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Eur J Gen Pract. 2019 Jan;25(1):44-48. doi: 10.1080/13814788.2018.1517154. Epub 2018 Nov 1.

Developments in euthanasia practice in the Netherlands: Balancing professional responsibility and the patient's autonomy.

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a Julius Centre for Health Sciences and Primary Care , University Medical Centre Utrecht , Utrecht , The Netherlands.
b Department of Public Health , Erasmus Medical Centre , Rotterdam , The Netherlands.


In 2015, euthanasia accounted for 4.5% of deaths in the Netherlands, of which 93% were performed by a GP. Historically, a conflict of physician's duties-to alleviate unbearable suffering and at the same time preserve the patient's life-is central to the justification of euthanasia practice in the Netherlands. However, there seems to be a shift towards a greater emphasis on the patient's autonomous wish as the primary basis for euthanasia. This shift has consequences for the role and interpretation of the physician's duties in end-of-life care. This paper aims to describe these developments in euthanasia practice and end-of-life decision-making. We describe important relevant developments and look into the role and the meaning of two dimensions of the concept of 'patient autonomy' regarding end-of-life decisions, in particular, the euthanasia request. We claim that the concept of autonomy 'as a right,' which can be distinguished from autonomy 'as an ideal,' narrows the physician's window of opportunity to offer end-of-life care other than euthanasia.


Euthanasia; general practice/family medicine; health ethics; palliative and terminal care

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