Experiences and views of Dutch general practitioners regarding physician-assisted death for patients suffering from severe mental illness: a mixed methods approach
Open accessAbstract
BACKGROUND: In the Netherlands, physician-assisted death (PAD) is allowed under certain conditions. Patients who suffer from mental illnesses are not excluded from this practice. In 2018, general practitioners (GPs) performed 20 out of a total of 67 cases of EAS for psychiatric suffering. OBJECTIVE: More insight into GPs' experiences and views with regard to PAD in psychiatry. DESIGN: The data for this study were obtained through a survey amongst 500 randomly selected Dutch GPs and by in-depth interviews with 20 Dutch GPs. SETTING: A survey study and in-depth interviews. SUBJECTS: Dutch GPs. RESULTS: 86 out of 101 GPs found it conceivable to perform EAS in case of somatic disease, and 51 out of 104 GPs found it conceivable in the case a patient suffered from a mental illness only. The main reason given for refusing an PAD request was that the criteria of due care were not met. Reasons for supporting psychiatric PAD related to responsibility, self-determination, compassion, fairness, and preventing suicide. Reasons for not supporting psychiatric PAD were related to the scope of medicine, a perceived lack of experience, uncertainties regarding the criteria of due care and life-expectancy. CONCLUSION: GPs are less likely to perform PAD for suffering from a mental illness, compared to somatic suffering. Some GPs apply an extra criterion of 'life-expectancy' in case of PAD for suffering from a mental illness. Refusing PAD based on a long life expectancy keeps open the possibility of recovery, but may also just prolong the suffering and add to the unbearableness of it.KEY POINTSCurrently, there is no qualitative research on what the views are of general practitioners regarding the subject of physician-assisted death (PAD) for patients suffering from severe mental disorders.General practitioners are less likely to consider a request for physician-assisted death by a patient suffering from a psychiatric disorder, compared to somatic suffering. Reasons for supporting psychiatric PAD related to responsibility, self-determination, compassion, fairness, and preventing suicide.Reasons for not supporting psychiatric PAD were related to the scope of medicine, a perceived lack of experience, uncertainties regarding the criteria of due care and life-expectancy.Significance for the reader: Although allowed in the Netherlands, PAD in case of severe mental suffering remains a controversial topic. We need in-depth information about the actual practice of it to have an informed debate with regard to this subject.
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Clinicians note concern that fluctuating symptoms or treatment response can alter decisional consistency over time.
“and note concern that fluctuating symptoms or treatment response can alter decisional consistency over time.9 31”
From Medical Assistance in Dying for the Sole Underlying Condition of Mental Disorder (MAiD MD-SUMC): an analysis and qualitative evidence synthesis (2026) · cites this paper as [31]
The Introduction says mental illness may impair decision-making capacity, and the Results report GPs’ uncertainty about whether a wish to die is well-considered and whether patients may recover (pages not supplied). The paper does not link fluctuating symptoms or treatment response to changes in decisional consistency over time. (LLM, conf=0.77)
Experimental — accuracy not yet measuredClinicians report uncertainty in distinguishing suicidal intent from enduring, well-considered requests for assisted dying.
“Clinicians report uncertainty in distinguishing suicidal intent from enduring, well-considered requests for assisted dying”
From Medical Assistance in Dying for the Sole Underlying Condition of Mental Disorder (MAiD MD-SUMC): an analysis and qualitative evidence synthesis (2026) · cites this paper as [31]
The Introduction says it can be hard to determine whether a psychiatric patient’s death wish is part of the illness, and Table 3 in the Results records GPs’ uncertainty about assessing whether a wish to die is well-considered. The paper does not specifically describe clinicians distinguishing suicidal intent from an enduring request for assisted dying; its reported uncertainty concerns the origin and assessment of the death wish. (LLM, conf=0.82)
Experimental — accuracy not yet measuredIn the Netherlands, 20% of medical specialists endorsed MAiD-NT, and about half of general practitioners endorsed it (main reasons: responsibility, self-determination, compassion, fairness, and preventing suicide).
“In the Netherlands, 20% of medical specialists endorsed the practice, about half among general practitioners (main reasons: responsibility, self-determination, compassion, fairness, and preventing suicide) [27, 38].”
From Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders (2022) · cites this paper as [38]
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- Authors
- Pronk, R., Sindram, N. P., van de Vathorst, S., & Willems, D. L.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- Department of General Practice, Medical Ethics Section, Amsterdam UMC, Academic Medical Centre, Amsterdam, The Netherlands
- Corresponding author
- Pronk, Rosalie
- Venue
- Scandinavian Journal of Primary Health Care
- Publisher
- Informa UK Limited
- Published
- 2021-04-03
- Volume
- 39
- Issue
- 2
- Pages
- 166-173
- ISSN
- 0281-3432 (ISSN-L)
- 1502-7724
- PMC
- PMC8293937
- OpenAlex
- W3179700870
- Cited by
- 14
- References
- 17
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 2 · 2023: 3 · 2022: 2
- FWCI
- 1.51
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Scandinavian Journal of Primary Health Care (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, cc-by)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Dutch Right to Die Society
- 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
- physician-assisted death, severe mental illness, general practitioners, euthanasia, life expectancy, self-determination, suicide prevention, end-of-life care, Dutch euthanasia law
- MeSH terms
- Mental Disorders, Euthanasia, Humans, Netherlands, Psychiatry, Suicide, Assisted, General Practitioners
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