with the consultant was sometimes unclear: the consultant was reported to have been an unknown colleague (39%), a known colleague (21%), otherwise (25%), or not clearly specified in the report (24%). Review committees relatively often scrutinized the consultation (41%) and the patient's (unbearable) suffering (32%); they had few questions about possible alternatives (1%).ConclusionDutch physicians substantiate their adherence to the criteria in a variable way with an emphasis on physical symptoms. The information they provide is in most cases sufficient to enable adequate review. Review committees' control seems to focus on (unbearable) suffering and on procedural issues.

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

“…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].…”

“…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].…”

“…When studying the motives of patients that have actually requested euthanasia in countries where it is legal, aspects of suffering are commonly identified [6,7,10]. Also, studies show that suffering from physical dimensions is not the most prominent motive for patients' wishes for a hastened death, despite the judgement of physicians.…”

Recruiting end-of-life cancer patients in the Netherlands for a study on suffering and euthanasia requests

“…It is obvious that eyes will be directed at the outcomes of research in the Netherlands. EAS is permitted if the criteria for due care are met 6,12 and these include unbearable and hopeless suffering, no realistic alternatives for treatment, a well-considered voluntary request, having informed the patient about his or her situation and prospects, consultation by an independent physician and a prudent performance of EAS. Successive studies, using data from death certificates and questionnaires directed at physicians, generated important information.…”

“…[1][2][3] Requests for EAS are directed at physicians, mainly by end-of-life cancer patients in primary care. [4][5][6] In many countries, relevant proportions of end-of-life cancer patients are cared for in primary care. [7][8][9] Requests by patients, directed at physicians to end their lives, touch the fundamental questions about the nature of suffering, the meaning of life and the goals of medicine.…”