Physician-assisted death in psychiatric practice in The Netherlands
Open accessAbstract
BACKGROUND: In 1994 the Dutch Supreme Court ruled that in exceptional instances, physician-assisted suicide might be justifiable for patients with unbearable mental suffering but no physical illness. We studied physician-assisted suicide and euthanasia in psychiatric practice in the Netherlands. METHODS: In 1996, we sent questionnaires to 673 Dutch psychiatrists - about half of all such specialists in the country - and received 552 responses from the 667 who met the study criteria (response rate, 83 percent). We estimated the annual frequencies of requests for physician-assisted suicide by psychiatrists and actual instances of assistance. RESULTS: Of the respondents, 205 (37 percent) had at least once received an explicit, persistent request for physician-assisted suicide and 12 had complied. We estimate there are 320 requests a year in psychiatric practice and 2 to 5 assisted suicides. Excluding those who had ever assisted, 345 of the respondents (64 percent) thought physician-assisted suicide because of a mental disorder could be acceptable, including 241 who said they could conceive of instances in which they themselves would be willing to assist. The most frequent reasons for refusing were the belief that the patient had a treatable mental disorder, opposition to assisted suicide in principle, and doubt that the suffering was unbearable or hopeless. Most, but not all, patients who had been assisted by their psychiatrists in suicide had both a mental disorder and a serious physical illness, often in a terminal phase. Thirty percent of the respondents had been consulted at least once by a physician in another specialty about a patient's request for assisted death. The annual number of such consultations was estimated at 310, about 3 percent of the estimated 9700 requests for euthanasia or physician-assisted suicide in medical practice. CONCLUSIONS: Explicit requests for physician-assisted suicide are not uncommon in psychiatric practice in the Netherlands, but these requests are rarely granted. Psychiatric consultation for medical patients who request physician-assisted death is relatively rare.
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In a 1997 questionnaire study among 204 Dutch psychiatrists who had experience with patients requesting PAD, 64% of the patients who requested PAD refused a form of treatment.
“as early as 1997, in a questionnaire study among 204 Dutch psychiatrists who had experience with patients requesting PAD, it was shown that 64% of the patients who requested PAD refused a form of treatment.48”
From Irremediable Psychiatric Suffering in the Context of Physician-assisted Death: A Scoping Review of Arguments: La souffrance psychiatrique irrémédiable dans le contexte du suicide assisté : Une revue étendue des arguments (2020) · cites this paper as [48]
The “Requests for Physician-Assisted Suicide” section reports that 129 of 202 patients (64%) refused remaining psychiatric treatment options, supporting the main finding. It reports 205 psychiatrists who had received a request and detailed case information from 202—not the claimed 204 psychiatrists. (LLM, conf=0.90)
Experimental — accuracy not yet measuredMAiD-NT practices have been extended in some countries to people who are not terminally ill because of a somatic disease but are affected by non-terminal conditions, including psychiatric disorders (e.g., depression, schizophrenia) or major neurocognitive disorders (e.g., dementia).
“Gradually, starting from the Dutch experience dating almost 30 years back [1], these practices have been extended in some countries to people that are not terminally ill because of a somatic disease, but are affected by non-terminal conditions(MAiD-NT), including psychiatric disorders (e.g., depression, schizophrenia) or major neurocognitive disorders (e.g., dementia).”
From Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders (2022) · cites this paper as [1]
The Abstract and the case table document physician-assisted death in Dutch psychiatric practice, including a patient with a mood disorder and no physical illness. The paper supports the cited Dutch experience, but it does not establish a subsequent expansion across countries or document assisted death for dementia. Its case table lists psychosis, but does not identify schizophrenia specifically. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe questionnaire was similar to the one used in a nation-wide study amongst Dutch psychiatrists in 1995.
“The questionnaire was similar to the one used in a nation-wide study amongst Dutch psychiatrists in 1995 [13].”
From Euthanasia and physician-assisted suicide in patients suffering from psychiatric disorders: a cross-sectional study exploring the experiences of Dutch psychiatrists (2019) · cites this paper as [13]
The Sample and Questionnaire sections identify a study of Dutch psychiatrists that used questionnaires asking about 1995, so the citation identifies a relevant instrument. But the Questionnaire section says the questionnaires were sent in March 1996; it does not establish that the study or questionnaire was used in 1995. No page numbers are available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredLittle is known about the experiences of psychiatrists with EAS in psychiatric practice.
“However, little is known about the experiences of psychiatrists with this practice.”
From Euthanasia and physician-assisted suicide in patients suffering from psychiatric disorders: a cross-sectional study exploring the experiences of Dutch psychiatrists (2019) · cites this paper as [13]
The paper’s introductory passage says the authors sought reliable estimates of requests and assisted deaths in psychiatric practice and examined psychiatrists’ roles and opinions, indicating a gap the study aimed to address. It does not explicitly establish the broader claim that little is known about psychiatrists’ experiences with the practice; its questionnaire and results report such experiences in the Netherlands. (LLM, conf=0.70)
Experimental — accuracy not yet measuredThe estimated absolute number of patients who received EAS increased from 5 in 1995 to 30 in 2008, to 60 in 2016.
