title: Cross-sectional research into counselling for non-physician assisted suicide: who asks for it and what happens?
abstract: BACKGROUND
  In the Netherlands, people with a wish to die can request physician assistance in dying. However, almost two thirds of the explicit requests do not result in physician assistance in dying. Some people with a wish to end life seek counselling outside the medical context to end their own life. The aim of this cross-sectional research was to obtain information about clients receiving counselling for non-physician assisted suicide, and the characteristics and outcome of the counselling itself.
  
  
  METHODS
  All counsellors working with foundation De Einder (an organisation that offers professional counselling for people with a wish to end life) (N=12) filled in registration forms about all clients they counselled in 2011 and/or 2012. Only client registration data forms with at least one face-to-face contact with the counsellor were selected for analysis (n=595).
  
  
  RESULTS
  More than half of the clients were over 65 years old. More than one third of the clients had no wish to end life and 16% had an urgent wish to end life. Almost two thirds of the clients had not requested physician assistance in dying. Half of the clients had others involved in the counselling. More than half of the clients received explicit practical information concerning non-physician assisted suicide, while 13% of all clients actually ended their own life through non-physician assisted suicide. Clients without a (severe) disease were older than clients with a severe disease. They also had more problems of old age and existential suffering and more often wanted to be prepared for self-determination. The clients without a (severe) disease more often had no wish to end life and requested physician assistance in dying less often than clients with a severe disease.
  
  
  CONCLUSIONS
  While some of the clients receiving counselling for non-physician assisted suicide seem to be looking for a peaceful death to escape from current suffering, others have no wish to end life and seem to be looking for reassurance in anticipation of prospective suffering. If non-physician assisted suicide is be distinguished from 'mutilating' suicide, this asks for a different approach than suicide crisis intervention, for example suicide-attempt prevention.
authors.affiliation: Department of Public and Occupational Health, Expertise Centre for Palliative Care, VU University Medical Centre, EMGO+ Institute for Health and Care Research, Van der Boechorststraat 7, 1091 BT Amsterdam, The Netherlands. M.Hagens@vumc.nl.
authors.forename: Martijn
authors.initials: M
authors.lastname: Hagens
authors.forename: H Roeline W
authors.initials: HR
authors.lastname: Pasman
authors.forename: Bregje D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003376:Counseling; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012042:Registries; D013315:Stress, Psychological / Q000145:classification; D017236:Suicide, Assisted; D019452:Terminally Ill / Q000706:statistics & numerical data; D055815:Young Adult