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J Am Geriatr Soc. 2005 Jul;53(7):1138-44.

Physicians' experiences with demented patients with advance euthanasia directives in the Netherlands.

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  • 1Department of Public and Occupational Health, Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, the Netherlands.

Abstract

OBJECTIVES:

To estimate the incidence of (compliance with) advance euthanasia directives of patients suffering from dementia in the Netherlands and to gain knowledge about the experiences of physicians.

DESIGN:

Retrospective interview study.

SETTING:

Physicians in the Netherlands.

PARTICIPANTS:

Four hundred ten physicians.

MEASUREMENTS:

Physicians were interviewed about their demented patients who had an advance euthanasia directive. Nursing home physicians were interviewed more extensively.

RESULTS:

Approximately 2,200 demented patients with an advance euthanasia directive die annually after being treated by a physician who knows about this directive. In 76% of such cases, compliance with the directive was discussed, but euthanasia was seldom performed. In two-thirds of the cases of demented nursing home patients with an advance euthanasia directive, the physician was able to identify during the course of the disease a situation for which the patient had intended the directive. One-quarter of the nursing home physicians thought that their most recent patient suffered unbearably to a (very) high degree, and half of them thought that the patient suffered hopelessly to a (very) high degree. In three-quarters of the cases, the relatives did not want the nursing home physician to comply with the directive, but they did want to respect the patient's wishes by forgoing life-prolonging treatment, which occurred in approximately 90% of cases.

CONCLUSION:

Most nursing home physicians think that the suffering of patients with dementia can be unbearable and hopeless as a consequence of dementia, but most physicians do not consider dementia to be grounds for euthanasia, unless perhaps the patient has an additional illness.

PMID:
16108931
[PubMed - indexed for MEDLINE]
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