Advance directives for euthanasia in dementia: how do they affect resident care in Dutch nursing homes? Experiences of physicians and relatives

J Am Geriatr Soc. 2011 Jun;59(6):989-96. doi: 10.1111/j.1532-5415.2011.03414.x. Epub 2011 Jun 7.


Objectives: To gain insight into how advance directives for euthanasia affect resident care in Dutch nursing homes.

Design: Survey of elderly care physicians and additional qualitative interviews with a selection of elderly care physicians and relatives of people with dementia who had an advance directive for euthanasia.

Setting: Dutch nursing home practice.

Participants: Four hundred thirty-four elderly care physicians completed the general part of the questionnaire; 110 physicians provided case histories. Interviews were conducted with 11 physicians and eight relatives.

Measurements: The questionnaire contained general questions about the incidence of advance directives for euthanasia in people with dementia. A second part involved questions about the most recent case of a person with dementia and an advance directive for euthanasia who had died. The interviews with elderly care physicians and relatives focused on further exploration of the decision-making process regarding adherence to the advance directive for euthanasia.

Results: Despite law-based possibilities, advance directives for euthanasia of people with dementia were rarely adhered to, although they seem to have a supportive role in setting limitations on life-sustaining treatments. Elderly care physicians and relatives were found to be reluctant to adhere to advance directives for euthanasia. Not being able to engage in meaningful communication played a crucial role in this reluctance.

Conclusion: Advance directives for euthanasia are never adhered to in the Netherlands in the case of people with advanced dementia, and their role in advance care planning and end-of-life care of people with advanced dementia is limited. Communication with the patient is essential for elderly care physicians to consider adherence to an advance directive for euthanasia of a person with dementia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Advance Directive Adherence / legislation & jurisprudence*
  • Advance Directive Adherence / psychology
  • Advance Directives / legislation & jurisprudence*
  • Advance Directives / psychology
  • Aged
  • Aged, 80 and over
  • Attitude of Health Personnel*
  • Caregivers* / psychology
  • Decision Making
  • Dementia / diagnosis
  • Dementia / psychology
  • Euthanasia / legislation & jurisprudence*
  • Female
  • Health Services Research
  • Homes for the Aged*
  • Humans
  • Interview, Psychological
  • Male
  • Medical Futility / legislation & jurisprudence
  • Medical Futility / psychology
  • Mental Competency / legislation & jurisprudence
  • Mental Competency / psychology
  • Netherlands
  • Nursing Homes*
  • Suicide, Assisted / legislation & jurisprudence
  • Suicide, Assisted / psychology
  • Surveys and Questionnaires