Can physicians conceive of performing euthanasia in case of psychiatric disease, dementia or being tired of living?
Open accessAbstract
Background: Euthanasia and physician-assisted suicide (EAS) in patients with psychiatric disease, dementia or patients who are tired of living (without severe morbidity) is highly controversial. Although such cases can fall under the Dutch Euthanasia Act, Dutch physicians seem reluctant to perform EAS, and it is not clear whether or not physicians reject the possibility of EAS in these cases. Aim: To determine whether physicians can conceive of granting requests for EAS in patients with cancer, another physical disease, psychiatric disease, dementia or patients who are tired of living, and to evaluate whether physician characteristics are associated with conceivability. A cross-sectional study (survey) was conducted among 2269 Dutch general practitioners, elderly care physicians and clinical specialists. Results: The response rate was 64% (n=1456). Most physicians found it conceivable that they would grant a request for EAS in a patient with cancer or another physical disease (85% and 82%). Less than half of the physicians found this conceivable in patients with psychiatric disease (34%), early-stage dementia (40%), advanced dementia (29–33%) or tired of living (27%). General practitioners were most likely to find it conceivable that they would perform EAS. Conclusions: This study shows that a minority of Dutch physicians find it conceivable that they would grant a request for EAS from a patient with psychiatric disease, dementia or a patient who is tired of living. For physicians who find EAS inconceivable in these cases, legal arguments and personal moral objections both probably play a role.
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In 2015, a study among Dutch physicians showed that physicians considered it significantly less likely to assist in the EAS of a patient suffering from a psychiatric disease than of a terminally ill patient with a severe somatic disease.
“In 2015, a study among Dutch physicians showed that physicians considered it significantly less likely to assist in the EAS of a patient suffering from a psychiatric disease than of a terminally ill patient with a severe somatic disease [17].”
Early and advanced stages of dementia are considered less conceivable conditions for MAiD-NT than patients with terminal somatic diseases.
“Early and advanced stages of dementia are considered less conceivable conditions than patients with terminal somatic diseases [39].”
From Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders (2022) · cites this paper as [39]
In a large survey of more than 2,000 physicians, while the majority would grant a request for MAiD in somatically ill patients, only about one-third found MAiD-NT conceivable, and one-quarter endorsed it for people just tired of living.
“However, a large survey of more than 2,000 physicians showed that while the majority would grant a request for MAiD in somatically ill patients, only about one-third found MAiD-NT conceivable, and one-quarter endorsed it for people just tired of living [40].”
From Debating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders (2022) · cites this paper as [40]
About half of Dutch citizens (55%) support the legal possibility of EAS in patients suffering from a psychiatric disorder.
“Despite the legal possibility of EAS in patients suffering from a PD, which is supported by about half of Dutch citizens (55%)”
From The Dutch practice of euthanasia and assisted suicide in patients suffering from psychiatric disorders: a qualitative case review study (2024) · cites this paper as [5]
Physicians are reluctant to consider or grant a patient's request for EAS based on suffering from a psychiatric disorder.
“It is known that physicians are reluctant to consider or grant a patient’s request for EAS based on suffering from a PD”
From The Dutch practice of euthanasia and assisted suicide in patients suffering from psychiatric disorders: a qualitative case review study (2024) · cites this paper as [5]
Most physicians (64%) find it inconceivable to ever perform EAS in patients suffering from a psychiatric disorder.
“most physicians (64%) find it inconceivable to ever perform EAS in patients suffering from a PD”
From The Dutch practice of euthanasia and assisted suicide in patients suffering from psychiatric disorders: a qualitative case review study (2024) · cites this paper as [5]
The finding that most studied cases were handled by an EE physician reflects previous research that the majority of physicians are reluctant to consider or grant requests of patients suffering from a psychiatric disorder.
“This reflects the findings from previous research that the majority of physicians are reluctant to consider or grant requests of patients suffering from a PD”
From The Dutch practice of euthanasia and assisted suicide in patients suffering from psychiatric disorders: a qualitative case review study (2024) · cites this paper as [5]
Most studies show that physicians tend to be less supportive of MAID than the general population, although support may be increasing in Western countries.
“Most studies show that physicians tend to be less supportive of MAID (or physician-assisted death as it is often referred to in other countries) than the general population, although support may be increasing in Western countries.7–9”
From A National Survey of Canadian Psychiatrists’ Attitudes toward Medical Assistance in Death (2017) · cites this paper as [8]
The few studies considering physician-assisted death on the basis of mental illness have found significantly less support among physicians than in general.
