Advance directives in the Netherlands: an empirical contribution to the exploration of a cross-cultural perspective on advance directives

Bioethics. 2010 Mar;24(3):118-26. doi: 10.1111/j.1467-8519.2009.01788.x.


Research objective: This study focuses on ADs in the Netherlands and introduces a cross-cultural perspective by comparing it with other countries.

Methods: A questionnaire was sent to a panel comprising 1621 people representative of the Dutch population. The response was 86%.

Results: 95% of the respondents didn't have an AD, and 24% of these were not familiar with the idea of drawing up an AD. Most of those familiar with ADs knew about the Advanced Euthanasia Directive (AED, 64%). Both low education and the presence of a religious conviction that plays an important role in one's life increase the chance of not wanting to draw up an AD. Also not having experienced a request for euthanasia from someone else, and the inconceivability of asking for euthanasia yourself, increase the chance of not wanting to draw up an AD.

Discussion: This study shows that the subjects of palliative care and end-of-life-decision-making were very much dominated by the issue of euthanasia in the Netherlands. The AED was the best known AD; and factors that can be linked to euthanasia play an important role in whether or not people choose to draw up an AD. This differentiates the Netherlands from other countries and, when it comes to ADs, the global differences between countries and cultures are still so large that the highest possible goals, at this moment in time, are observing and possibly learning from other cultural settings.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Advance Directives*
  • Aged
  • Attitude to Health*
  • Christianity
  • Cross-Cultural Comparison*
  • Educational Status
  • Euthanasia, Active, Voluntary
  • Female
  • Humans
  • Male
  • Middle Aged
  • Netherlands
  • Terminal Care*
  • United States
  • Withholding Treatment