“The estimated absolute number of patients who received EAS also increased, from 5 in 1995 to 30 in 2008, to 60 in 2016.”
From Euthanasia and physician-assisted suicide in patients suffering from psychiatric disorders: a cross-sectional study exploring the experiences of Dutch psychiatrists (2019) · cites this paper as [13]
The Statistical Analysis and Psychiatrists’ Assistance in Suicide sections (page unavailable) describe estimates based on 1994–1995 data and give a range of two to five psychiatrist-assisted suicides per year. They do not give a separate estimate of five for 1995 or report the figures for 2008 and 2016, so this source cannot establish the claimed increase. (LLM, conf=0.86)
Experimental — accuracy not yet measured
There seems to be a shift in the nature of suffering underlying the EAS request: in 1995, 10 out of 11 psychiatric patients who received EAS had severe and life-limiting somatic comorbidity, whereas in 2016 only 3 out of 9 had somatic comorbidity.
“Whilst in 1995, 10 out of 11 psychiatric patients who received EAS had severe and life-limiting somatic comorbidity, in 2016 only 3 out of 9 psychiatric patients had somatic comorbidity.”
From Euthanasia and physician-assisted suicide in patients suffering from psychiatric disorders: a cross-sectional study exploring the experiences of Dutch psychiatrists (2019) · cites this paper as [13]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThe number of patients aged 50 years or younger decreased from 7 out of 11 in 1995, to 12 out of 22 in 2008, to only 1 out of 9 in 2016.
“The number of patients aged 50 years or younger decreased from 7 out of 11 in 1995, to 12 out of 22 in 2008, to only 1 out of 9 in 2016 [13].”
From Euthanasia and physician-assisted suicide in patients suffering from psychiatric disorders: a cross-sectional study exploring the experiences of Dutch psychiatrists (2019) · cites this paper as [13]
The table describing 11 patients whose psychiatrists assisted their suicides lists seven aged 50 or younger. But the Psychiatrists’ Assistance in Suicide section says respondents described their most recent case, not necessarily a case from 1995. This 1997 paper cannot support the 2008 and 2016 figures or the claimed decline across those years. (LLM, conf=0.90)
Experimental — accuracy not yet measuredThe estimated total number of psychiatric patients explicitly requesting EAS in the Netherlands in a one-year period increased from 320 in 1995 to 500 in 2008, to 1100 requests in 2016.
“The estimated total number of psychiatric patients explicitly requesting EAS in the Netherlands in a one year period increased from 320 in 1995 to 500 in 2008, to 1100 requests in 2016.”
From Euthanasia and physician-assisted suicide in patients suffering from psychiatric disorders: a cross-sectional study exploring the experiences of Dutch psychiatrists (2019) · cites this paper as [13]
The Requests for Physician-Assisted Suicide section estimates about 320 explicit requests per year in Dutch psychiatric practice; Statistical Analysis says the estimate was based on 1994 and 1995 data. This 1997 paper does not support the claimed figures for 2008 or 2016, or the asserted increase across those years. (LLM, conf=0.91)
Experimental — accuracy not yet measuredThe percentage of EAS requests from psychiatric patients that is granted remains low: 2% in 1995, 6% in 2008, and 5% in 2016.
“However, the percentage of EAS requests from psychiatric patients that is granted remains low: 2% in 1995, 6% in 2008 and 5% in 2016 [13].”
From Euthanasia and physician-assisted suicide in patients suffering from psychiatric disorders: a cross-sectional study exploring the experiences of Dutch psychiatrists (2019) · cites this paper as [13]
The Discussion reports that about 2% of requests in Dutch psychiatric practice were granted, supporting the early figure. This 1997 paper does not report the claimed 6% for 2008 or 5% for 2016. (LLM, conf=0.94)
Experimental — accuracy not yet measuredIt is less likely that the low response rate has compromised the validity of our findings.
“Therefore, it is less likely that the low response rate has compromised the validity of our findings.”
From Euthanasia and physician-assisted suicide in patients suffering from psychiatric disorders: a cross-sectional study exploring the experiences of Dutch psychiatrists (2019) · cites this paper as [13]
The Response section reports that a subset of nonrespondents did not differ markedly from respondents on several core measures. The Discussion describes the paper’s findings as reliable, but cites its 83 percent response rate as one reason. It does not establish that a low response rate was unlikely to compromise the citing authors’ findings. (LLM, conf=0.78)
Experimental — accuracy not yet measuredIn a survey of Dutch psychiatrists (552 respondents out of 673), among patients who requested pEAS in the previous two years (n=201, 63% women), the most frequent diagnoses were mood disorder (51%) and personality disorder (64%), or both (48%).
