title: Euthanasia and physician-assisted suicide among patients with amyotrophic lateral sclerosis in the Netherlands.
abstract: BACKGROUND
  Amyotrophic lateral sclerosis (ALS) is a disease that causes progressive paralysis leading to respiratory failure. Patients with ALS may consider physician-assisted suicide. However, it is not known how many patients, if given the option, would actually decide to end their lives by physician-assisted suicide or euthanasia nor at what stage of the disease they would choose to do so.
  
  
  METHODS
  We identified physicians of 279 patients in the Netherlands with a diagnosis of ALS who died between 1994 and 1999. Physicians were asked to fill out a validated questionnaire about the end-of-life decisions that were made. Of 241 eligible physicians, 203 returned the questionnaire (84 percent).
  
  
  RESULTS
  Of the 203 patients, 35 (17 percent) chose euthanasia and died that way. An additional six patients (3 percent) died as a result of physician-assisted suicide. Patients to whom religion was important were less likely to have died as a result of euthanasia or physician-assisted suicide. The choice of euthanasia or physician-assisted suicide was not associated with any particular characteristics of the disease or of the patient's care, nor was it associated with income or educational level. Disability before death was significantly more severe in patients who died as a result of euthanasia than among those who died in other ways. Physician-assisted suicide appeared to occur somewhat earlier in the course of the disease than did euthanasia. An additional 48 patients (24 percent) received palliative treatment, which probably shortened their lives.
  
  
  CONCLUSIONS
  In the Netherlands, we found that one in five patients with ALS died as a result of euthanasia or physician-assisted suicide.
authors.affiliation: Department of Neurology, University Medical Center, Utrecht, the Netherlands.
authors.forename: Jan H
authors.initials: JH
authors.lastname: Veldink
authors.forename: John H J
authors.initials: JH
authors.lastname: Wokke
authors.forename: Gerrit
authors.initials: G
authors.lastname: van der Wal
authors.forename: J M B
authors.initials: JM
authors.lastname: Vianney de Jong
authors.forename: Leonard H
authors.initials: LH
authors.lastname: van den Berg
mesh_terms: D016223:Advance Directives; D000690:Amyotrophic Lateral Sclerosis / Q000145:classification; D015331:Cohort Studies; D003657:Decision Making; D005065:Euthanasia / Q000706:statistics & numerical data*; D033101:Euthanasia, Active, Voluntary; D006801:Humans; D009426:Netherlands; D012044:Regression Analysis; D012067:Religion; D012720:Severity of Illness Index; D017236:Suicide, Assisted / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires