Prevalence and content analysis of guidelines on handling requests for euthanasia or assisted suicide in Dutch nursing homes

Background: The growing number of requests for euthanasia or assisted suici de (EAS) makes it imperative for health care institutions, such as nursing homes, to have written guidelines on how to handle requests for EAS. The ob jective of this study was to determine the prevalence of EAS guidelines in Dutch nursing homes and to analyze the content. Methods: Directors of patient care in 324 Dutch nursing homes were asked, b y means of a mailed short list of questions, if they had an institutional g uideline on EAS and, if so, to provide a copy. Guidelines were analyzed acc ording to a structured list of items based on current jurisprudence, model documents, and opinions of experts. Results: Of the 324 directors, 313 (97%) responded. In 58% of the nursing h omes that responded, there existed written guidelines for EAS. Of those gui delines, 74% concerned EAS; in 26%, EAS was integrated in a guideline on te rminal care. Of the guidelines, 165 (90%) were based on the policy that EAS is acceptable under specific conditions, and 18 (10%) banned EAS completel y. Of the first-mentioned guidelines, 81% described one or more procedures for in-principle objections. In 65% of these guidelines, all official requi rements for prudent practice were described. Conclusions: Despite the rapidly growing number of nursing-home guidelines on EAS and the existence of model documents, there is still considerable va riation in the guidelines, and they can be improved in many aspects. A basi c prerequisite is that the guidelines include all the official requirements for prudent, practice.