“A first analysis of the data from a survey of Dutch psychiatrists (552 respondents out of 673) indicated that among patients who requested pEAS in the previous two years (n=201, 63% women), the most frequent diagnoses were mood disorder (51%) and personality disorder (64%), or both (48% of patients) (Groenewoud et al., 1997).”
From Euthanasia and assisted suicide in psychiatric patients: A systematic review of the literature (2021) · cites this paper as Groenewoud et al., 1997
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThe numbers of EAS in psychiatric practice are low and our findings are largely consistent with existing evidence.
“However, the numbers of EAS in psychiatric practice are low and our findings are largely consistent with existing evidence [10–14].”
Among these pEAS requesters, 64% refused the remaining psychiatric treatment options.
“Among these patients, 64% refused the remaining psychiatric treatment options.”
From Euthanasia and assisted suicide in psychiatric patients: A systematic review of the literature (2021) · cites this paper as Groenewoud et al., 1997
Women were preponderant in both pEAS cases and pEAS requests.
“Women were preponderant in both pEAS-C and pEAS-R (Dierickx et al., 2017;Groenewoud et al., 1997;Kim et al., 2016;Nicolini et al., 2019;Thienpont et al., 2015a;van Veen et al., 2018).”
From Euthanasia and assisted suicide in psychiatric patients: A systematic review of the literature (2021) · cites this paper as Groenewoud et al., 1997
The characteristics of patients whose EAS request was granted appear to be consistent over time.
“Although the numbers are small, the characteristics of patients whose request was granted appear to be consistent over time [13].”
From Euthanasia and physician-assisted suicide in patients suffering from psychiatric disorders: a cross-sectional study exploring the experiences of Dutch psychiatrists (2019) · cites this paper as [13]
The section on psychiatric consultations compares patients whose requests were granted with those whose requests were refused, not patients across time periods. The Requests for Physician-Assisted Suicide section gives dates for requests but does not compare the characteristics of patients whose requests were granted across those dates. I found no passage assessing whether those characteristics remained consistent over time. (LLM, conf=0.76)
Experimental — accuracy not yet measuredThe age of patients who received EAS increased over the last 20 years.
“The age of patients who received EAS thus increased over the last 20 years.”
From Euthanasia and physician-assisted suicide in patients suffering from psychiatric disorders: a cross-sectional study exploring the experiences of Dutch psychiatrists (2019) · cites this paper as [13]
The ‘Requests for Physician-Assisted Suicide’ section (page unavailable) gives patients’ ages and dates of requests, but does not compare ages across those dates. The ‘Statistical Analysis’ section (page unavailable) describes estimates for 1994–1995, not a 20-year age trend. Searched for an increase in the age of patients receiving assisted death over time. (LLM, conf=0.72)
Experimental — accuracy not yet measured
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References 12 · Cited by 104
Research works printed but not linked: 3
- [2]2. N Engl J Med 1996;335:1699-705.
- [6]6. Hoge Raad, 21 juni 1994. Hulp bij zelfdoding psychiatrische patiënt. Ned Jurisprudentie 1994;656:3142.
- [10]10. Baile WF, DiMaggio JR, Schapira DV, Janofsky JS. The request for as- sistance in dying: the need for psychiatric consultation. Cancer 1993;72: 2786-91.
- Authors
- Groenewoud, J. H., van der Maas, P. J., van der Wal, G., Hengeveld, M. W., Tholen, A. J., Schudel, W. J., & van der Heide, A.
- Affiliations
- Erasmus University Rotterdam (NL)
- Leiden University (NL)
- University Medical Center Groningen (NL)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1997-06-19
- Volume
- 336
- Issue
- 25
- Pages
- 1795-1801
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2126610988
- Cited by
- 104
- References
- 12
- Citations by year
- 2026: 1 · 2024: 4 · 2023: 2 · 2022: 4 · 2021: 4 · 2020: 4 · 2019: 3 · 2017: 1 · 2016: 4 · 2015: 2 · 2014: 1 · 2013: 5 · 2012: 3
- FWCI
- 14.78
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- RePub (Erasmus University Rotterdam) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- 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 › Ethics and bioethics in healthcare
- Keywords
- physician-assisted suicide, euthanasia, psychiatric practice, psychiatrists' attitudes, mental illness, Dutch Supreme Court judgment, psychiatric consultation, terminal illness, Netherlands
- MeSH terms
- Acquired Immunodeficiency Syndrome, Adult, Aged, Attitude of Health Personnel, Mental Disorders, Data Collection, Female, Humans, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Neoplasms, Nervous System Diseases, Netherlands, Psychiatry, Referral and Consultation, Stress, Psychological, Suicide, Assisted, Persons with Psychiatric Disorders, Mentally Ill Persons, Euthanasia, Active, Voluntary
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