End-of-life practices in the Netherlands under the Euthanasia Act.
BACKGROUND
In 2002, an act regulating the ending of life by a physician at the request of a patient with unbearable suffering came into effect in the Netherlands. In 2005, we performed a follow-up study of euthanasia, physician-assisted suicide, and other end-of-life practices.


METHODS
We mailed questionnaires to physicians attending 6860 deaths that were identified from death certificates. The response rate was 77.8%.


RESULTS
In 2005, of all deaths in the Netherlands, 1.7% were the result of euthanasia and 0.1% were the result of physician-assisted suicide. These percentages were significantly lower than those in 2001, when 2.6% of all deaths resulted from euthanasia and 0.2% from assisted suicide. Of all deaths, 0.4% were the result of the ending of life without an explicit request by the patient. Continuous deep sedation was used in conjunction with possible hastening of death in 7.1% of all deaths in 2005, significantly increased from 5.6% in 2001. In 73.9% of all cases of euthanasia or assisted suicide in 2005, life was ended with the use of neuromuscular relaxants or barbiturates; opioids were used in 16.2% of cases. In 2005, 80.2% of all cases of euthanasia or assisted suicide were reported. Physicians were most likely to report their end-of-life practices if they considered them to be an act of euthanasia or assisted suicide, which was rarely true when opioids were used.


CONCLUSIONS
The Dutch Euthanasia Act was followed by a modest decrease in the rates of euthanasia and physician-assisted suicide. The decrease may have resulted from the increased application of other end-of-life care interventions, such as palliative sedation.
van der Heide
Agnes
A
Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands. a.vanderheide@erasmusmc.nl
Onwuteaka-Philipsen
Bregje D
BD
Rurup
Mette L
ML
Buiting
Hilde M
HM
van Delden
Johannes J M
JJ
Hanssen-de Wolf
Johanna E
JE
Janssen
Anke G J M
AG
Pasman
H Roeline W
HR
Rietjens
Judith A C
JA
Prins
Cornelis J M
CJ
Deerenberg
Ingeborg M
IM
Gevers
Joseph K M
JK
van der Maas
Paul J
PJ
van der Wal
Gerrit
G
D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage; D002423:Cause of Death; D005065:Euthanasia / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017236:Suicide, Assisted / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data / Q000639:trends*; D011795:Surveys and Questionnaires; D028761:Withholding Treatment / Q000706:statistics & numerical data / Q000639:trends
D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives