Dutch nursing home policies and guidelines on physician-assisted death and decisions to forego treatment

Abstract

Objective: The purpose of this study was to describe: (a) the prevalence and content of policies on euthanasia or assisted suicide (EAS) in three different types of nursing homes; (b) specific content items of written guidelines for EAS; and (c) the prevalence of guidelines on withholding or withdrawing treatment from severely demented patients and patients in a persistent vegetative state in the nursing homes. Design: Descriptive, cross-sectional. Methods: We have used a postal survey among directors of patient care of all ( n = 304) Dutch somatic nursing homes (meant for physically handicapped patients), psychogeriatric nursing homes (meant for patients suffering from dementia) and combined nursing homes. Data were collected from October 1994 through January 1995. Results: Results indicate that psychogeriatric nursing homes less often had a written EAS policy than somatic and combined nursing homes (62, 68 and 80% respectively). The most frequently reported aspects in the EAS guidelines, by the nursing homes with guidelines based on a policy that EAS was accepted under certain conditions; were consultation of another physician (97%), referral to another physician if the attending physician had in-principle objections (82%), and the involvement of the nurse in the decision-making procedure (82%). Of the nursing homes, 9% reported having specific written procedures concerning withholding or withdrawing treatment from severely demented patients. Conclusion: Guidelines in the nursing homes on euthanasia and assisted suicide might be improved. Especially with regard to withholding or withdrawing treatment from incompetent patients, more guidelines should be developed.