What happens after a request for euthanasia is refused? Qualitative interviews with patients, relatives and physicians
Abstract
Objective Obtaining in-depth information from both patient and physician perspectives about what happens after a request for euthanasia or physician-assisted suicide (EAS) is refused.Methods In-depth interviews with nine patients whose EAS request was refused and seven physicians of these patients, and with three relatives of patients who had died after a request was refused and four physicians of these patients. Interviews were conducted at least 6 months after the refusal.Results A wish to die remained in all patients after refusal, although it sometimes diminished. In most cases patient and physician stopped discussing this wish, and none of the physicians had discussed plans for the future with the patient or evaluated the patient's situation after their refusal. Physicians were aware of patients' continued wish to die.Conclusions Patients who are refused EAS may subsequently be silent about a wish to die without abandoning it. Open communication about wishes to die is important, even outside the context of EAS, because if people feel unable to talk about them, their quality of life may be further diminished.Practice implications Follow up appointments after refusal could give patients the opportunity to discuss their feelings and physicians to support them.
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The literature suggests that many MAiD applicants report ongoing suicidal ideation following a denied MAiD request, calling for follow-up assessments and safety planning following the MAiD assessment.
“The literature suggests that many MAiD applicants report ongoing suicidal ideation following a denied MAiD request [61], calling for follow-up assessments and safety planning following the MAiD assessment.”
Very few treating physicians further discuss or evaluate the patient's death ideation or situation after the refusal of a euthanasia request.
“yet very few treating physicians further discuss or evaluate the patient's death ideation or situation after the refusal”
From Psychiatric patients requesting euthanasia: Guidelines for sound clinical and ethical decision making (2019) · cites this paper as Pasman, Willems, & Onwuteaka-Philipsen, 2013
Recent qualitative research shows that a death wish might diminish, but rarely disappears, in patients whose euthanasia request has been refused.
“Recent qualitative research shows that a death wish might diminish, but rarely disappears, in patients whose euthanasia request has been refused”
From Psychiatric patients requesting euthanasia: Guidelines for sound clinical and ethical decision making (2019) · cites this paper as Pasman, Willems, & Onwuteaka-Philipsen, 2013
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Self-citation
- Authors
- Pasman, H. R. W., Willems, D. L., & Onwuteaka-Philipsen, B. D.
- Affiliations
- Amsterdam Public Health (NL)
- Amsterdam UMC Location University of Amsterdam (NL)
- Corresponding author
- Pasman, H. Roeline W.
- Venue
- Patient Education and Counseling
- Publisher
- Elsevier BV
- Published
- 2013-09
- Volume
- 92
- Issue
- 3
- Pages
- 313-318
- ISSN
- 0738-3991 (ISSN-L)
- OpenAlex
- W2069603644
- Cited by
- 44
- References
- 21
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 5 · 2023: 2 · 2022: 3 · 2021: 4 · 2020: 4 · 2019: 10 · 2017: 2 · 2016: 2 · 2015: 2 · 2014: 4 · 2013: 1
- FWCI
- 3.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Patient Education and Counseling (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- euthanasia, physician-assisted suicide, desire for death, end-of-life communication, physician-patient communication, relatives of patients, follow-up care, quality of life
- MeSH terms
- Aged, Aged, 80 and over, Attitude to Death, Communication, Decision Making, Euthanasia, Family, Female, Humans, Interviews as Topic, Male, Netherlands, Patients, Physician-Patient Relations, Suicide, Assisted, Qualitative Research, Refusal to Participate
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