title: Withdrawing an explicit request for euthanasia or physician-assisted suicide: a retrospective study on the influence of mental health status and other patient characteristics.
abstract: BACKGROUND
  Mental health status may be closely related to an instability of intentions toward a premature death, but little is known about such instability following an explicit request for euthanasia or physician-assisted suicide (EAS) and patient characteristics associated with a change of mind.
  
  
  METHODS
  A questionnaire was sent to 6596 general practitioners in The Netherlands (response rate 60%). Of these, 1681 provided descriptions of the most recent explicit request for EAS they had received in the preceding 18 months.
  
  
  RESULTS
  Symptoms of depression and anxiety were related to a change of mind, but no relationship was found with the total score of the NOSGER Mood Dimension. Multinomial regression analysis revealed that patients who changed their mind had more mental health problems and less mental clarity than those who died by EAS. They also had fewer general health problems, had less unbearable and pointless suffering (according to the physician), were less concerned about loss of dignity and alternative treatment options were more frequently available. A further analysis revealed that mental health problems were more prevalent among patients whose requests were refused than among those who changed their mind. The physicians' evaluations of the reasons why a patient requested EAS were similar to a more objective measure of the patient characteristics.
  
  
  CONCLUSIONS
  These findings suggest that mental health status must be carefully assessed, and possible instability of desire must be taken into account in the course of a request for EAS. These results require replication, and future studies should adopt a prospective method.
authors.affiliation: Vrije Universiteit Medical Center, Department of Public and Occupational Health and Institute for Research in Extramural Medicine, Amsterdam, The Netherlands. marcoux.isabelle@uqam.ca
authors.forename: Isabelle
authors.initials: I
authors.lastname: Marcoux
authors.forename: Bregje D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
authors.forename: Marijke C
authors.initials: MC
authors.lastname: Jansen-van der Weide
authors.forename: Gerrit
authors.initials: G
authors.lastname: van der Wal
mesh_terms: D001007:Anxiety; D003657:Decision Making; D003863:Depression; D028601:Euthanasia, Active; D006801:Humans; D008603:Mental Health; D009426:Netherlands; D012189:Retrospective Studies; D017236:Suicide, Assisted