title: Perspectives of decision-making in requests for euthanasia: a qualitative research among patients, relatives and treating physicians in the Netherlands.
abstract: BACKGROUND
  Euthanasia has been legally performed in the Netherlands since 2002. Respect for patient's autonomy is the underpinning ethical principal. However, patients have no right to euthanasia, and physicians have no obligation to provide it. Although over 3000 cases are conducted per year in the Netherlands, there is little known about how decision-making occurs and no guidance to support this difficult aspect of clinical practice.
  
  
  OBJECTIVE
  To explore the decision-making process in cases where patients request euthanasia and understand the different themes relevant to optimise this decision-making process.
  
  
  METHODS
  A qualitative thematic analysis of interviews with patients making explicit requests for euthanasia, most-involved relative(s) and treating physician.
  
  
  METHODS
  Thirty-two cases, 31 relatives and 28 treating physicians. Settings were patients' and relatives' homes and physicians' offices.
  
  
  RESULTS
  Five main themes emerged: (1) initiation of sharing views and values about euthanasia, (2) building relationships as part of the negotiation, (3) fulfilling legal requirements, (4) detailed work of preparing and performing euthanasia and (5) aftercare and closing.
  
  
  CONCLUSIONS
  A patient's request for euthanasia entails a complex process that demands emotional work by all participants. It is characterised by an intensive period of sharing information, relationship building and negotiation in order to reach agreement. We hypothesise that making decisions about euthanasia demands a proactive approach towards participants' preferences and values regarding end of life, towards the needs of relatives, towards the burden placed on physicians and a careful attention to shared decision-making. Future research should address the communicational skills professionals require for such complex decision-making.
authors.affiliation: Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands. m.dees@elg.umcn.nl
authors.forename: Marianne K
authors.initials: MK
authors.lastname: Dees
authors.forename: Myrra J
authors.initials: MJ
authors.lastname: Vernooij-Dassen
authors.forename: Wim J
authors.initials: WJ
authors.lastname: Dekkers
authors.forename: Glyn
authors.initials: G
authors.lastname: Elwyn
authors.forename: Kris C
authors.initials: KC
authors.lastname: Vissers
authors.forename: Chris
authors.initials: C
authors.lastname: van Weel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003142:Communication; D003657:Decision Making; D033101:Euthanasia, Active, Voluntary / Q000331:legislation & jurisprudence / Q000523:psychology; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017008:Negotiating; D009426:Netherlands; D010817:Physician-Patient Relations; D036301:Qualitative Research; D011795:Surveys and Questionnaires