OBJECTIVE: To obtain insight into current practices regarding compliance with advance directives for euthanasia (ADEs) in cases of incompetent patients with dementia in Dutch nursing homes, in light of the legal possibility offered by the new euthanasia law to perform euthanasia in these cases. METHODS: A written questionnaire was completed by 434 elderly care physicians (ECPs). FINDINGS: Over the years 2005-2006, many ECPs took care of patients with dementia and an ADE, actual life termination of these patients took place very rarely and never in incompetent patients. ECPs reported practical difficulties in determining the 'unbearableness' of the suffering and choosing the right moment of carrying out the ADE. CONCLUSIONS: Although the enactment of the Dutch euthanasia law in theory provided a window of opportunity for euthanasia in incompetent patients with dementia and an ADE, it has not led to obvious changes in compliance with ADEs of this patient group in practice. Crucial in the reticent attitudes of ECPs appears to be the impossibility of patient-physician communication. This raises questions on the feasibility of the law on this point. In our opinion, the role of ADEs in end-of-life care of patients with advanced dementia in the Netherlands deserves serious reconsideration.
OBJECTIVE: To obtain insight into current practices regarding compliance with advance directives for euthanasia (ADEs) in cases of incompetent patients with dementia in Dutch nursing homes, in light of the legal possibility offered by the new euthanasia law to perform euthanasia in these cases. METHODS: A written questionnaire was completed by 434 elderly care physicians (ECPs). FINDINGS: Over the years 2005-2006, many ECPs took care of patients with dementia and an ADE, actual life termination of these patients took place very rarely and never in incompetent patients. ECPs reported practical difficulties in determining the 'unbearableness' of the suffering and choosing the right moment of carrying out the ADE. CONCLUSIONS: Although the enactment of the Dutch euthanasia law in theory provided a window of opportunity for euthanasia in incompetent patients with dementia and an ADE, it has not led to obvious changes in compliance with ADEs of this patient group in practice. Crucial in the reticent attitudes of ECPs appears to be the impossibility of patient-physician communication. This raises questions on the feasibility of the law on this point. In our opinion, the role of ADEs in end-of-life care of patients with advanced dementia in the Netherlands deserves serious reconsideration.
Authors: Pauline S C Kouwenhoven; Natasja J H Raijmakers; Johannes J M van Delden; Judith A C Rietjens; Donald G van Tol; Suzanne van de Vathorst; Nienke de Graeff; Heleen A M Weyers; Agnes van der Heide; Ghislaine J M W van Thiel Journal: BMC Med Ethics Date: 2015-01-28 Impact factor: 2.652
Authors: Gina Bravo; Claudie Rodrigue; Vincent Thériault; Marcel Arcand; Jocelyn Downie; Marie-France Dubois; Sharon Kaasalainen; Cees M Hertogh; Sophie Pautex; Lieve Van den Block Journal: JMIR Res Protoc Date: 2017-11-13
Authors: Angela Jjm Keijzer-van Laarhoven; Dorothea P Touwen; Bram Tilburgs; Madelon van Tilborg-den Boeft; Claudia Pees; Wilco P Achterberg; Jenny T van der Steen Journal: BMJ Open Date: 2020-11-12 Impact factor: 2.692
Authors: Judith A C Rietjens; Natasja J H Raijmakers; Pauline S C Kouwenhoven; Clive Seale; Ghislaine J M W van Thiel; Margo Trappenburg; Johannes J M van Delden; Agnes van der Heide Journal: BMC Med Ethics Date: 2013-03-06 Impact factor: 2.652