Dutch criteria of due care for physician-assisted dying in medical practice: a physician perspective
Abstract
INTRODUCTION: The Dutch Euthanasia Act (2002) states that euthanasia is not punishable if the attending physician acts in accordance with the statutory due care criteria. These criteria hold that: there should be a voluntary and well-considered request, the patient's suffering should be unbearable and hopeless, the patient should be informed about their situation, there are no reasonable alternatives, an independent physician should be consulted, and the method should be medically and technically appropriate. This study investigates whether physicians experience problems with these criteria in medical practice. METHODS: In 2006, questionnaires were sent to a random, stratified sample of 2100 Dutch physicians (response rate: 56%). Physicians were asked about problems in their decision-making related to requests for euthanasia or assisted suicide after enforcement of the 2002 Euthanasia Act. RESULTS: Of all physicians who had received a request for euthanasia or assisted suicide (75%), 25% had experienced problems in the decision-making with regard to at least one of the criteria of due care. Physicians who had experienced problems mostly indicated to have had problems related to evaluating whether or not the patient's suffering was unbearable and hopeless (79%) and whether or not the patient's request was voluntary or well considered (58%). DISCUSSION: Physicians in The Netherlands most frequently reported problems related to aspects in which they have to evaluate the patient's subjective perspective(s). However, it can be questioned whether placing emphasis on these subjective aspects is an adequate fulfilment of the duties imposed on physicians, as laid down in the Dutch Euthanasia Act.
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In the Netherlands, research suggests that approximately 20% of euthanasia cases are not reported to the review committees, down from 46% in 2001.
“In the Netherlands, research suggests that approximately 20% of euthanasia cases are not reported to the review committees, down from 46% in 2001 (78, 81, 82).”
From Assisted death in eating disorders: a systematic review of cases and clinical rationales (2024) · cites this paper as [81]
The absence of futility as a rationale in Dutch cases may be because the Dutch due care criteria only require physicians to confirm with patients there is 'no reasonable alternative' to euthanasia.
“This may be because the Dutch due care criteria only require physicians to confirm with patients there is “no reasonable alternative” to euthanasia (81).”
From Assisted death in eating disorders: a systematic review of cases and clinical rationales (2024) · cites this paper as [81]
Cites
THE NATURE OF SUFFERING AND THE GOALS OF MEDICINE
Cassel, E. J. (1982) · New England Journal of Medicine · doi:10.1056/nejm198203183061104 · Cited by 2,149 · see citing works
The Nature of Suffering and the Goals of Medicine
Cassell, E. J. (1998) · Loss Grief & Care · doi:10.1300/j132v08n01_18 · Cited by 1,178 · see citing works
Euthanasia and other medical decisions concerning the end of life
van der Maas, P. J., van Delden, J. J. M., Pijnenborg, L., & Looman, C. W. N. (1991) · The Lancet · doi:10.1016/0140-6736(91)91241-l · Cited by 738 · see citing works
Cancer patients' perceptions of their disease and its treatment
Wj, M., Stewart, W., Ginsburg, A. D., & Stewart, S. (1988) · British Journal of Cancer · doi:10.1038/bjc.1988.218 · Cited by 306 · see citing works
Euthanasia and Law in the Netherlands
Griffiths, J., Bood, A., & Weyers, H. (1998) · Amsterdam University Press eBooks · doi:10.5117/9789053562758 · Cited by 202 · see citing works
Hertogh, C. M. P. M., de Boer, M. E., Dröes, R., & Eefsting, J. A. (2007) · The American Journal of Bioethics · doi:10.1080/15265160701220881 · Cited by 129 · see citing works
The New Dutch Law on Euthanasia
de Haan, J. (2002) · Medical Law Review · doi:10.1093/medlaw/10.1.57 · Cited by 101 · see citing works
The unfeasibility of requests for euthanasia in advance directives
van Delden, J. J. M. (2004) · Journal of Medical Ethics · doi:10.1136/jme.2002.002857 · Cited by 87 · see citing works
Self-citationvan der Maas, P. J., van Delden, J. J. M., & Pijnenborg, L. (1992) · PubMed · Cited by 65 · see citing works
Prior capacity of patients lacking decision making ability early in hospitalization
Wenger, N. S., Oye, R. K., Bellamy, P. E., Lynn, J., Phillips, R. S., Desbiens, N. A., Kussin, P. S., Youngner, S. J., & the SUPPORT Investigators (1994) · Journal of General Internal Medicine · doi:10.1007/bf02599276 · Cited by 50 · see citing works
Brandt, H. E., Ooms, M. E., Deliëns, L., et al. (2006) · Palliative Medicine · doi:10.1191/0269216306pm1164oa · Cited by 48 · see citing works
Evaluatie Wet toetsing levensbeëindiging op verzoek en hulp bij zelfdoding
Onwuteaka-Philipsen, B. D., Gevers, J. K. M., van der Heide, A., van Delden, J. J. M., Pasman, H. R. W., Rientjens, J. A. C., Rürup, M., Buiting, H. M., Wolf, J., Janssen, A. G. J. M., et al. (2007) · Data Archiving and Networked Services (DANS) · Cited by 37 · see citing works
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Dees, M. K., Vernooij-Dassen, M. J., Dekkers, W. J., Elwyn, G., Vissers, K. C., & van Weel, C. (2013) · Palliative Medicine · doi:10.1177/0269216312463259 · Cited by 146 · see citing works
Rietjens, J. A. C., van der Maas, P. J., Onwuteaka-Philipsen, B. D., van Delden, J. J. M., & van der Heide, A. (2009) · Journal of Bioethical Inquiry · doi:10.1007/s11673-009-9172-3 · Cited by 138 · see citing works
Self-citationMiller, D. G., & Kim, S. Y. H. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-017628 · Cited by 69 · see citing works
Assisted death in eating disorders: a systematic review of cases and clinical rationales
Roff, C., & Cook-Cottone, C. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1431771 · Cited by 16 · see citing works
Eutanasia y suicidio asistido en enfermedades neurológicas: una revisión sistemática
Trejo-Gabriel-Galán, J. M. (2024) · Neurología · doi:10.1016/j.nrl.2021.04.016 · Cited by 8 · see citing works
- Authors
- Buiting, H. M., Gevers, J. K. M., Rietjens, J. A. C., Onwuteaka-Philipsen, B. D., van der Maas, P. J., van der Heide, A., & van Delden, J. J. M.
- Affiliations
- Erasmus MC (NL)
- Amsterdam UMC Location University of Amsterdam (NL)
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- Corresponding author
- Buiting, H M
- Venue
- Journal of Medical Ethics
- Publisher
- BMJ
- Published
- 2008-08-29
- Volume
- 34
- Issue
- 9
- Pages
- e12-e12
- ISSN
- 0306-6800 (ISSN-L)
- 1473-4257
- OpenAlex
- W2159104749
- Cited by
- 79
- References
- 12
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 3 · 2023: 4 · 2021: 5 · 2020: 2 · 2019: 3 · 2018: 35 · 2017: 1 · 2016: 2 · 2015: 2 · 2014: 4 · 2013: 3 · 2012: 3
- FWCI
- 2.63
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Medical Ethics (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- VUBIR (Vrije Universiteit Brussel) (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
- physician-assisted death, euthanasia, assisted suicide, physician decision-making, physician attitudes, medical ethics
- MeSH terms
- Decision Making, Euthanasia, Humans, Netherlands, Physician-Patient Relations, Physician's Role, Surveys and Questionnaires, Right to Die, Statistics as Topic, Suicide, Assisted, Guidelines as Topic, Guideline Adherence
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