General practitioners were most likely to assist patients
One of the most difficult requests a physician can receive is that for euthanasia or physician-assisted suicide (EAS). EAS is defined as the act of administering lethal drugs to a patient (euthanasia) or providing a patient with lethal drugs (physician-assisted suicide) by a physician with the intention of ending his or her life, on the patient’s explicit request, resulting in the death of the patient.
In the Netherlands, most requests for EAS are from patients with cancer, 72 percent or another physical disease, 19 percent. A minority of requests is from patients who have dementia, four percent, re tired of living in the absence of severe disease, three percent or have a psychiatric disease, two percent.
In the Netherlands, euthanasia or assisted suicide for those whose suffering is psychiatric/psychological in nature is legally permissible, but it represents a fraction of the numbers of patients who are assisted in die in this way.
Euthanasia and physician-assisted suicide in patients with psychiatric diseases; dementia or patients who are tired of living is highly controversial. Although such cases can fall under the Dutch Euthanasia Act, Dutch physicians seem reluctant to perform EAS, and it is not clear whether or not physicians reject the possibility of EAS in these cases.
In this new study researchers from The Netherlands set out to determine whether physicians can conceive of granting requests for EAS in patients with cancer, another physical disease, psychiatric disease, dementia or patients who are tired of living, and to evaluate whether physician characteristics are associated with conceivability,
For the study a survey was conducted among 2269 Dutch general practitioners, elderly care physicians and clinical specialists. A questionnaire was mailed to a random sample of 1100 GPs, 400 ECPs and 1000 clinical specialists (250 internists, 150 cardiologists, 150 intensivists, 150 neurologists, 150 pulmonologists and 150 surgeons) between October 2011 and June 2012. These groups of physicians were chosen because they are involved in most deaths.
The survey inquired if the physician had ever helped a patient with cancer, other physical disease, mental illness, early or advanced dementia, or someone without any severe physical ailments, but who was tired of living, to die. Those who had not done so were asked if they would even consider helping someone to die, and under what circumstances.
Of 2500 sampled physicians, 2269 were eligible. A total of 1456 physicians responded (64%), with 27 using the on-line version. The respondents were 708 GPs (response rate 72%), 287 ECPs (response rate 80%) and 461 clinical specialists (56 cardiologists, 70 surgeons, 75 intensivists, 105 internists, 71 pulmonologists, 78 neurologists, 6 specialties unknown; response rate 49%).
The response rate was 64% (1456)/ Around three out of four (77%) had been asked at least once for help to die, rising to more than nine out of 10 among general practitioners.
Most physicians found it conceivable that they would grant a request for EAS in a patient with cancer (85%) or another physical disease (82%). Less than half of the physicians found this conceivable in patients with psychiatric disease (34%), early-stage dementia (40%), advanced dementia (29–33%) or tired of living (27%). But fewer than one in five (18%) would do so in these circumstances if the person had no other medical grounds for suffering.
Among responds just 14% would not assist.
Among the 60% of respondents who had actually helped a patient to die, almost half (28%) had done so within the past 12 months.
Only a few of the respondents (7%) had actually helped a patient who did not have cancer or another severe physical illness to die, whereas over half (56%) had helped a cancer patient to die, and around a third (31%) had assisted someone with another physical disease.
Dr. Eva Bolt of the EMGO Institute for Health and Care Research, Amsterdam, the Netherlands, and lead author of this study in a linked blog commented “Each physician needs to form his or her own standpoint on euthanasia, based on legal boundaries and personal values. We would advise people with a future wish for euthanasia to discuss this wish with their physician in time, and we would advise physicians to be clear about their standpoint on the matter.”
Can physicians conceive of performing euthanasia in case of psychiatric disease, dementia or being tired of living, J Med Ethics doi: 10.1136/medethics-2014-102150
Journal of Medical Ethics Press Release