A “Suicide Pill” For Older People: Attitudes of Physicians, the General Population, and Relatives of Patients who died After Euthanasia or Physician-Assisted Suicide in The Netherlands

Voluntary active euthanasia (VAE) and physician-assisted suicide (PAS) remain technically illegal in the Netherlands, but the practices are openly tolerated provided that physicians adhere to carefully constructed guidelines. Harsh criticism of the Dutch practice by authors in the United States and Great Britain has made achieving a balanced understanding of its clinical, moral, and policy implications very difficult. Similar practice patterns probably exist in the United States, but they are conducted in secret because of a more uncertain legal and ethical climate. In this manuscript, we plan to compare end-of-life care in the United States and the Netherlands with regard to underlying values, justifications, and practices. We will explore the risks and benefits of each system for a real patient who was faced with a common end-of-life clinical dilemma, and close with challenges for public policies in both countries.

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Experiences and Motivations Underlying Wishes to Die in Older People Who Are Tired of Living: A Research Area in its Infancy

OMEGA - Journal of Death and Dying ◽

10.2190/om.69.2.f ◽

2014 ◽

Vol 69 (2) ◽

pp. 191-216 ◽

Cited By ~ 21

Author(s):

Els van Wijngaarden ◽

Carlo Leget ◽

Anne Goossensen

Keyword(s):

Older People ◽

Assisted Suicide ◽

Severe Depression ◽

Personal Characteristics ◽

Research Area ◽

Physician Assisted Suicide ◽

Age Related ◽

Wish To Die ◽

Life Threatening ◽

Insight Into

The wish to die in older people who are tired of living and the possibilities to organize death are currently being discussed within the debate on self-determination and physician-assisted suicide. Until now insight into the experiences and thoughts of people who are tired of life but not suffering from a severe depression or a life-threatening disease is lacking. Studies focussing specifically on this topic are rare. This review provides an overview of this research area in its infancy. The existential impact of age-related loss experiences play an important role in developing a wish to die. Other influencing factors are: personal characteristics, biographical factors, social context, perceptions and values. Further research to experiences and motivations underlying these specific age-related wishes to die and the existential impact of the loss-experiences seems necessary to deepen the understanding of this group of older people and for the development of policy and good care.

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Euthanasia and physician-assisted suicide not meeting due care criteria in the Netherlands: a qualitative review of review committee judgements

BMJ Open ◽

10.1136/bmjopen-2017-017628 ◽

2017 ◽

Vol 7 (10) ◽

pp. e017628 ◽

Cited By ~ 11

Author(s):

David Gibbes Miller ◽

Scott Y H Kim

Keyword(s):

The Netherlands ◽

Assisted Suicide ◽

Medication Administration ◽

Physician Assisted Suicide ◽

Review Committee ◽

Qualitative Review ◽

Physician Consultation ◽

Directed Content Analysis ◽

Incapacitated Patients ◽

Reported Data

AbstractObjectivesTo assess how Dutch regional euthanasia review committees (RTE) apply the euthanasia and physician-assisted suicide (EAS) due care criteria in cases where the criteria are judged not to have been met (‘due care not met’ (DCNM)) and to evaluate how the criteria function to set limits in Dutch EAS practice.DesignA qualitative review using directed content analysis of DCNM cases in the Netherlands from 2012 to 2016 published on the RTE website (https://www.euthanasiecommissie.nl/) as of 31 January 2017.ResultsOf 33 DCNM cases identified (occurring 2012–2016), 32 cases (97%) were published online and included in the analysis. 22 cases (69%) violated only procedural criteria, relating to improper medication administration or inadequate physician consultation. 10 cases (31%) failed to meet substantive criteria, with the most common violation involving the no reasonable alternative (to EAS) criterion (seven cases). Most substantive cases involved controversial elements, such as EAS for psychiatric disorders or ‘tired of life’, in incapacitated patients or by physicians from advocacy organisations. Even in substantive criteria cases, the RTE’s focus was procedural. The cases were more about unorthodox, unprofessional or overconfident physician behaviours and not whether patients should have received EAS. However, in some cases, physicians knowingly pushed the limits of EAS law. Physicians from euthanasia advocacy organisations were over-represented in substantive criteria cases. Trained EAS consultants tended to agree with or facilitate EAS in DCNM cases. Physicians and families had difficulty applying ambiguous advance directives of incapacitated patients.ConclusionAs a retrospective review of physician self-reported data, the Dutch RTEs do not focus on whether patients should have received EAS, but instead primarily gauge whether doctors conducted EAS in a thorough, professional manner. To what extent this constitutes enforcement of strict safeguards, especially when cases contain controversial features, is not clear.

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Incidence and risk factors for euthanasia or physician-assisted suicide in oncology patients: A systematic review.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.12034 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 12034-12034

Author(s):

Wei Liu ◽

Luke Liu ◽

Alissa Liu ◽

Sang Jia ◽

Tony Liu ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

The Netherlands ◽

Assisted Suicide ◽

Included Study ◽

Physician Assisted Suicide ◽

Severe Nausea ◽

Oncology Patients ◽

Assisted Death ◽

Chi Squared

12034 Background: In a growing number of jurisdictions, oncology patients may choose euthanasia or physician-assisted suicide (EPAS). A 2016 systematic review reported that 75% of U.S. and over 70% of Dutch and Belgian EPAS cases involved oncology patients. In the Netherlands and Belgium, the percentage of deaths among oncology patients via EPAS has been increasing. We investigated the incidence and risk factors for EPAS and EPAS requests in oncology patients. Methods: A systematic review was performed following PRISMA guidelines. PubMed, Embase and Cochrane databases were searched for articles from January 2000 to April 2020. Search terms were related to suicide, euthanasia, assisted dying, assisted death, right to die, mercy killing, and cancer. Eligible studies reported incidence and/or risk factors for EPAS/EPAS request based on at least 50 oncology patients. Eligibility for inclusion was independently reviewed by two authors, with discrepancies adjudicated by a third. Data obtained included: study type, country, cancer diagnosis, number of eligible patients, inclusion criteria, follow-up length, incidence of EPAS or EPAS request, and odds ratios (OR) for risk factors for EPAS and EPAS request. ORs and p values were extracted from studies whenever possible and were otherwise calculated based on the data provided using chi-squared test. Results: The search strategy identified 6519 results. 25 abstracts were selected for full-text review and 10 studies were included for analysis. All studies reported incidence of EPAS/EPAS request and 6 studies reported risk factors for EPAS/EPAS request. Six studies were from the Netherlands, 3 from Belgium, and 1 from Canada. Inclusion period for studies spanned from 1996 to 2018. Half of the included studies were prospectively conducted. Incidence of EPAS in cancer patients ranged from 7% to 15% and EPAS requests ranged from 8% to 27%. Factors significantly associated (p<0.05) with EPAS or EPAS request in any study are shown in the Table. Conclusions: Up to 15% of oncology patients choose euthanasia or physician-assisted suicide. Potentially modifiable symptoms including severe nausea, vomiting, and pain are significantly associated with EPAS in oncology patients.[Table: see text]

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