FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 335:1699-1705 November 28, 1996 Number 22 Next

	Full Text PDF Purchase this article Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background In 1991 a new procedure for reporting physician-assisted deaths was introduced in the Netherlands that led to a tripling in the number of reported cases. In 1995, as part of an evaluation of this procedure, a nationwide study of euthanasia and other medical practices concerning the end of life was begun that was identical to a study conducted in 1990.

Methods We conducted two studies, the first involving interviews with 405 physicians (general practitioners, nursing home physicians, and clinical specialists) and the second involving questionnaires mailed to the physicians attending 6060 deaths that were identified from death certificates. The response rates were 89 percent and 77 percent, respectively.

Results Among the deaths studied, 2.3 percent of those in the interview study and 2.4 percent of those in the death-certificate study were estimated to have resulted from euthanasia, and 0.4 percent and 0.2 percent, respectively, resulted from physician-assisted suicide. In 0.7 percent of cases, life was ended without the explicit, concurrent request of the patient. Pain and symptoms were alleviated with doses of opioids that may have shortened life in 14.7 to 19.1 percent of cases, and decisions to withhold or withdraw life-prolonging treatment were made in 20.2 percent. Euthanasia seems to have increased in incidence since 1990, and the ending of life without the patient's explicit request seems to have decreased slightly. For each type of medical decision except those in which life-prolonging treatment was withheld or withdrawn, cancer was the most frequently reported diagnosis.

Conclusions Since the notification procedure was introduced, end-of-life decision making in the Netherlands has changed only slightly, in an anticipated direction. Close monitoring of such decisions is possible, and we found no signs of an unacceptable increase in the number of decisions or of less careful decision making.

Source Information

From the Department of Public Health, Erasmus University Rotterdam, Rotterdam (P.J.M., A.H.), the Institute for Research in Extramural Medicine, Vrije Universiteit Amsterdam, Amsterdam (G.W., I.H., B.D.O.-P., J.M.B., D.L.W.); and Statistics Netherlands, Voorburg (C.L.M.G., J.G.C.K.) — all in the Netherlands.

Address reprint requests to Dr. van der Maas at the Department of Public Health, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands.

Full Text of this Article

Related Letters:

Euthanasia and Physician-Assisted Suicide in the Netherlands
Hendin H., Glick S. M., Miller F. G., Simcic K. J., van der Maas P. J., van der Wal G.
Extract | Full Text  
N Engl J Med 1997; 336:1385-1387, May 8, 1997. Correspondence

This article has been cited by other articles:

