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Dutch criteria of due care for physician-assisted dying in medical practice: a physician perspective
  1. H M Buiting1,
  2. J K M Gevers2,
  3. J A C Rietjens1,
  4. B D Onwuteaka-Philipsen3,
  5. P J van der Maas1,
  6. A van der Heide1,
  7. J J M van Delden4
  1. 1
    Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, The Netherlands
  2. 2
    Academic Medical Center, Department of Social Medicine, Health Law Section, Amsterdam, The Netherlands
  3. 3
    Vrije Universiteit Medical Center, Department of Public and Occupational Health and Institute for Research in Extramural Medicine, Amsterdam, The Netherlands
  4. 4
    University Medical Center Utrecht, Julius Center for Health Sciences, Utrecht, The Netherlands
  1. Ms H M Buiting, Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands; h.buiting{at}erasmusmc.nl

Abstract

Introduction: The Dutch Euthanasia Act (2002) states that euthanasia is not punishable if the attending physician acts in accordance with the statutory due care criteria. These criteria hold that: there should be a voluntary and well-considered request, the patient’s suffering should be unbearable and hopeless, the patient should be informed about their situation, there are no reasonable alternatives, an independent physician should be consulted, and the method should be medically and technically appropriate. This study investigates whether physicians experience problems with these criteria in medical practice.

Methods: In 2006, questionnaires were sent to a random, stratified sample of 2100 Dutch physicians (response rate: 56%). Physicians were asked about problems in their decision-making related to requests for euthanasia or assisted suicide after enforcement of the 2002 Euthanasia Act.

Results: Of all physicians who had received a request for euthanasia or assisted suicide (75%), 25% had experienced problems in the decision-making with regard to at least one of the criteria of due care. Physicians who had experienced problems mostly indicated to have had problems related to evaluating whether or not the patient’s suffering was unbearable and hopeless (79%) and whether or not the patient’s request was voluntary or well considered (58%).

Discussion: Physicians in The Netherlands most frequently reported problems related to aspects in which they have to evaluate the patient’s subjective perspective(s). However, it can be questioned whether placing emphasis on these subjective aspects is an adequate fulfilment of the duties imposed on physicians, as laid down in the Dutch Euthanasia Act.

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Footnotes

  • Competing interests: None.

  • Funding: This study was supported by a grant from ZonMW, The Netherlands Organization for Health Research and Development.

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