End-of-life practices in the Netherlands under the Euthanasia Act.

Abstract

BACKGROUND:

In 2002, an act regulating the ending of life by a physician at the request of a patient with unbearable suffering came into effect in the Netherlands. In 2005, we performed a follow-up study of euthanasia, physician-assisted suicide, and other end-of-life practices.

METHODS:

We mailed questionnaires to physicians attending 6860 deaths that were identified from death certificates. The response rate was 77.8%.

RESULTS:

In 2005, of all deaths in the Netherlands, 1.7% were the result of euthanasia and 0.1% were the result of physician-assisted suicide. These percentages were significantly lower than those in 2001, when 2.6% of all deaths resulted from euthanasia and 0.2% from assisted suicide. Of all deaths, 0.4% were the result of the ending of life without an explicit request by the patient. Continuous deep sedation was used in conjunction with possible hastening of death in 7.1% of all deaths in 2005, significantly increased from 5.6% in 2001. In 73.9% of all cases of euthanasia or assisted suicide in 2005, life was ended with the use of neuromuscular relaxants or barbiturates; opioids were used in 16.2% of cases. In 2005, 80.2% of all cases of euthanasia or assisted suicide were reported. Physicians were most likely to report their end-of-life practices if they considered them to be an act of euthanasia or assisted suicide, which was rarely true when opioids were used.

CONCLUSIONS:

The Dutch Euthanasia Act was followed by a modest decrease in the rates of euthanasia and physician-assisted suicide. The decrease may have resulted from the increased application of other end-of-life care interventions, such as palliative sedation.

• Authors: Agnes van der Heide, Bregje D Onwuteaka-Philipsen, Mette L Rurup, Hilde M Buiting, Johannes J M van Delden, Johanna E Hanssen-de Wolf, Anke G J M Janssen, H Roeline W Pasman, Judith A C Rietjens, Cornelis J M Prins, Ingeborg M Deerenberg, Joseph K M Gevers, Paul J van der Maas, Gerrit van der Wal
• Journal: The New England journal of medicine (N Engl J Med) Vol. 356 Issue 19 Pg. 1957-65 (May 10 2007) ISSN: 1533-4406 [Electronic] United States
• PMID: 17494928 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright 2007 Massachusetts Medical Society.

Chemical References

• Analgesics, Opioid
• Hypnotics and Sedatives

Topics

• Aged
• Aged, 80 and over
• Analgesics, Opioid (administration & dosage)
• Cause of Death
• Euthanasia (legislation & jurisprudence, statistics & numerical data, trends)
• Female
• Follow-Up Studies
• Humans
• Hypnotics and Sedatives (administration & dosage)
• Male
• Middle Aged
• Netherlands
• Suicide, Assisted (legislation & jurisprudence, statistics & numerical data, trends)
• Surveys and Questionnaires
• Withholding Treatment (statistics & numerical data, trends)