• Reuzel, R., Hasselaar, G., Vissers, K., van der Wilt, G., Groenewoud, J., Crul, B. (2008). Inappropriateness of using opioids for end-stage palliative sedation: a Dutch study. Palliat Med 22: 641-646 [Abstract]  
• Bryon, E, de Casterle, B D., Gastmans, C (2008). Nurses' attitudes towards artificial food or fluid administration in patients with dementia and in terminally ill patients: a review of the literature. J. Med. Ethics 34: 431-436 [Abstract] [Full Text]  
• van Bruchem-van de Scheur, G G, Arend, A J G v. d., Abu-Saad, H H., Spreeuwenberg, C, van Wijmen, F C B, ter Meulen, R H J (2008). The role of nurses in euthanasia and physician-assisted suicide in The Netherlands. J. Med. Ethics 34: 254-258 [Abstract] [Full Text]  
• Cohen, J., Bilsen, J., Fischer, S., Lofmark, R., Norup, M., van der Heide, A., Miccinesi, G., Deliens, L., on behalf of the EURELD Consortium, (2007). End-of-life decision-making in Belgium, Denmark, Sweden and Switzerland: does place of death make a difference?. J. Epidemiol. Community Health 61: 1062-1068 [Abstract] [Full Text]  
• Battin, M. P, van der Heide, A., Ganzini, L., van der Wal, G., Onwuteaka-Philipsen, B. D (2007). Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in "vulnerable" groups. J. Med. Ethics 33: 591-597 [Abstract] [Full Text]  
• Verhagen, A. A. E., van der Hoeven, M. A. H., van Meerveld, R. C., Sauer, P. J. J. (2007). Physician Medical Decision-making at the End of Life in Newborns: Insight Into Implementation at 2 Dutch Centers. Pediatrics 120: e20-e28 [Abstract] [Full Text]  
• van der Heide, A., Onwuteaka-Philipsen, B. D., Rurup, M. L., Buiting, H. M., van Delden, J. J.M., Hanssen-de Wolf, J. E., Janssen, A. G.J.M., Pasman, H. R. W., Rietjens, J. A.C., Prins, C. J.M., Deerenberg, I. M., Gevers, J. K.M., van der Maas, P. J., van der Wal, G. (2007). End-of-Life Practices in the Netherlands under the Euthanasia Act. NEJM 356: 1957-1965 [Abstract] [Full Text]  
• Van den Block, L., Bilsen, J., Deschepper, R., Van Der Kelen, G., Bernheim, J. L., Deliens, L. (2006). End-of-Life Decisions Among Cancer Patients Compared With Noncancer Patients in Flanders, Belgium. JCO 24: 2842-2848 [Abstract] [Full Text]  
• NAUDTS, K., DUCATELLE, C., KOVACS, J., LAURENS, K., VAN DEN EYNDE, F., VAN HEERINGEN, C. (2006). Euthanasia: the role of the psychiatrist. Br. J. Psychiatry 188: 405-409 [Abstract] [Full Text]  
• Rietjens, J. A. C., van Delden, J. J. M., van der Heide, A., Vrakking, A. M., Onwuteaka-Philipsen, B. D., van der Maas, P. J., van der Wal, G. (2006). Terminal sedation and euthanasia: a comparison of clinical practices.. Arch Intern Med 166: 749-753 [Abstract] [Full Text]  
• Chochinov, H. M. (2006). Dying, Dignity, and New Horizons in Palliative End-of-Life Care.. CA Cancer J Clin 56: 84-103 [Abstract] [Full Text]  
• Seale, C. (2006). National survey of end-of-life decisions made by UK medical practitioners. Palliat Med 20: 3-10 [Abstract]  
• Georges, J.-J., Onwuteaka-Philipsen, B. D, van der Wal, G., van der Heide, A., van der Maas, P. J (2005). Differences between terminally ill cancer patients who died after euthanasia had been performed and terminally ill cancer patients who did not request euthanasia. Palliat Med 19: 578-586 [Abstract]  
• van der Lee, M. L., van der Bom, J. G., Swarte, N. B., Heintz, A. P. M., de Graeff, A., van den Bout, J. (2005). Euthanasia and Depression: A Prospective Cohort Study Among Terminally Ill Cancer Patients. JCO 23: 6607-6612 [Abstract] [Full Text]  
• Johansen, S., Holen, J. Chr., Kaasa, S., Kaasa, S., Loge, J. H., Materstvedt, L. J. (2005). Attitudes towards, and wishes for, euthanasia in advanced cancer patients at a palliative medicine unit. Palliat Med 19: 454-460 [Abstract]  
