Euthanasia and Physician-Assisted Suicide in Patients With Multiple Geriatric Syndromes

Vera Van Den Berg,Alfred Sachs,Margot Zomers,Cuno Uiterwaal,Carlo Leget,Ghislaine Van Thiel,Els Van Wijngaarden,Iris Hartog

doi:10.1001/jamainternmed.2020.6895

Abstract

The Dutch Regional Euthanasia Review Committees (RTEs) reviewed and reported an increasing number of cases of euthanasia and physician-assisted suicide (EAS) requested by older people with multiple geriatric syndromes (MGS). Knowledge of the characteristics of cases of EAS for MGS is important to facilitate societal debate and to monitor EAS practice. To examine the accumulation of patient characteristics, geriatric syndromes, and other circumstances as reported in the case summaries of the RTEs that led to unbearable suffering associated with a request for EAS and to analyze the RTEs' assessments of these cases of EAS. A qualitative content analysis was conducted of all case summaries filed from January 1, 2013, to December 31, 2019, under the category MGS and published in a national open access database. These case summaries were selected by the RTEs from the total of 1605 reported cases of EAS in the category MGS. The RTEs published 53 cases (41 [77%] female) under the category MGS. A total of 28 patients (53%) had always perceived themselves as independent, active, and socially involved. None of the patients suffered from life-threatening conditions. Multiple geriatric syndromes, such as visual impairment (34 cases [64%]), hearing loss (28 cases [53%]), pain (25 cases [47%]), and chronic tiredness (22 cases [42%]), were common. The request for EAS was often preceded by a sequence of events, especially recurrent falls (33 cases [62%]). Although physical suffering could be determined in all cases, the case descriptions found that suffering occurred on multiple dimensions, such as the loss of mobility (44 [83%]), fears (21 [40%]), dependence (23 [43%]), and social isolation (19 [36%]). This qualitative study suggests that an accumulation of geriatric syndromes leading to a request for EAS is often intertwined with the social and existential dimension of suffering. This leads to a complex interplay of physical, psychological, and existential suffering that changes over time.

Highlights

This qualitative study suggests that an accumulation of geriatric syndromes leading to a request for euthanasia and physician-assisted suicide (EAS) is often intertwined with the social and existential dimension of suffering
An accumulation of geriatric syndromes alone is insufficient to explain the unbearableness of suffering that leads to a request for EAS in older persons with multiple geriatric syndromes (MGS)
All cases referred to patients who had been suffering from MGS for several years

Summary

Methods

We studied all 53 anonymized case summaries filed under the category MGS from an open access database on the RTE website.[1]. In a meeting with a member and the chairman of the RTEs, we discussed the question of which cases are to be published in the national database. They confirmed that cases that address questions and dilemmas were selected and cases representing situations that often occurred and were considered common (oral communication, February 28, 2019). Among the more extensive case reports are the ones in which the RTE asked the physician (and sometimes the consultant) for additional information. In these cases, the RTE had a face-to-face discussion with the physician (and consultant)

Results

Discussion

Conclusion