Factors associated with requesting and receiving euthanasia: a nationwide mortality follow-back study with a focus on patients with psychiatric disorders, dementia, or an accumulation of health problems related to old age
Tóm tắt
Recently, euthanasia and assisted suicide (EAS) in patients with psychiatric disorders, dementia, or an accumulation of health problems has taken a prominent place in the public debate. However, limited is known about this practice. The purpose of this study was threefold: to estimate the frequency of requesting and receiving EAS among people with (also) a psychiatric disorder, dementia, or an accumulation of health problems; to explore reasons for physicians to grant or refuse a request; and to describe differences in characteristics, including the presence of psychiatric disorders, dementia, and accumulation of health problems, between patients who did and did not request EAS and between patients whose request was or was not granted. A nationwide cross-sectional survey study was performed. A stratified sample of death certificates of patients who died between 1 August and 1 December 2015 was drawn from the central death registry of Statistics Netherlands. Questionnaires were sent to the certifying physician (n = 9351, response 78%). Only deceased patients aged ≥ 17 years and who died a non-sudden death were included in the analyses (n = 5361). The frequency of euthanasia requests among deceased people who died non-suddenly and with (also) a psychiatric disorder (11.4%), dementia (2.1%), or an accumulation of health problems (8.0%) varied. Factors positively associated with requesting euthanasia were age (< 80 years), ethnicity (Dutch/Western), cause of death (cancer), attending physician (general practitioner), and involvement of a pain specialist or psychiatrist. Cause of death (neurological disorders, another cause) and attending physician (general practitioner) were also positively associated with receiving euthanasia. Psychiatric disorders, dementia, and/or an accumulation of health problems were negatively associated with both requesting and receiving euthanasia. EAS in deceased patients with psychiatric disorders, dementia, and/or an accumulation of health problems is relatively rare. Partly, this can be explained by the belief that the due care criteria cannot be met. Another explanation is that patients with these conditions are less likely to request EAS.
Tài liệu tham khảo
Wet toetsing levensbeëindiging op verzoek en hulp bij zelfdoding (Act on termination of life on request and assisted suicide) [statute on the Internet] 2001. Available from: http://wetten.overheid.nl/BWBR0012410/2014-02-15. [Cited: 08-01-2018].
Uitspraak Hoge Raad, de zaak-Brongersma (Verdict Supreme Court, the Brongersma case) [statute on the Internet] 24-12-2002. Available from: https://uitspraken.rechtspraak.nl/inziendocument?id=ECLI:NL:PHR:2002:AE8772.
van der Heide A, van Delden JJM, Onwuteaka-Philipsen BD. End-of-life decisions in the Netherlands over 25 years. N Engl J Med. 2017;377(5):492–4.
Onwuteaka-Philipsen BD, Brinkman-Stoppelenburg A, Penning C, et al. Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey. Lancet. 2012;380(9845):908–15.
Onwuteaka-Philipsen BD, Rurup ML, Pasman HR, et al. The last phase of life: who requests and who receives euthanasia or physician-assisted suicide? Med Care. 2010;48(7):596–603.
Haverkate I, Onwuteaka-Philipsen BD, van Der Heide A, et al. Refused and granted requests for euthanasia and assisted suicide in the Netherlands: interview study with structured questionnaire. BMJ. 2000;321(7265):865–6.
Jansen-van der Weide MC, Onwuteaka-Philipsen BD, van der Wal G. Granted, undecided, withdrawn, and refused requests for euthanasia and physician-assisted suicide. Arch Intern Med. 2005;165(15):1698–704.
Meier DE, Emmons CA, Litke A, et al. Characteristics of patients requesting and receiving physician-assisted death. Arch Intern Med. 2003;163(13):1537–42.
‘Psychiaters te bang bij euthanasie’. Psychiaters krijgen vanuit eigen kring kritiek op hoe ze omgaan met euthanasieverzoeken. NRC [newspaper on the Internet]. 26-10-2017. Available from: https://www.nrc.nl/nieuws/2017/10/26/psychiaters-te-bang-bij-euthanasie-13691181-a1578871. [cited 19–07-2018]
Appelbaum PS. Physician-assisted death for patients with mental disorders-reasons for concern. JAMA Psychiat. 2016;73(4):325–6.
de Beaufort ID, van de Vathorst S. Dementia and assisted suicide and euthanasia. J Neurol. 2016;263(7):1463–7.
Kouwenhoven PS, Raijmakers NJ, van Delden JJ, et al. Opinions about euthanasia and advanced dementia: a qualitative study among Dutch physicians and members of the general public. BMC Med Ethics. 2015;16:7.
Raijmakers NJ, van der Heide A, Kouwenhoven PS, et al. Assistance in dying for older people without a serious medical condition who have a wish to die: a national cross-sectional survey. J Med Ethics. 2015;41(2):145–50.
Euthanasia Code 2018. De toetsingspraktijk toegelicht. (Euthanasia Code 2018. The review procedures explained) [report at the Internet] Available from: https://www.euthanasiecommissie.nl/uitspraken/brochures/brochures/euthanasiecode/2018/euthanasiecode2018. [Cited: 11-09-2018].
Regionale Toetsingscommissie Euthanasie. Jaarverslag 2016. (Regional Euthanasia Review Committees. Annual report 2016) [report at the Internet] Available from: https://www.euthanasiecommissie.nl/de-toetsingscommissies/uitspraken/jaarverslagen/2016/april/12/jaarverslag-2016. [Cited: 10-01-2018].
Regionale Toetsingscommissies Euthanasie. Jaarverslag 2013. (Regional Euthanasia Review Committees. Annual report 2013) [report at the Internet] Available from: https://www.euthanasiecommissie.nl/de-toetsingscommissies/uitspraken/jaarverslagen/2013/nl-en-du-fr/nl-en-du-fr/jaarverslag-2013. [Cited: 10-01-2018].