• Vrakking, A. M., van der Heide, A., Arts, W. F. M., Pieters, R., van der Voort, E., Rietjens, J. A. C., Onwuteaka-Philipsen, B. D., van der Maas, P. J., van der Wal, G. (2005). Medical End-of-Life Decisions for Children in the Netherlands. Arch Pediatr Adolesc Med 159: 802-809 [Abstract] [Full Text]  
• Wolf, S. M. (2005). Assessing Physician Compliance With the Rules for Euthanasia and Assisted Suicide. Arch Intern Med 165: 1677-1679 [Full Text]  
• Bilsen, J., Bauwens, M., Bernheim, J., Stichele, R. V., Deliens, L. (2005). Physician-assisted death: attitudes and practices of community pharmacists in East Flanders, Belgium. Palliat Med 19: 151-157 [Abstract]  
• Bosshard, G., Nilstun, T., Bilsen, J., Norup, M., Miccinesi, G., van Delden, J. J. M., Faisst, K., van der Heide, A., for the European End-of-Life (EURELD) Consortium, (2005). Forgoing Treatment at the End of Life in 6 European Countries. Arch Intern Med 165: 401-407 [Abstract] [Full Text]  
• Hem, E., Loge, J. H., Haldorsen, T., Ekeberg, O. (2004). Suicide Risk in Cancer Patients From 1960 to 1999. JCO 22: 4209-4216 [Abstract] [Full Text]  
• Magnusson, R. S. (2004). "Underground Euthanasia" and the Harm Minimization Debate. J Law Med Ethics 32: 486-495  
• Bilsen, J., Stichele, R. V., Mortier, F., Bernheim, J., Deliens, L. (2004). The incidence and characteristics of end-of-life decisions by GPs in Belgium. Fam Pract 21: 282-289 [Abstract] [Full Text]  
• Mortier, F., Bilsen, J., Vander Stichele, R. H., Bernheim, J., Deliens, L. (2003). Attitudes, Sociodemographic Characteristics, and Actual End-of-Life Decisions of Physicians in Flanders, Belgium. Med Decis Making 23: 502-510 [Abstract]  
• Sprung, C. L., Cohen, S. L., Sjokvist, P., Baras, M., Bulow, H.-H., Hovilehto, S., Ledoux, D., Lippert, A., Maia, P., Phelan, D., Schobersberger, W., Wennberg, E., Woodcock, T. (2003). End-of-Life Practices in European Intensive Care Units: The Ethicus Study. JAMA 290: 790-797 [Abstract] [Full Text]  
• Swarte, N. B, van der Lee, M. L, van der Bom, J. G, van den Bout, J., Heintz, A P. M (2003). Effects of euthanasia on the bereaved family and friends: a cross sectional study. BMJ 327: 189- [Abstract] [Full Text]  
• Meier, D. E., Emmons, C.-A., Litke, A., Wallenstein, S., Morrison, R. S. (2003). Characteristics of Patients Requesting and Receiving Physician-Assisted Death. Arch Intern Med 163: 1537-1542 [Abstract] [Full Text]  
• Mehr, D. R., van der Steen, J. T., Kruse, R. L., Ooms, M. E., Rantz, M., Ribbe, M. W. (2003). Lower Respiratory Infections in Nursing Home Residents With Dementia: A Tale of Two Countries. Gerontologist 43: 85-93 [Abstract] [Full Text]  
• Ratner, E. R., Song, J. Y. (2003). Ethics and Dying at Home. Home Health Care Management Practice 15: 123-125 [Abstract]  
• Hurst, S. A, Mauron, A. (2003). Assisted suicide and euthanasia in Switzerland: allowing a role for non-physicians. BMJ 326: 271-273 [Full Text]  
• Veldink, J. H., Wokke, J. H.J., van der Wal, G., Vianney de Jong, J.M.B., van den Berg, L. H. (2002). Euthanasia and Physician-Assisted Suicide among Patients with Amyotrophic Lateral Sclerosis in the Netherlands. NEJM 346: 1638-1644 [Abstract] [Full Text]  
• Tanida, N., Asai, A., Ohnishi, M., Nagata, S. K, Fukui, T., Yamazaki, Y., Kuhse, H. (2002). Voluntary Active Euthanasia and the Nurse: a comparison of Japanese and Australian nurses. Nurs Ethics 9: 313-322 [Abstract]  
• Chochinov, H. M. (2002). Dignity-Conserving Care--A New Model for Palliative Care: Helping the Patient Feel Valued. JAMA 287: 2253-2260 [Abstract] [Full Text]  
• Chao, D., Chan, N., Chan, W. (2002). Euthanasia revisited. Fam Pract 19: 128-134 [Abstract] [Full Text]  
• Cohen-Almagor, R. (2002). Why the Netherlands?. J Law Med Ethics 30: 95-104  
• Morita, T., Akechi, T., Sugawara, Y., Chihara, S., Uchitomi, Y. (2002). Practices and Attitudes of Japanese Oncologists and Palliative Care Physicians Concerning Terminal Sedation: A Nationwide Survey. JCO 20: 758-764 [Abstract] [Full Text]  
