title: What happens after a request for euthanasia is refused? Qualitative interviews with patients, relatives and physicians.
abstract: OBJECTIVE
  Obtaining in-depth information from both patient and physician perspectives about what happens after a request for euthanasia or physician-assisted suicide (EAS) is refused.
  
  
  METHODS
  In-depth interviews with nine patients whose EAS request was refused and seven physicians of these patients, and with three relatives of patients who had died after a request was refused and four physicians of these patients. Interviews were conducted at least 6 months after the refusal.
  
  
  RESULTS
  A wish to die remained in all patients after refusal, although it sometimes diminished. In most cases patient and physician stopped discussing this wish, and none of the physicians had discussed plans for the future with the patient or evaluated the patient's situation after their refusal. Physicians were aware of patients' continued wish to die.
  
  
  CONCLUSIONS
  Patients who are refused EAS may subsequently be silent about a wish to die without abandoning it. Open communication about wishes to die is important, even outside the context of EAS, because if people feel unable to talk about them, their quality of life may be further diminished.
  
  
  CONCLUSIONS
  Follow up appointments after refusal could give patients the opportunity to discuss their feelings and physicians to support them.
authors.affiliation: EMGO Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands. eol@vumc.nl
authors.forename: H Roeline W
authors.initials: HR
authors.lastname: Pasman
authors.forename: Dick L
authors.initials: DL
authors.lastname: Willems
authors.forename: Bregje D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D003142:Communication; D003657:Decision Making; D005065:Euthanasia; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009426:Netherlands; D010361:Patients / Q000523:psychology*; D010817:Physician-Patient Relations; D036301:Qualitative Research; D045808:Refusal to Participate; D017236:Suicide, Assisted
keywords: Euthanasia; Patient–physician communication; Qualitative research; Wish to die