title: Psychiatric consultation with regard to requests for euthanasia or physician-assisted suicide.
abstract: The objective of this article is to describe the practice of psychiatric consultation with regard to explicit requests for euthanasia or physician-assisted suicide in the Netherlands. Written questionnaires were sent to an unselected sample of 673 Dutch psychiatrists, about half of all such specialists in the Netherlands. The response rate was 83%. Of the respondents, 36% (199 of 549) had at least once been consulted about a patient's request for physician-assisted death. The annual number of such psychiatric consultations is estimated to be 400 (about 4% of all requests for physician-assisted death). About one in four consultations is initiated by another psychiatrist. Consultants were mainly asked to assess whether the patient had a treatable mental disorder (68%) or whether the patient's request was well considered (66%). Assessment of the influence of transference and countertransference was less frequently sought (24%). Of the 221 consultation cases described, 67 (30%) ended in euthanasia or assisted suicide, whereas another 124 (56%) did not. In most, but not all, cases where the patient's request for physician-assisted death was refused, the respondent had judged that the request was not well considered or that the patient had a treatable mental disorder, or that the decision-making was influenced by transference and countertransference. We conclude that psychiatric consultation for patients requesting physician-assisted death in the Netherlands is rare, as in other countries. The issue of psychiatric consultation with regard to requests for physician-assisted death, especially in patients with a physical disease, needs to be further addressed.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands. j.groenewoud@erasmusmc.nl
authors.forename: Johanna H
authors.initials: JH
authors.lastname: Groenewoud
authors.forename: Agnes
authors.initials: A
authors.lastname: Van Der Heide
authors.forename: Alfons J
authors.initials: AJ
authors.lastname: Tholen
authors.forename: W Joost
authors.initials: WJ
authors.lastname: Schudel
authors.forename: Michiel W
authors.initials: MW
authors.lastname: Hengeveld
authors.forename: Bregje D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Van Der Maas
authors.forename: Gerrit
authors.initials: G
authors.lastname: Van Der Wal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005065:Euthanasia / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D033182:Intention; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D017236:Suicide, Assisted / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014167:Transference, Psychology