End-of-life practices in the Netherlands under the Euthanasia Act

N Engl J Med. 2007 May 10;356(19):1957-65. doi: 10.1056/NEJMsa071143.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Analgesics, Opioid / administration & dosage
  • Cause of Death
  • Euthanasia / legislation & jurisprudence
  • Euthanasia / statistics & numerical data
  • Euthanasia / trends*
  • Female
  • Follow-Up Studies
  • Humans
  • Hypnotics and Sedatives / administration & dosage
  • Male
  • Middle Aged
  • Netherlands
  • Suicide, Assisted / legislation & jurisprudence
  • Suicide, Assisted / statistics & numerical data
  • Suicide, Assisted / trends*
  • Surveys and Questionnaires
  • Withholding Treatment / statistics & numerical data
  • Withholding Treatment / trends

Substances

  • Analgesics, Opioid
  • Hypnotics and Sedatives