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

Abstract

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 MEASURES:

A request could be granted, rejected, or withdrawn or the patient could have died before a final decision was reached.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.

RESULTS:

Of 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.

• Authors: Marianne C Snijdewind, Dick L Willems, Luc Deliens, Bregje D Onwuteaka-Philipsen, Kenneth Chambaere
• Journal: JAMA internal medicine (JAMA Intern Med) Vol. 175 Issue 10 Pg. 1633-40 (Oct 2015) ISSN: 2168-6114 [Electronic] United States
• PMID: 26258534 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged
• Aged, 80 and over
• Ambulatory Care Facilities (organization & administration, statistics & numerical data)
• Attitude to Death
• Clinical Decision-Making
• Euthanasia, Active, Voluntary (statistics & numerical data)
• Female
• Health Status
• Humans
• Male
• Middle Aged
• Netherlands (epidemiology)
• Physician-Patient Relations
• Right to Die
• Socioeconomic Factors
• Suicide, Assisted (statistics & numerical data)