title: Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands, 1990-1995.
abstract: 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, a nationwide study of euthanasia and other medical practices concerning the end of life was begun that was identical to a study conducted in 1990.
  
  
  METHODS
  We conducted two studies, the first involving interviews with 405 physicians (general practitioners, nursing home physicians, and clinical specialists) and the second involving questionnaires mailed to the physicians attending 6060 deaths that were identified from death certificates. The response rates were 89 percent and 77 percent, respectively.
  
  
  RESULTS
  Among the deaths studied, 2.3 percent of those in the interview study and 2.4 percent of those in the death-certificate study were estimated to have resulted from euthanasia, and 0.4 percent and 0.2 percent, respectively, resulted from physician-assisted suicide. In 0.7 percent of cases, life was ended without the explicit, concurrent request of the patient. Pain and symptoms were alleviated with doses of opioids that may have shortened life in 14.7 to 19.1 percent of cases, and decisions to withhold or withdraw life-prolonging treatment were made in 20.2 percent. Euthanasia seems to have increased in incidence since 1990, and ending of life without the patient's explicit request to have decreased slightly. For each type of medical decision except those in which life-prolonging treatment was withheld or withdrawn, cancer was the most frequently reported diagnosis.
  
  
  CONCLUSIONS
  Since the notification procedure was introduced, end-of-life decision making in the Netherlands has changed only slightly, in an anticipated direction. Close monitoring of such decisions is possible, and we found no signs of an unacceptable increase in the number of decisions or of less careful decision making.
authors.affiliation: Department of Public Health, Erasmus University Rotterdam, the Netherlands.
authors.forename: P J
authors.initials: PJ
authors.lastname: van der Maas
authors.forename: G
authors.initials: G
authors.lastname: van der Wal
authors.forename: I
authors.initials: I
authors.lastname: Haverkate
authors.forename: C L
authors.initials: CL
authors.lastname: de Graaff
authors.forename: J G
authors.initials: JG
authors.lastname: Kester
authors.forename: B D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
authors.forename: A
authors.initials: A
authors.lastname: van der Heide
authors.forename: J M
authors.initials: JM
authors.lastname: Bosma
authors.forename: D L
authors.initials: DL
authors.lastname: Willems
mesh_terms: D003625:Data Collection; D003644:Death Certificates; D003657:Decision Making; D005065:Euthanasia / Q000706:statistics & numerical data / Q000639:trends*; D028601:Euthanasia, Active; D033101:Euthanasia, Active, Voluntary; D005066:Euthanasia, Passive / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D015994:Incidence; D033182:Intention; D009426:Netherlands; D010358:Patient Participation / Q000706:statistics & numerical data / Q000639:trends; D010820:Physicians; D011897:Random Allocation; D012494:Sampling Studies; D012922:Social Change; D017236:Suicide, Assisted / Q000706:statistics & numerical data / Q000639:trends*; D035761:Wedge Argument; D028761:Withholding Treatment