Clinical Problems With the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands
Groenewoud, Johanna H.
van der Heide, Agnes
Onwuteaka-Philipsen, Bregje D.
Willems, Dick L.
van der Maas, Paul J.
van der Wal, Gerrit
New England Journal of Medicine. 2000 Feb 24; 342(8): 551-556.
BACKGROUND AND METHODS: The characteristics and frequency of clinical problems with the performance of euthanasia and physician-assisted suicide are uncertain. We analyzed data from two studies of euthanasia and physician-assisted suicide in The Netherlands (one conducted in 1990 and 1991 and the other in 1995 and 1996), with a total of 649 cases. We categorized clinical problems as technical problems, such as difficulty inserting an intravenous line; complications, such as myoclonus or vomiting; or problems with completion, such as a longer-than-expected interval between the administration of medications and death. RESULTS: In 114 cases, the physician's intention was to provide assistance with suicide, and in 535, the intention was to perform euthanasia. Problems of any type were more frequent in cases of assisted suicide than in cases of euthanasia. Complications occurred in 7 percent of cases of assisted suicide, and problems with completion (a longer-than-expected time to death, failure to induce coma, or induction of coma followed by awakening of the patient) occurred in 16 percent of the cases; complications and problems with completion occurred in 3 percent and 6 percent of cases of euthanasia, respectively. The physician decided to administer a lethal medication in 21 of the cases of assisted suicide (18 percent), which thus became cases of euthanasia. The reasons for this decision included problems with completion (in 12 cases) and the inability of the patient to take all the medications (in 5). CONCLUSIONS: There may be clinical problems with the performance of euthanasia and physician-assisted suicide. In The Netherlands, physicians who intend to provide assistance with suicide sometimes end up administering a lethal medication themselves because of the patient's inability to take the medication or because of problems with the completion of physician-assisted suicide.
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Clinical Problems With the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands Groenewoud, Johanna H.; van der Heide, Agnes; Onwuteaka- Philipsen, Bregje D.; Willems, Dick L.; van der Maas, Paul J.; van der Wal, Gerrit (2000-02-24)
Euthanasia, Physician-Assisted Suicide, and Other Medical Practices Involving the End of Life in the Netherlands, 1990-1995 van der Maas, Paul J.; van der Wal, Gerrit; Haverkate, Ilinka; de Graaff, Carmen L.M.; Kester, John G.C.; Onwuteaka-Philipsen, Bregje D.; van der Heide, Agnes; Bosma, Jacqueline M.; Willems, Dick L. (1996-11-28)BACKGROUND: In 1991 a new procedure for reporting physician-assisted deaths was introduced in the Netherlands that led to a tripling in the number of reported cases. In 1995, as part of an evaluation of this procedure, ...
Groenewoud, Johanna H.; van der Heide, Agnes; Tholen, Alfons J.; Schudel, W. Joost; Hengeveld, Michiel W.; Onwuteaka-Philipsen, Bregje D.; van der Maas, Paul J.; van der Wal, Gerrit (2004-07)