• Emanuel, E. J. (2002). Euthanasia and Physician-Assisted Suicide: A Review of the Empirical Data From the United States. Arch Intern Med 162: 142-152 [Full Text]  
• Materstvedt, L J, Kaasa, S (2002). Euthanasia and physician-assisted suicide in Scandinavia -- with a conceptual suggestion regarding international research in relation to the phenomena. Palliat Med 16: 17-32 [Abstract]  
• Janssens, R. J P A, ten Have, H. A M J (2001). The concept of palliative care in the Netherlands. Palliat Med 15: 481-486 [Abstract]  
• ten Have, H A M J (2001). Euthanasia: moral paradoxes. Palliat Med 15: 505-511 [Abstract]  
• Emanuel, E. J (2001). Euthanasia: where the Netherlands leads will the world follow?. BMJ 322: 1376-1377 [Full Text]  
• Kohlwes, R. J., Koepsell, T. D., Rhodes, L. A., Pearlman, R. A. (2001). Physicians' Responses to Patients' Requests for Physician-Assisted Suicide. Arch Intern Med 161: 657-663 [Abstract] [Full Text]  
• Pollard, B. J (2001). Can euthanasia be safely legalized?. Palliat Med 15: 61-65  
• Emanuel, E. J., Fairclough, D. L., Emanuel, L. L. (2000). Attitudes and Desires Related to Euthanasia and Physician-Assisted Suicide Among Terminally Ill Patients and Their Caregivers. JAMA 284: 2460-2468 [Abstract] [Full Text]  
• Haverkate, I., Onwuteaka-Philipsen, B. D, van der Heide, A., Kostense, P. J, van der Wal, G., van der Maas, P. J (2000). Refused and granted requests for euthanasia and assisted suicide in the Netherlands: interview study with structured questionnaire. BMJ 321: 865-866 [Full Text]  
• Wilson, K. G., Scott, J. F., Graham, I. D., Kozak, J. F., Chater, S., Viola, R. A., de Faye, B. J., Weaver, L. A., Curran, D. (2000). Attitudes of Terminally Ill Patients Toward Euthanasia and Physician-Assisted Suicide. Arch Intern Med 160: 2454-2460 [Abstract] [Full Text]  
• Thiadens, H A (2000). A message from Holland. BMJ 320: 1655-1655 [Full Text]  
• Quill, T. E. (2000). Regulating How We Die: The Ethical, Medical, and Legal Issues Surrounding Physician-Assisted Suicide. Journal of Health Politics, Policy and Law 25: 391-402  
• Battin, M. P. (2000). On the Structure of the Euthanasia Debate: Observations Provoked by a Near-Perfect For-and-Against Book. Journal of Health Politics, Policy and Law 25: 415-430  
• Caplan, A. L., Snyder, L., Faber-Langendoen, K., for the University of Pennsylvania Center for Bioe, (2000). The Role of Guidelines in the Practice of Physician-Assisted Suicide. ANN INTERN MED 132: 476-481 [Abstract] [Full Text]  
• Quill, T. E., Byock, I. R., for the ACP-ASIM End-of-Life Care Consensus Panel, (2000). Responding to Intractable Terminal Suffering: The Role of Terminal Sedation and Voluntary Refusal of Food and Fluids. ANN INTERN MED 132: 408-414 [Abstract] [Full Text]  
• Valverius, E, Nilstun, T, Nilsson, B (2000). Palliative care, assisted suicide and euthanasia: nationwide questionnaire to Swedish physicians. Palliat Med 14: 141-148 [Abstract]  
• Groenewoud, J. H., van der Heide, A., Onwuteaka-Philipsen, B. D., Willems, D. L., van der Maas, P. J., van der Wal, G. (2000). Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands. NEJM 342: 551-556 [Abstract] [Full Text]  
• Haverkate, I., Muller, M. T., Cappetti, M., Jonkers, F. J., van der Wal, G. (2000). Prevalence and Content Analysis of Guidelines on Handling Requests for Euthanasia or Assisted Suicide in Dutch Nursing Homes. Arch Intern Med 160: 317-322 [Abstract] [Full Text]  
• Groenewoud, J. H., van der Heide, A., Kester, J. G. C., de Graaff, C. L. M., van der Wal, G., van der Maas, P. J. (2000). A Nationwide Study of Decisions to Forego Life-Prolonging Treatment in Dutch Medical Practice. Arch Intern Med 160: 357-363 [Abstract] [Full Text]  
• Wineberg, H. (2000). Oregon's Death With Dignity Act: Fourteen Months and Counting. Arch Intern Med 160: 21-23 [Full Text]  
