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Trajectories to seeking demedicalised assistance in suicide: a qualitative in-depth interview study
  1. Martijn Hagens,
  2. Bregje D Onwuteaka-Philipsen,
  3. H Roeline W Pasman
  1. Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU Medical Centre, Amsterdam, The Netherlands
  1. Correspondence to Martijn Hagens, Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU Medical Centre, Amsterdam, The Netherlands. Address: Office C-580, Van der Boechorststraat 7, Amsterdam 1081 BT, The Netherlands; EOL{at}, M.Hagens{at}


Background In the Netherlands, people can receive (limited) demedicalised assistance in suicide (DAS)—an option less well known than physician-assisted dying (PAD).

Aim This study explores which trajectories people take to seek DAS, through open-coding and inductive analysis of in-depth interviews with 17 people who receive(d) DAS from counsellors facilitated by foundation De Einder.

Results People sought DAS as a result of current suffering or as a result of anticipating possible prospective suffering. People with current suffering were unable or assumed they would be unable to obtain PAD. For people anticipating possible prospective suffering, we distinguished two trajectories. In one trajectory, people preferred PAD but were not reassured of help by the physician in due time and sought DAS as a backup plan. In the other trajectory, people expressed a preference for DAS mainly as a result of emphasising self-determination, independence, taking their own responsibility and preparing suicide carefully. In all trajectories, dissatisfaction with physician–patient communication—for instance about (a denied request for) PAD or fearing to discuss this—influenced the decision to seek DAS.

Conclusions While PAD is the preferred option of people in two trajectories, obtaining PAD is uncertain and not always possible. Dissatisfaction with physician–patient communication can result in the physician not being involved in DAS, being unable to diagnose diseases and offer treatment nor offer reassurance that people seem to seek. We plea for more mutual understanding, respect and empathy for the limitations and possibilities of the position of the physician and the patient in discussing assistance in dying.

  • Autonomy
  • End-of-life
  • End of Life Care
  • Euthanasia
  • Suicide/Assisted Suicide

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  • Contributors MH had the initial idea for this study and wrote the research protocol, performed the interviews and the analysis and drafted the manuscript. HRWP and BDO-P commented on and contributed to the design, the analysis of the data and the final draft of the manuscript. All authors had access to all the data, can take responsibility for the integrity of the data and the accuracy of the data analysis and approved the final manuscript.

  • Funding The Netherlands Organisation for Scientific Research (NWO, The Hague; VICI 916.96.628).

  • Competing interests MH received an imbursement of expenses in 2015 (amount €150) for analysing the data for the annual report 2014 of Foundation De Einder.

  • Ethics approval VU Medical Center Medical Ethics Committee.

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

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