title: The reporting rate of euthanasia and physician-assisted suicide: a study of the trends.
abstract: OBJECTIVE
  To study trends in reporting rates of euthanasia from 1990 to 2005 in relation to whether recommended or nonrecommended drugs were used, and the most important differences between reported and unreported cases in 2005.
  
  
  METHODS
  Questionnaires were sent to a sample of 6860 physicians who had reported a death in 2005 (response 78%). Previously, 3 similar studies were done at 5-year intervals. The total number of euthanasia and physician-assisted suicide cases was estimated using a "gold standard" definition: death was-according to the physician-the result of the use of drugs at the explicit request of the patient with the explicit goal of hastening death (denominator). The Euthanasia Review Committees provided the number of reported cases (numerator).
  
  
  RESULTS
  The reporting rate of euthanasia and physician-assisted suicide increased from 18% in 1990, 41% in 1995, and 54% in 2001 to 80% in 2005. The reporting rate in the subgroup of euthanasia with recommended drugs (barbiturates and muscle relaxants) was 73% in 1995, 71% in 2001, and 99% in 2005. The reporting rate of euthanasia with nonrecommended drugs (eg, opioids) was below 3% in 1995, 2001, and 2005. Unreported euthanasia differed also from reported euthanasia in the fact that physicians less often labeled their act as euthanasia.
  
  
  CONCLUSIONS
  Euthanasia with nonrecommended drugs is almost never reported. The total reporting rate increased because of an increase in the use of recommended drugs for euthanasia between 1995 and 2001, and an increase in the reporting rate for euthanasia with recommended drugs between 2001 and 2005.
authors.affiliation: Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands. m.rurup@vumc.nl
authors.forename: Mette L
authors.initials: ML
authors.lastname: Rurup
authors.forename: Hilde M
authors.initials: HM
authors.lastname: Buiting
authors.forename: H Roeline W
authors.initials: HR
authors.lastname: Pasman
authors.forename: Paul J
authors.initials: PJ
authors.lastname: van der Maas
authors.forename: Agnes
authors.initials: A
authors.lastname: van der Heide
authors.forename: Bregje D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage; D004363:Drug Utilization; D005065:Euthanasia / Q000706:statistics & numerical data* / Q000639:trends*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D019221:Mandatory Reporting; D009125:Muscle Relaxants, Central / Q000008:administration & dosage; D009426:Netherlands; D010166:Palliative Care / Q000379:methods; D017236:Suicide, Assisted / Q000706:statistics & numerical data* / Q000639:trends*
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D009125:Muscle Relaxants, Central