“The few studies considering physician-assisted death on the basis of mental illness have found significantly less support among physicians than in general.8,10”
From A National Survey of Canadian Psychiatrists’ Attitudes toward Medical Assistance in Death (2017) · cites this paper as [8]
General practitioners were 2.6 times more likely than clinical specialists to find it conceivable that they would grant EAS in patients with mental illnesses.
“Interestingly, general practitioners were 2.6 times more likely than clinical specialists to find it conceivable that they would grant EAS in patients with mental illnesses.”
From Euthanasia and assisted suicide in patients with personality disorders: a review of current practice and challenges (2020) · cites this paper as [27]
In a Dutch study, a lower proportion of physicians found it conceivable that they would grant EAS in patients with mental illnesses (34%) than the proportion who found it conceivable that they would grant EAS in patients with physical illnesses, such as cancer (85%).
“In a Dutch study, a lower proportion of physicians found it conceivable that they would grant EAS in patients with mental illnesses (34%) than the proportion who found it conceivable that they would grant EAS in patients with physical illnesses, such as cancer (85%) [27].”
From Euthanasia and assisted suicide in patients with personality disorders: a review of current practice and challenges (2020) · cites this paper as [27]
Evidence from the Netherlands shows that requests for euthanasia from psychiatric patients (as well as from patients suffering from severe dementia and patients being tired of living) are much less likely to be granted as compared to requests for euthanasia from patients suffering from physical disorders.
“evidence from the Netherlands shows that requests for euthanasia from psychiatric patients (as well as from patients suffering from severe dementia and patients being tired of living) are much less likely to be granted as compared to requests for euthanasia from patients suffering from physical disorders”
From Psychiatric patients requesting euthanasia: Guidelines for sound clinical and ethical decision making (2019) · cites this paper as Bolt, Snijdewind, Willems, van der Heide, & Onwuteaka-Philipsen, 2015
Only a minority of physicians are willing to perform euthanasia for psychological suffering, although the number is increasing over time.
“only a minority of physicians are willing to perform euthanasia for psychological suffering (although the number is increasing over time)”
From Psychiatric patients requesting euthanasia: Guidelines for sound clinical and ethical decision making (2019) · cites this paper as Bolt, Snijdewind, Willems, van der Heide, & Onwuteaka-Philipsen, 2015
The proportion of physician-rejected and/or patient-withdrawn MAID requests is notably higher in psychiatric contexts compared to somatic medicine.
“Conversely, the proportion of physician-rejected and/or patient-withdrawn MAID requests is notably higher in psychiatric contexts compared to somatic medicine ( 2 , 9 , 11 ).”
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Self-citation
- Authors
- Bolt, E. E., Snijdewind, M. C., Willems, D. L., van der Heide, A., & Onwuteaka-Philipsen, B. D.
- Affiliations
- Amsterdam Public Health (NL)
- Amsterdam UMC Location University of Amsterdam (NL)
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Corresponding author
- Bolt, Eva Elizabeth
- Venue
- Journal of Medical Ethics
- Publisher
- BMJ
- Published
- 2015-02-18
- Volume
- 41
- Issue
- 8
- Pages
- 592-598
- ISSN
- 0306-6800 (ISSN-L)
- 1473-4257
- OpenAlex
- W2118166928
- Cited by
- 178
- References
- 16
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 12 · 2023: 8 · 2022: 12 · 2021: 18 · 2020: 20 · 2019: 17 · 2018: 38 · 2017: 27 · 2016: 9 · 2015: 4
- FWCI
- 27.84
- Type
- journal article
- Language
- en
- Open access
- green
- pure.amsterdamumc.nl
- Licence
- other-oa
- 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, other-oa)
- 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 suicide, euthanasia, mental illness, dementia, physician attitudes, conceivability, general practitioners, physician characteristics, moral objections
- MeSH terms
- Aged, Aged, 80 and over, Attitude to Death, Cross-Sectional Studies, Decision Making, Dementia, Female, Humans, Male, Netherlands, Nursing Homes, Patients, Physician-Patient Relations, Physician's Role, Physicians, Quality of Life, Fatigue Syndrome, Chronic, Euthanasia, Active, Voluntary
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