Euthanasie en andere medische beslissingen rond het levenseinde in Nederland in 1990, 1995 en 2001

Objective. To determine the incidence of euthanasia and other end-of-life decisions in the Netherlands in I990, 1995 and 2001, and the physicians' attitudes towards such decisions. Design. Interview and questionnaire study. Methods. Physician interviews and death-certificate studies performed in 1990 and 1995 were again repeated in 2001. Interviews were held with general practitioners, clinical specialists and nursing home physicians: 1990: n = 405; response: 91%; 1995: n = 405; response: 89%; 2001: n = 410; response: 85%. For the deaths, random samples were drawn from the register of death certificates at Statistics Netherlands after which a questionnaire was sent to the treating physicians: 1990: n = 5197; response: 76%; 1995: n = 5146; response: 77%; 2001: n = 5617; response: 74%. Results. In 2001 44% of all deaths were preceded by an end-of-life medical decision. Euthanasia was performed in 2.6% of cases (1995: 2.4%; 1990: 1.7%). This increase was mostly in the patient categories where euthanasia had been most frequently applied in 1990: patients under 80 years of age, patients with cancer and patients under the care of their general practitioner. The prevalence of assisted suicide and the termination of life without the express permission of the patient as well as the opinions of the majority of physicians with respect to euthanasia has not changed over the years studied. However in 2001, the number of physicians who indicated a more restrictive and less permissive approach was higher than in previous years. Conclusion. There has been a stabilisation in the practice of end-of-life medical decision-taking over the period surveyed (1990-2001). No further increase in the number of requests to terminate life was found after 1995 and physicians seem to have become more reticent with respect to these procedures.