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 356:1957-1965 May 10, 2007 Number 19 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Perspective by Quill, T. E. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background In 2002, an act regulating the ending of life by a physician at the request of a patient with unbearable suffering came into effect in the Netherlands. In 2005, we performed a follow-up study of euthanasia, physician-assisted suicide, and other end-of-life practices.

Methods We mailed questionnaires to physicians attending 6860 deaths that were identified from death certificates. The response rate was 77.8%.

Results In 2005, of all deaths in the Netherlands, 1.7% were the result of euthanasia and 0.1% were the result of physician-assisted suicide. These percentages were significantly lower than those in 2001, when 2.6% of all deaths resulted from euthanasia and 0.2% from assisted suicide. Of all deaths, 0.4% were the result of the ending of life without an explicit request by the patient. Continuous deep sedation was used in conjunction with possible hastening of death in 7.1% of all deaths in 2005, significantly increased from 5.6% in 2001. In 73.9% of all cases of euthanasia or assisted suicide in 2005, life was ended with the use of neuromuscular relaxants or barbiturates; opioids were used in 16.2% of cases. In 2005, 80.2% of all cases of euthanasia or assisted suicide were reported. Physicians were most likely to report their end-of-life practices if they considered them to be an act of euthanasia or assisted suicide, which was rarely true when opioids were used.

Conclusions The Dutch Euthanasia Act was followed by a modest decrease in the rates of euthanasia and physician-assisted suicide. The decrease may have resulted from the increased application of other end-of-life care interventions, such as palliative sedation.

Source Information

From Erasmus Medical Center, Rotterdam (A.H., H.M.B., J.A.C.R., P.J.M.); Vrije Universiteit Medical Center, Amsterdam (B.D.O.-P., M.L.R., J.E.H.-W., H.R.W.P., G.W.); University Medical Center, Utrecht (J.J.M.D.); Academic Medical Center, Amsterdam (A.G.J.M.J., J.K.M.G.); and Statistics Netherlands, Voorburg (C.J.M.P., I.M.D.) — all in the Netherlands.

Address reprint requests to Dr. van der Heide at the Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands, or at a.vanderheide{at}erasmusmc.nl.

Full Text of this Article

This article has been cited by other articles:

• Janssen, D. J. A., Spruit, M. A., Schols, J. M. G. A., Wouters, E. F. M. (2008). A Dosage of Opioids Should Never Exceed What Is Necessary to Relieve Symptoms. Am. J. Respir. Crit. Care Med. 178: 1186-1186 [Full Text]  
• Buiting, H. M., Rietjens, J. A.C., Onwuteaka-Philipsen, B. D., van der Maas, P. J., van Delden, J. J. M., van der Heide, A. (2008). A comparison of physicians' end-of-life decision making for non-western migrants and Dutch natives in the Netherlands. Eur J Public Health 18: 681-687 [Abstract] [Full Text]  
• Terry, P. B., Lanken, P. N. (2008). A Dosage of Opioids Should Never Exceed What Is Necessary to Relieve Symptoms. Am. J. Respir. Crit. Care Med. 178: 1186-1186 [Full Text]  
• Fischer, S, Huber, C A, Imhof, L, Mahrer Imhof, R, Furter, M, Ziegler, S J, Bosshard, G (2008). Suicide assisted by two Swiss right-to-die organisations. J. Med. Ethics 34: 810-814 [Abstract] [Full Text]  
• van Bruchem-van de Scheur, G. G, van der Arend, A. J., Abu-Saad, H. H., van Wijmen, F. C., Spreeuwenberg, C., ter Meulen, R. H. (2008). Alleviation of Pain and Symptoms With a Life-Shortening Intention. Nurs Ethics 15: 682-695 [Abstract]  
• 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]  
• Pereira, J, Laurent, P, Cantin, B, Petremand, D, Currat, T (2008). The response of a Swiss university hospital's palliative care consult team to assisted suicide within the institution. Palliat Med 22: 659-667 [Abstract]  
• Bernheim, J. L, Deschepper, R., Distelmans, W., Mullie, A., Bilsen, J., Deliens, L. (2008). Development of palliative care and legalisation of euthanasia: antagonism or synergy?. BMJ 336: 864-867 [Full Text]  
• Rietjens, J., Delden, J. v., Onwuteaka-Philipsen, B., Buiting, H., Maas, P. v. d., Heide, A. v. d. (2008). Continuous deep sedation for patients nearing death in the Netherlands: descriptive study. BMJ 336: 810-813 [Abstract] [Full Text]  
• Hasselaar, J. G. J., Reuzel, R. P. B., van den Muijsenbergh, M. E. T. C., Koopmans, R. T. C. M., Leget, C. J. W., Crul, B. J. P., Vissers, K. C. P. (2008). Dealing With Delicate Issues in Continuous Deep Sedation: Varying Practices Among Dutch Medical Specialists, General Practitioners, and Nursing Home Physicians. Arch Intern Med 168: 537-543 [Abstract] [Full Text]  
• van Marwijk, H., Haverkate, I., van Royen, P., The, A.-M. (2007). Impact of euthanasia on primary care physicians in the Netherlands. Palliat Med 21: 609-614 [Abstract]  
• 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]  
• Quill, T. E (2007). Physician assisted death in vulnerable populations. BMJ 335: 625-626 [Full Text]