title: Palliative treatment alternatives and euthanasia consultations: a qualitative interview study.
abstract: BACKGROUND
  There is much debate about euthanasia within the context of palliative care. The six criteria of careful practice for lawful euthanasia in The Netherlands aim to safeguard the euthanasia practice against abuse and a disregard of palliative treatment alternatives. Those criteria need to be evaluated by the treating physician as well as an independent euthanasia consultant.
  
  
  OBJECTIVE
  To investigate 1) whether and how palliative treatment alternatives come up during or preceding euthanasia consultations and 2) how the availability of possible palliative treatment alternatives are assessed by the independent consultant.
  
  
  METHODS
  We interviewed 14 euthanasia consultants and 12 physicians who had requested a euthanasia consultation. We transcribed and analyzed the interviews and held consensus meetings about the interpretation.
  
  
  RESULTS
  Treating physicians generally discuss the whole range of treatment options with the patient before the euthanasia consultation. Consultants actively start thinking about and proposing palliative treatment alternatives after consultations, when they have concluded that the criteria for careful practice have not been met. During the consultation, they take into account various aspects while assessing the criterion concerning the availability of reasonable alternatives, and they clearly distinguish between euthanasia and continuous deep sedation. Most consultants said that it was necessary to verify which forms of palliative care had previously been discussed. Advice concerning palliative care seemed to be related to the timing of the consultation ("early" or "late"). Euthanasia consultants were sometimes unsure whether or not to advise about palliative care, considering it not their task or inappropriate in view of the previous discussions.
  
  
  CONCLUSIONS
  Two different roles of a euthanasia consultant were identified: a limited one, restricted to the evaluation of the criteria for careful practice, and a broad one, extended to actively providing advice about palliative care. Further medical and ethical debate is needed to determine consultants' most appropriate role.
authors.affiliation: VU University Medical Center, EMGO Institute for Health and Care Research, Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam, The Netherlands. h.buiting@vumc.nl
authors.forename: Hilde M
authors.initials: HM
authors.lastname: Buiting
authors.forename: Dick L
authors.initials: DL
authors.lastname: Willems
authors.forename: H Roeline W
authors.initials: HR
authors.lastname: Pasman
authors.forename: Mette L
authors.initials: ML
authors.lastname: Rurup
authors.forename: Bregje D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
mesh_terms: D033101:Euthanasia, Active, Voluntary / Q000941:ethics*; D006801:Humans; D007407:Interviews as Topic; D009426:Netherlands; D010166:Palliative Care / Q000941:ethics*; D010820:Physicians; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D012017:Referral and Consultation