Dealing with requests for euthanasia in incompetent patients with dementia

Qualitative research revealing underexposed aspects of the societal debate

De abstractcommissie heeft op verzoek van de congrescommissie zes abstracts geselecteerd die tijdens het Verenso najaarscongres 'Innovatie' op 25 november 2021 middels een flitspresentatie gepresenteerd worden. Onderstaande abstract is daar een van.

Djura Coers, Marike de Boer, Eefje Sizoo, Martin Smalbrugge, Carlo Leget, Cees Hertogh

Objectives

In 2002, the Termination of Life on Request and Assisted Suicide Act has been introduced in the Dutch law, allowing physicians to perform euthanasia after meeting the due care criteria, without being prosecuted. Nonetheless, this legislation remains a much-debated topic among experts and in society. Several cases of euthanasia of incompetent patients with dementia and an advance euthanasia directive (AED) in the Netherlands in 2016, led to opposition of doctors. In this study we investigate the (underlying) motives for physicians to support the petition ‘no sneaky euthanasia in dementia cases’.

Design

A qualitative interview study involving semi-structured, in-depth interviews with physicians in the Dutch health care system.

Methods

Twelve semi-structured, in-depth interviews were conducted with physicians, based on a predefined topic-list. All participants were recruited from the open name-list, published on the webpage of ‘no sneaky euthanasia’ by purposeful selection (based on gender, profession and additional expertise on the subject) or the snowball method. The general topics discussed in the interviews were 1) reasons for signing the petition, 2) views on good end-of-life care and 3) role of euthanasia in case of incompetent patients with dementia. Both data collection and analysis took place based on a cyclical and iterative process. Thematic content analysis and the framework method were used to interpret the data.

Results

According to participants, the following aspects of the social debate are underexposed: 1) patient autonomy in incompetent patients, 2) the one-sided social debate, 3) the growing pressure on doctors, 4) physicians’ personal moral boundaries, 5) a different opinion on the Euthanasia Act. In-depth analysis revealed three themes contributing to these motives: 1) good care at the end of life, 2) essential aspects of handling a euthanasia request, 3) the doctor as a human being.

Conclusions

Physicians supporting the petition emphasize the importance of high-quality palliative care at the end of life. An extensive preliminary trajectory and moral deliberation with care team members are reported as essential requirements in handling a written euthanasia request in dementia patients. Uncertainty regarding the patient’s point of view is noted as a restraining factor. More education of society on end-of-life care and euthanasia in dementia is warranted. The emotional impact euthanasia has on doctors should be recognized and their personal moral boundaries and autonomy should be respected.

Auteurs

• Djura O. Coers MSc, promovenda DALT-project & huisarts in opleiding, Amsterdam UMC (VUmc), Afdeling Ouderengeneeskunde, Amsterdam Public Health research institute, Amsterdam
• Dr. Marike E. de Boer, senior onderzoeker, Amsterdam UMC (VUmc), Afdeling Ouderengeneeskunde, Amsterdam Public Health research institute, Amsterdam
• Dr. Eefje M. Sizoo, specialist ouderengeneeskunde, senior onderzoeker en docent Gerion, Afdeling Ouderengeneeskunde Amsterdam UMC (VUmc), Amsterdam Public Health research institute, Amsterdam
• Dr. Martin Smalbrugge, specialist ouderengeneeskunde, hoofd opleiding Gerion en senior onderzoeker, Afdeling Ouderengeneeskunde Amsterdam UMC (VUmc), Amsterdam Public Health research institute, Amsterdam
• Prof. dr. Carlo J.W. Leget, hoogleraar Zorgethiek, bijzonder hoogleraar Palliatieve Zorg, Universiteit voor Humanistiek, Afdeling Zorgethiek, Utrecht
• Prof. dr. Cees M.P.M. Hertogh, hoogleraar ouderengeneeskunde, Amsterdam UMC (VUmc), Afdeling Ouderengeneeskunde, Amsterdam Public Health research institute, Amsterdam