End-of-Life Practices in the Netherlands under the Euthanasia Act

New England Journal of Medicine 356;19 May 10, 2007

Agnes van der Heide, M.D., Ph.D., Bregje D. Onwuteaka-Philipsen, Ph.D., Mette L. Rurup, Ph.D., Hilde M. Buiting, M.Sc., Johannes J.M. van Delden, M.D., Ph.D., Johanna E. Hanssen-de Wolf, M.Sc., Anke G.J.M. Janssen, M.A., H. Roeline W. Pasman, Ph.D., Judith A.C. Rietjens, Ph.D., Cornelis J.M. Prins, M.Sc., Ingeborg M. Deerenberg, M.Sc., Joseph K.M. Gevers, Ph.D., Paul J. van der Maas, M.D., Ph.D., and Gerrit van der Wal, M.D., Ph.D.

Background

In 2002, an act regulating the ending of life by a physician at the request of a patient with unbearable suffering came into effect in the Netherlands. In 2005, we performed a follow-up study of euthanasia, physician-assisted suicide, and other end-of-life practices.

Methods

We mailed questionnaires to physicians attending 6860 deaths that were identified from death certificates. The response rate was 77.8%.

Results

In 2005, of all deaths in the Netherlands, 1.7% were the result of euthanasia and 0.1% were the result of physician-assisted suicide. These percentages were significantly lower than those in 2001, when 2.6% of all deaths resulted from euthanasia and 0.2% from assisted suicide. Of all deaths, 0.4% were the result of the ending of life without an explicit request by the patient. Continuous deep sedation was used in conjunction with possible hastening of death in 7.1% of all deaths in 2005, significantly increased from 5.6% in 2001.

Before end-of-life decisions were made, physicians discussed euthanasia and assisted suicide with all patients whose death was caused by either act (Table 3). The physician also discussed the decision to perform euthanasia or assisted suicide with relatives of the patient in 75.5% of deaths in 2005 and with one or more colleagues in 87.7% of deaths. When life was ended without the explicit request of the patient, there had been discussion about the act or a previous wish of the patient for the act in 60.0% of patients, as compared with 26.5% in 2001. In 2005, the ending of life was not discussed with patients because they were unconscious (10.4%) or incompetent owing to young age (14.4%) or because of other factors (15.3%). Of all cases of the ending of life in 2005 without an explicit request by the patient, 80.9% had been discussed with relatives. In 65.3% of cases, the physician had discussed the decision with one or more colleagues.