Dutch nursing home policies and guidelines on physician-assisted death anddecisions to forego treatment

Objective: The purpose of this study was to describe: (a) the prevalence an d content of policies on euthanasia or assisted suicide (EAS) in three diff erent types of nursing homes; (b) specific content items of written guideli nes for EAS; and (c) the prevalence of guidelines on withholding or withdra wing treatment from severely demented patients and patients in a persistent vegetative state in the nursing homes. Design: Descriptive, cross-sectional. Methods: We have used a postal survey among directors of patient care of al l (n = 304) Dutch somatic nursing homes (meant for physically handicapped p atients), psychogeriatric nursing homes (meant for patients suffering from dementia) and combined nursing homes. Data were collected from October 1994 through January 1995. Results: Results indicate that psychogeriatric nursing homes less often had a written EAS policy than somatic and combined nursing homes (62, 68 and 8 0% respectively). The most frequently reported aspects in the EAS guideline s, by the nursing homes with guidelines based on a policy that EAS was acce pted under certain conditions; were consultation of another physician (97%) , referral to another physician if the attending physician had in-principle objections (82%), and the involvement of the nurse in the decision-making procedure (82%). Of the nursing homes, 9% reported having specific written procedures concerning withholding or withdrawing treatment from severely de mented patients. Conclusion: Guidelines in the nursing homes on euthanasia and assisted suic ide might be improved. Especially with regard to withholding or withdrawing treatment from incompetent patients, more guidelines should be developed.