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Do guidelines on euthanasia and physician-assisted suicide in Dutch hospitals and nursing homes reflect the law? A content analysis
  1. B A M Hesselink1,
  2. B D Onwuteaka-Philipsen1,
  3. A J G M Janssen2,
  4. H M Buiting1,
  5. M Kollau1,
  6. J A C Rietjens3,
  7. H R W Pasman1
  1. 1VU University Medical Center, EMGO Institute for Health and Care Research, Department of Public and Occupational Health, Amsterdam, The Netherlands
  2. 2VU University Medical Center, Department of Medical Affairs, Amsterdam, The Netherlands
  3. 3Erasmus MC, Department of Public Health, Rotterdam, The Netherlands
  1. Correspondence to B A M Hesselink, VU University Medical Center, EMGO Institute for Health and Care Research, Van der Boechorststraat 7, Amsterdam 1081 BT, The Netherlands; berniek.hesselink{at}


To describe the content of practice guidelines on euthanasia and assisted suicide (EAS) and to compare differences between settings and guidelines developed before or after enactment of the euthanasia law in 2002 by means of a content analysis. Most guidelines stated that the attending physician is responsible for the decision to grant or refuse an EAS request. Due care criteria were described in the majority of guidelines, but aspects relevant for assessing these criteria were not always described. Half of the guidelines described the role of the nurse in the performance of euthanasia. Compared with hospital guidelines, nursing home guidelines were more often stricter than the law in excluding patients with dementia (30% vs 4%) and incompetent patients (25% vs 4%). As from 2002, the guidelines were less strict in categorically excluding patients groups (32% vs 64%) and in particular incompetent patients (10% vs 29%). Healthcare institutions should accurately state the boundaries of the law, also when they prefer to set stricter boundaries for their own institution. Only then can guidelines provide adequate support for physicians and nurses in the difficult EAS decision-making process.

  • Care of the dying patient
  • living wills/advance directives
  • policy guidelines/inst. review boards/review cttes.
  • suicide/assisted suicide

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  • Funding This study was supported by a grant from the Dutch Ministry of Health.The study sponsors did not have any role in the design of the study, the data collection, analysis, or interpretation of data, in the writing of the report; or in the decision to submit the article for publication. The researchers are independent from the funders.

  • Competing interests None to declare.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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