Clinical problems with the performance of euthanasia and physician-assisted suicide in the netherlands.

Background and Methods: The characteristics and frequency of clinical probl ems with the performance of euthanasia and physician-assisted suicide are u ncertain. We analyzed data from two studies of euthanasia and physician-ass isted suicide in the Netherlands (one conducted in 1990 and 1991 and the ot her in 1995 and 1996), with a total of 649 cases. We categorized clinical p roblems as technical problems, such as difficulty inserting an intravenous line; complications, such as myoclonus or vomiting; or problems with comple tion, such as a longer-than-expected interval between the administration of medications and death. Results: In 114 cases, the physician's intention was to provide assistance with suicide, and in 535, the intention was to perform euthanasia. Problems of any type were more frequent in cases of assisted suicide than in cases of euthanasia. Complications occurred in 7 percent of cases of assisted sui cide, and problems with completion (a longer-than-expected time to death, f ailure to induce coma, or induction of coma followed by awakening of the pa tient) occurred in 16 percent of the cases; complications and problems with completion occurred in 3 percent and 6 percent of cases of euthanasia, res pectively. The physician decided to administer a lethal medication in 21 of the cases of assisted suicide (18 percent), which thus became cases of eut hanasia. The reasons for this decision included problems with completion (i n 12 cases) and the inability of the patient to take all the medications (i n 5). Conclusions: There may be clinical problems with the performance of euthana sia and physician-assisted suicide. In the Netherlands, physicians who inte nd to provide assistance with suicide sometimes end up administering a leth al medication themselves because of the patient's inability to take the med ication or because of problems with the completion of physician-assisted su icide. (N Engl J Med 2000;342:551-6.) (C)2000, Massachusetts Medical Societ y.