Regionale Toetsingscommissies Euthanasie. Jaarverslag 2010. (Regional Euthanasia Review Committees. Annual report 2010) [report at the Internet] Available from: https://www.euthanasiecommissie.nl/de-toetsingscommissies/uitspraken/jaarverslagen/2010/nl-en-du-fr/nl-en-du-fr/jaarverslag-2010. [Cited: 10-01-2018].
Onwuteaka-Philipsen BD, van der Heide A, Koper D, et al. Euthanasia and other end-of-life decisions in the Netherlands in 1990, 1995, and 2001. Lancet. 2003;362(9381):395–9.
van der Heide A, Onwuteaka-Philipsen BD, Rurup ML, et al. End-of-life practices in the Netherlands under the Euthanasia Act. N Engl J Med. 2007;356(19):1957–65.
Van Der Maas PJ, Van Delden JJ, Pijnenborg L, et al. Euthanasia and other medical decisions concerning the end of life. Lancet. 1991;338(8768):669–74.
van der Maas PJ, van der Wal G, Haverkate I, et al. Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands, 1990-1995. N Engl J Med. 1996;335(22):1699–705.
Wet bescherming persoonsgegevens. (Personal Data Protection Act) [statute on the Internet] Available from: http://wetten.overheid.nl/BWBR0011468/2018-05-01#Hoofdstuk1. [Cited: 17-09-2018].
Bolt EE, Snijdewind MC, Willems DL, et al. Can physicians conceive of performing euthanasia in case of psychiatric disease, dementia or being tired of living? J Med Ethics. 2015;41(8):592–8.
Kouwenhoven PS, Raijmakers NJ, van Delden JJ, et al. Opinions of health care professionals and the public after eight years of euthanasia legislation in the Netherlands: a mixed methods approach. Palliat Med. 2013;27(3):273–80.
Snijdewind MC, Willems DL, Deliens L, et al. A study of the first year of the end-of-life clinic for physician-assisted dying in the Netherlands. JAMA Intern Med. 2015;175(10):1633–40.
Doernberg SN, Peteet JR, Kim SY. Capacity evaluations of psychiatric patients requesting assisted death in the Netherlands. Psychosomatics. 2016;57(6):556–65.
van Tol D, Rietjens J, van der Heide A. Judgment of unbearable suffering and willingness to grant a euthanasia request by Dutch general practitioners. Health Policy. 2010;97(2–3):166–72.
de Boer ME, Hertogh CM, Droes RM, et al. Suffering from dementia - the patient’s perspective: a review of the literature. Int Psychogeriatr. 2007;19(6):1021–39.
van Wijmen MP, Pasman HR, Widdershoven GA, et al. Motivations, aims and communication around advance directives: a mixed-methods study into the perspective of their owners and the influence of a current illness. Patient Educ Couns. 2014;95(3):393–9.
Winter L, Parker B. Current health and preferences for life-prolonging treatments: an application of prospect theory to end-of-life decision making. Soc Sci Med. 2007;65(8):1695–707.
Onwuteaka-Philipsen B, Legemaate J, van der Heide A, et al. Derde evaluatie Wet toetsing levensbeëindiging op verzoek en hulp bij zelfdoding [Third evaluation of the Termination of Life on Request and Assisted Suicide Act]. Den Haag: ZonMw; 2017.
Regionale Toetsingscommissie Euthanasie. Jaarverslag 2017. (Regional Euthanasia Review Committees. Annual report 2017) [report at the Internet] Available from: https://www.euthanasiecommissie.nl/de-toetsingscommissies/uitspraken/jaarverslagen/2017/mei/17/jaarverslag-2017. [Cited: 12-06-2018].
Dierickx S, Deliens L, Cohen J, et al. Euthanasia in Belgium: trends in reported cases between 2003 and 2013. CMAJ. 2016;188(16):E407–E14.
Twenge, JMC, N.T.; Campbell, W.K. Time period, generational, and age differences in tolerance for controversial beliefs and lifestyles in the United States, 1972–2012. Social Forces 2015;94(1):379–399.
Lee CH, Duck IM, Sibley CG. Demographic and psychological correlates of New Zealanders support for euthanasia. N Z Med J. 2017;130(1448):9–17.
Collins JW, Zoucha R, Lockhart JS, et al. Cultural aspects of end-of-life care planning for African Americans: an integrative review of literature. J Transcult Nurs. 2018;29(6):578–90.
Manalo MF. End-of-life decisions about withholding or withdrawing therapy: medical, ethical, and religio-cultural considerations. Palliat Care. 2013;7:1–5.
Ohr S, Jeong S, Saul P. Cultural and religious beliefs and values, and their impact on preferences for end-of-life care among four ethnic groups of community-dwelling older persons. J Clin Nurs. 2017;26(11–12):1681–9.
Portanova J, Ailshire J, Perez C, et al. Ethnic differences in advance directive completion and care preferences: what has changed in a decade? J Am Geriatr Soc. 2017;65(6):1352–7.
Sachedina A. End-of-life: the Islamic view. Lancet. 2005;366(9487):774–9.
Hedberg K, Hopkins D, Kohn M. Five years of legal physician-assisted suicide in Oregon. N Engl J Med. 2003;348(10):961–4.
Dierickx S, Deliens L, Cohen J, et al. Involvement of palliative care in euthanasia practice in a context of legalized euthanasia: a population-based mortality follow-back study. Palliat Med. 2018;32(1):114–22.
Radbruch L, Leget C, Bahr P, et al. Euthanasia and physician-assisted suicide: a white paper from the European Association for Palliative Care. Palliat Med. 2016;30(2):104–16.