Factors associated with requesting and receiving euthanasia: a nationwide mortality follow-back study with a focus on patients with psychiatric disorders, dementia, or an accumulation of health problems related to old age

Kirsten Evenblij,Bregje D Onwuteaka-Philipsen,H Roeline W Pasman,Trynke Hoekstra,Agnes Van Der Heide

doi:10.1186/s12916-019-1276-y

Kirsten Evenblij, Bregje D Onwuteaka-Philipsen + Show 3 more

Open Access

https://doi.org/10.1186/s12916-019-1276-y

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Abstract

BackgroundRecently, euthanasia and assisted suicide (EAS) in patients with psychiatric disorders, dementia, or an accumulation of health problems has taken a prominent place in the public debate. However, limited is known about this practice. The purpose of this study was threefold: to estimate the frequency of requesting and receiving EAS among people with (also) a psychiatric disorder, dementia, or an accumulation of health problems; to explore reasons for physicians to grant or refuse a request; and to describe differences in characteristics, including the presence of psychiatric disorders, dementia, and accumulation of health problems, between patients who did and did not request EAS and between patients whose request was or was not granted.MethodsA nationwide cross-sectional survey study was performed. A stratified sample of death certificates of patients who died between 1 August and 1 December 2015 was drawn from the central death registry of Statistics Netherlands. Questionnaires were sent to the certifying physician (n = 9351, response 78%). Only deceased patients aged ≥ 17 years and who died a non-sudden death were included in the analyses (n = 5361).ResultsThe frequency of euthanasia requests among deceased people who died non-suddenly and with (also) a psychiatric disorder (11.4%), dementia (2.1%), or an accumulation of health problems (8.0%) varied. Factors positively associated with requesting euthanasia were age (< 80 years), ethnicity (Dutch/Western), cause of death (cancer), attending physician (general practitioner), and involvement of a pain specialist or psychiatrist. Cause of death (neurological disorders, another cause) and attending physician (general practitioner) were also positively associated with receiving euthanasia. Psychiatric disorders, dementia, and/or an accumulation of health problems were negatively associated with both requesting and receiving euthanasia.ConclusionsEAS in deceased patients with psychiatric disorders, dementia, and/or an accumulation of health problems is relatively rare. Partly, this can be explained by the belief that the due care criteria cannot be met. Another explanation is that patients with these conditions are less likely to request EAS.

Highlights

Euthanasia and assisted suicide (EAS) in patients with psychiatric disorders, dementia, or an accumulation of health problems has taken a prominent place in the public debate
Using a nationwide sample of deceased people, we studied requests for euthanasia and assisted suicide (EAS) in people with and without these conditions focusing on the following questions: How many deaths among people with psychiatric disorders, dementia, and accumulation of health problems were preceded by a request for EAS and how many of these requests were granted? What are the reasons to grant or refuse a request for EAS? Which patient and care characteristics, including the presence of psychiatric disorders, dementia, and an accumulation of health problems, are associated with a patient requesting EAS and with a patient receiving EAS?
In people with a psychiatric disorder, dementia, or an accumulation of health problems, the most frequently reported cause of death was “other.” Of the people with dementia, 25.3% died of a neurological disorder, and of the people with an accumulation of health problems, 22.1% died of a cardiovascular disorder

Summary

Introduction

Euthanasia and assisted suicide (EAS) in patients with psychiatric disorders, dementia, or an accumulation of health problems has taken a prominent place in the public debate. The practice of EAS is restricted to physicians who must adhere to the “statutory due care criteria,” i.e., they must (1) be satisfied that the patient’s request is voluntary and well-considered; (2) be satisfied that the patient’s suffering is unbearable and without prospect of improvement; (3) have informed the patient about his situation and prognosis; (4) have come to the conclusion, together with the patient, that there is no reasonable alternative; (5) consult at least one other, independent physician; and (6) exercise EAS with due medical care and attention. The cause of suffering underlying the request must have a medical dimension, either somatic or psychiatric [1, 2], and physicians must report each case to the Regional Euthanasia Review Committees which review all EAS cases regarding whether the due care criteria were met. Demographic and care factors have been reported to influence requesting and receiving EAS [5,6,7,8]

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