Perspectives of decision-making in requests for euthanasia: A qualitative research among patients, relatives and treating physicians in the Netherlands
Abstract
Background: Euthanasia has been legally performed in the Netherlands since 2002. Respect for patient’s autonomy is the underpinning ethical principal. However, patients have no right to euthanasia, and physicians have no obligation to provide it. Although over 3000 cases are conducted per year in the Netherlands, there is little known about how decision-making occurs and no guidance to support this difficult aspect of clinical practice. Aim: To explore the decision-making process in cases where patients request euthanasia and understand the different themes relevant to optimise this decision-making process. Design: A qualitative thematic analysis of interviews with patients making explicit requests for euthanasia, most-involved relative(s) and treating physician. Participants/setting: Thirty-two cases, 31 relatives and 28 treating physicians. Settings were patients’ and relatives’ homes and physicians’ offices. Results: Five main themes emerged: (1) initiation of sharing views and values about euthanasia, (2) building relationships as part of the negotiation, (3) fulfilling legal requirements, (4) detailed work of preparing and performing euthanasia and (5) aftercare and closing. Conclusions: A patient’s request for euthanasia entails a complex process that demands emotional work by all participants. It is characterised by an intensive period of sharing information, relationship building and negotiation in order to reach agreement. We hypothesise that making decisions about euthanasia demands a proactive approach towards participants’ preferences and values regarding end of life, towards the needs of relatives, towards the burden placed on physicians and a careful attention to shared decision-making. Future research should address the communicational skills professionals require for such complex decision-making.
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To the best of our knowledge, this is the first report on a relatively large series of requests for euthanasia based on psychological suffering due to psychiatric disorders.
“To the best of our knowledge, this is the first report on a relatively large series of requests for euthanasia based on psychological suffering due to psychiatric disorders.”
From Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: a retrospective, descriptive study (2015) · cites this paper as [16]
A few studies have explored the determinants of psychological suffering in patients in the context of requests for euthanasia, but these studies did not exclusively report on patients requesting euthanasia based on unbearable and untreatable psychological suffering due to a psychiatric illness.
“A few studies have explored the determinants of psychological suffering in patients in the context of requests for euthanasia,16 17 but these studies did not exclusively report on patients requesting euthanasia based on unbearable and untreatable psychological suffering due to a psychiatric illness.”
From Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: a retrospective, descriptive study (2015) · cites this paper as [16]
Recent studies highlight the need for holistic, interdisciplinary care, relationship building and anticipatory guidance throughout the process, as well as bereavement supports for family and loved ones, and dedicated space for MAiD provision.
“Recent studies have also highlighted the need for holistic, interdisciplinary care, relationship building and anticipatory guidance throughout the process, as well as bereavement supports for family and loved ones, and dedicated space for MAiD provision [25–27].”
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References 42 · Cited by 146
- Authors
- Dees, M. K., Vernooij-Dassen, M. J., Dekkers, W. J., Elwyn, G., Vissers, K. C., & van Weel, C.
- Affiliations
- Radboud University Medical Center (NL)
- Cardiff University (GB)
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Venue
- Palliative Medicine
- Publisher
- SAGE Publications
- Published
- 2012-10-26
- Volume
- 27
- Issue
- 1
- Pages
- 27-37
- ISSN
- 0269-2163 (ISSN-L)
- 1477-030X
- OpenAlex
- W2060697709
- Cited by
- 146
- References
- 42
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 19 · 2023: 13 · 2022: 12 · 2021: 7 · 2020: 9 · 2019: 10 · 2018: 37 · 2017: 6 · 2016: 3 · 2015: 5 · 2014: 7 · 2013: 3
- FWCI
- 4.63
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Palliative Medicine (publishedVersion)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- ANU Open Research (Australian National University) (submittedVersion)
- Radboud Repository (Radboud University) (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, euthanasia requests, decision-making, shared decision-making, patient autonomy, physician-patient relationship, family involvement, end-of-life care, follow-up care, emotional work, communication skills, Netherlands
- MeSH terms
- Adult, Aged, Aged, 80 and over, Attitude of Health Personnel, Communication, Decision Making, Family, Female, Humans, Male, Middle Aged, Netherlands, Physician-Patient Relations, Surveys and Questionnaires, Negotiating, Euthanasia, Active, Voluntary, Qualitative Research
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