PHYSICIAN-ASSISTED DEATH IN PSYCHIATRIC PRACTICE IN THE NETHERLANDS

Background In 1994 the Dutch Supreme Court ruled that in exceptional i nstances, physician-assist ed suicide might be justifiable for patient s with unbearable mental suffering but no physical illness. We studied physician-assisted suicide and euthanasia in psychiatric practice in the Netherlands. Methods In 1996, we sent questionnaires to 673 Dutch psychiatrists - about half of all such special ists in the country - a nd received 552 responses from the 667 who met the study criteria (res ponse rate, 83 percent). We estimated the annual frequencies of reques ts for physician-assisted suicide by psychiatrists and actual instance s of assistance. Results Of the respondents, 205 (37 percent) had at l east once received an explicit, persistent request for physician-assis ted suicide and 12 had complied. We estimate there are 320 requests a year in psychiatric practice and 2 to 5 assisted suicides. Excluding t hose who had ever assisted, 345 of the respondents (64 percent) though t physician-assisted suicide because of a mental disorder could be acc eptable, including 241 who said they could conceive of instances in wh ich they themselves would be willing to assist. The most frequent reas ons for refusing were the belief that the patient had a treatable ment al disorder, opposition to assisted suicide in principle, and doubt th at the suffering was unbearable or hopeless. Most, but not all, patien ts who had been assisted by their psychiatrists in suicide had both a mental disorder and a serious physical illness, often in a terminal ph ase. Thirty percent of the respondents had been consulted at least onc e by a physician in another specialty about a patient's request for as sisted death. The annual number of such consultations was estimated at 310, about 3 percent of the estimated 9700 requests for euthanasia or physician-assisted suicide in medical practice. Conclusions Explicit requests for physician-assisted suicide are not uncommon in psychiatri c practice in the Netherlands, but these requests are rarely granted. Psychiatric consultation for medical patients who request physician-as sisted death is relatively rare. (C)1997, Massachusetts Medical Societ y.