• Willems, D. L., Daniels, E. R., van der Wal, G., van der Maas, P. J., Emanuel, E. J. (2000). Attitudes and Practices Concerning the End of Life: A Comparison Between Physicians From the United States and From the Netherlands. Arch Intern Med 160: 63-68 [Abstract] [Full Text]  
• Carver, A. C., Vickrey, B. G., Bernat, J. L., Keran, C., Ringel, S. P., Foley, K. M. (1999). End-of-life care: A survey of US neurologists' attitudes, behavior, and knowledge. Neurology 53: 284-284 [Abstract] [Full Text]  
• Hartmann, L., Meyerson, A. (1998). A Debate on Physician-Assisted Suicide. Psychiatr. Serv. 49: 1468-1474 [Full Text]  
• Schoevers, R. A., Asmus, F. P., Tilburg, W. V. (1998). Physician-Assisted Suicide in Psychiatry: Developments in the Netherlands. Psychiatr. Serv. 49: 1475-1480 [Abstract] [Full Text]  
• Hendin, H., Goold, S. D., Meier, D. E., Morrison, R. S., Wallenstein, S. (1998). Physician-Assisted Suicide and Euthanasia in the United States. NEJM 339: 775-776 [Full Text]  
• Emanuel, E. J., Daniels, E. R., Fairclough, D. L., Clarridge, B. R. (1998). The Practice of Euthanasia and Physician-Assisted Suicide in the United States: Adherence to Proposed Safeguards and Effects on Physicians. JAMA 280: 507-513 [Abstract] [Full Text]  
• Emanuel, E. J., Battin, M. P. (1998). What Are the Potential Cost Savings from Legalizing Physician-Assisted Suicide?. NEJM 339: 167-172 [Full Text]  
• Sulmasy, D. P. (1998). Killing and Allowing to Die: Another Look. J Law Med Ethics 26: 55-64  
• van der Heide, A., van der Maas, P. J., van der Wal, G., Kollee, L. A. A., de Leeuw, R., Holl, R. A. (1998). The Role of Parents in End-of-Life Decisions in Neonatology: Physicians' Views and Practices. Pediatrics 101: 413-418 [Abstract] [Full Text]  
• Muskin, P. R. (1998). The Request to Die: Role for a Psychodynamic Perspective on Physician-Assisted Suicide. JAMA 279: 323-328 [Abstract] [Full Text]  
• Bradley, P., Przygoda, P., Saimovici, J., Poll, J., Figar, S., Raithatha, N. (1998). Physician assisted suicide, euthanasia, and withdrawal of treatment. BMJ 316: 71a-71 [Full Text]  
• de Boer, A., Lau, H. S., Porsius, A. (1997). Physician-Assisted Death and Pharmacy Practice in the Netherlands. NEJM 337: 1091-1092 [Full Text]  
• Drickamer, M. A., Lee, M. A., Ganzini, L. (1997). Physician-Assisted Suicide. ANN INTERN MED 127: 174-174 [Full Text]  
• Groenewoud, J. H., van der Maas, P. J., van der Wal, G., Hengeveld, M. W., Tholen, A. J., Schudel, W. J., van der Heide, A. (1997). Physician-Assisted Death in Psychiatric Practice in the Netherlands. NEJM 336: 1795-1801 [Abstract] [Full Text]  
• Batavia, A. I. (1997). Disability and Physician-Assisted Suicide. NEJM 336: 1671-1673 [Full Text]  
• Hendin, H., Glick, S. M., Miller, F. G., Simcic, K. J., van der Maas, P. J., van der Wal, G. (1997). Euthanasia and Physician-Assisted Suicide in the Netherlands. NEJM 336: 1385-1387 [Full Text]  
• Angell, M. (1997). The Supreme Court and Physician-Assisted Suicide -- The Ultimate Right. NEJM 336: 50-53 [Full Text]  
• (1997). Physician-Assisted Death in the Netherlands. Journal Watch Dermatology 1997: 14-14 [Full Text]  
• (1996). PHYSICIAN-ASSISTED DEATH IN THE NETHERLANDS. JWatch General 1996: 5-5 [Full Text]  
• Angell, M. (1996). Euthanasia in the Netherlands -- Good News or Bad?. NEJM 335: 1676-1678 [Full Text]  
• van der Maas, P. J., van der Wal, G., Haverkate, I., de Graaff, C. L.M., Kester, J. G.C., Onwuteaka-Philipsen, B. D., van der Heide, A., Bosma, J. M., Willems, D. L., van der Wal, G., van der Maas, P. J., Bosma, J. M., Onwuteaka-Philipsen, B. D., Willems, D. L., Haverkate, I., Kostense, P. J. (1996). Evaluation of the Notification Procedure for Physician-Assisted Death in the Netherlands. NEJM 335: 1706-1712 [Abstract] [Full Text]