POLICIES ON MEDICAL DECISIONS CONCERNING THE END OF LIFE IN DUTCH HEALTH-CARE INSTITUTIONS

Objective.-To describe the prevalence and some features of policies on medical decisions concerning the end of life (MDELs) in Dutch hospita ls, nursing homes, and institutions for the mentally disabled. Design. -A cross-sectional descriptive postal survey of 558 Dutch health care institutions. Setting.-All Dutch hospitals, nursing homes, and general institutions for the mentally disabled. Participants.-Directors of pa tient care of the institutions. Main Outcome Measures.-Respondents' re ports on the existence of policies and guidelines on the following MDE Ls: euthanasia/assisted suicide (EAS), life-terminating acts without e xplicit request of the patient, refusal of treatment by patient, withh olding or withdrawing treatment, symptom and pain control, and do-not- resuscitate (DNR) decisions. Results.-Of 558 health care institution m anagers, 86% responded. Most of the hospitals (69.2%) and nursing home s (73.9%) but only 16.3% of the institutions for the disabled had a wr itten EAS policy. Nursing homes with a ban on EAS often had religious affiliations. In 37% of nursing homes, 15% of hospitals, and 15% of in stitutions for the disabled, the management had written policies on te rminating life without request. Sixty percent of the hospitals, 35% of the nursing homes, and 17% of the institutions for the disabled had g uidelines for one or more of four other distinct MDELs. Forty-five per cent, 20%, and 8% of hospitals, nursing homes, and institutions of men tally disabled, respectively, had guidelines on DNR decisions. The man agement of 89% of the hospitals and 94% of the nursing homes communica ted their policies on EAS to physicians and nurses in their institutio ns without being asked. Far fewer of these hospitals (3.9%) and nursin g homes (30.5%) made their policies on EAS known to patients without b eing asked. Conclusions.-This study indicates that an important step t oward policy development on EAS has been made by Dutch hospitals and n ursing homes. Particularly with respect to policies on such decisions as withholding or withdrawing treatment, symptom and pain control, and DNR orders, an unexplored field is open to management for policy deve lopment in the Netherlands.