title: Advance directives for euthanasia in dementia: do law-based opportunities lead to more euthanasia?
abstract: OBJECTIVE
  To obtain insight into current practices regarding compliance with advance directives for euthanasia (ADEs) in cases of incompetent patients with dementia in Dutch nursing homes, in light of the legal possibility offered by the new euthanasia law to perform euthanasia in these cases.
  
  
  METHODS
  A written questionnaire was completed by 434 elderly care physicians (ECPs).
  
  
  RESULTS
  Over the years 2005-2006, many ECPs took care of patients with dementia and an ADE, actual life termination of these patients took place very rarely and never in incompetent patients. ECPs reported practical difficulties in determining the 'unbearableness' of the suffering and choosing the right moment of carrying out the ADE.
  
  
  CONCLUSIONS
  Although the enactment of the Dutch euthanasia law in theory provided a window of opportunity for euthanasia in incompetent patients with dementia and an ADE, it has not led to obvious changes in compliance with ADEs of this patient group in practice. Crucial in the reticent attitudes of ECPs appears to be the impossibility of patient-physician communication. This raises questions on the feasibility of the law on this point. In our opinion, the role of ADEs in end-of-life care of patients with advanced dementia in the Netherlands deserves serious reconsideration.
authors.affiliation: Department of Nursing Home Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. m.deboer@vumc.nl
authors.forename: Marike E
authors.initials: ME
authors.lastname: de Boer
authors.forename: Rose-Marie
authors.initials: RM
authors.lastname: Dröes
authors.forename: Cees
authors.initials: C
authors.lastname: Jonker
authors.forename: Jan A
authors.initials: JA
authors.lastname: Eefsting
authors.forename: Cees M P M
authors.initials: CM
authors.lastname: Hertogh
mesh_terms: D000328:Adult; D016223:Advance Directives / Q000331:legislation & jurisprudence*; D003704:Dementia; D005065:Euthanasia; D005260:Female; D006291:Health Policy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009735:Nursing Homes / Q000331:legislation & jurisprudence; D011795:Surveys and Questionnaires