EUTHANASIA, PHYSICIAN-ASSISTED SUICIDE, AND OTHER MEDICAL PRACTICES INVOLVING THE END OF LIFE IN THE NETHERLANDS, 1990-1995

Background In 1991 a new procedure for reporting physician-assisted de aths was introduced in the Netherlands that led to a tripling in the n umber of reported cases. In 1995, as part of an evaluation of this pro cedure, a nationwide study of euthanasia and other medical practices c oncerning the end of life was begun that was identical to a study cond ucted in 1990. Methods We conducted two studies, the first involving i nterviews with 405 physicians (general practitioners, nursing home phy sicians, and clinical specialists) and the second involving questionna ires mailed to the physicians attending 6060 deaths that were identifi ed from death certificates. The response rates were 89 percent and 77 percent, respectively. Results Among the deaths studied, 2.3 percent o f those in the interview study and 2.4 percent of those in the death-c ertificate study were estimated to have resulted from euthanasia, and 0.4 percent and 0.2 percent, respectively, resulted from physician-ass isted suicide. In 0.7 percent of cases, life was ended without the exp licit, concurrent request of the patient. Pain and symptoms were allev iated with doses of opioids that may have shortened life in 14.7 to 19 .1 percent of cases, and decisions to withhold or withdraw life-prolon ging treatment were made in 20.2 percent. Euthanasia seems to have inc reased in incidence since 1990, and the ending of life without the pat ient's explicit request seems to have decreased slightly. For each typ e of medical decision except those in which life-prolonging treatment was withheld or withdrawn, cancer was the most frequently reported dia gnosis. Conclusions Since the notification procedure was introduced, e nd-of-life decision making in the Netherlands has changed only slightl y, in an anticipated direction. Close monitoring of such decisions is possible, and we found no signs of an unacceptable increase in the num ber of decisions or of less careful decision making. (C)1996, Massachu setts Medical Society.