title: Opinions about euthanasia and advanced dementia: a qualitative study among Dutch physicians and members of the general public.
abstract: BACKGROUND
  The Dutch law states that a physician may perform euthanasia according to a written advance euthanasia directive (AED) when a patient is incompetent as long as all legal criteria of due care are met. This may also hold for patients with advanced dementia. We investigated the differing opinions of physicians and members of the general public on the acceptability of euthanasia in patients with advanced dementia.
  
  
  METHODS
  In this qualitative study, 16 medical specialists, 19 general practitioners, 16 elderly physicians and 16 members of the general public were interviewed and asked for their opinions about a vignette on euthanasia based on an AED in a patient with advanced dementia.
  
  
  RESULTS
  Members of the general public perceived advanced dementia as a debilitating and degrading disease. Physicians emphasized the need for direct communication with the patient when making decisions about euthanasia. Respondent from both groups acknowledged difficulties in the assessment of patients' autonomous wishes and the unbearableness of their suffering.
  
  
  CONCLUSIONS
  Legally, an AED may replace direct communication with patients about their request for euthanasia. In practice, physicians are reluctant to forego adequate verbal communication with the patient because they wish to verify the voluntariness of patients' request and the unbearableness of suffering. For this reason, the applicability of AEDs in advanced dementia seems limited.
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Room number STR.5.133, Internal post number STR.6.131, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands. p.s.c.kouwenhoven@umcutrecht.nl.
authors: Pauline S C
authors: PS
authors: Kouwenhoven
authors: Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands. n.raijmakers@erasmusmc.nl.
authors: Natasja J H
authors: NJ
authors: Raijmakers
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Room number STR.5.133, Internal post number STR.6.131, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands. j.j.m.vandelden@umcutrecht.nl.
authors: Johannes J M
authors: JJ
authors: van Delden
authors: Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands. j.rietjens@erasmusmc.nl.
authors: Judith A C
authors: JA
authors: Rietjens
authors: Department of General Practice, University Medical Center Groningen, Groningen, The Netherlands. d.g.vantol@umcg.nl.
authors: Donald G
authors: DG
authors: van Tol
authors: Department of Ethics and Philosophy of Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands. s.vandevathorst@erasmusmc.nl.
authors: Suzanne
authors: S
authors: van de Vathorst
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Room number STR.5.133, Internal post number STR.6.131, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands. n.degraeff@students.uu.nl.
authors: Nienke
authors: N
authors: de Graeff
authors: Department of Legal Theory, University of Groningen, Groningen, The Netherlands. h.a.m.weijers@rug.nl.
authors: Heleen A M
authors: HA
authors: Weyers
authors: Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands. a.vanderheide@erasmusmc.nl.
authors: Agnes
authors: A
authors: van der Heide
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Room number STR.5.133, Internal post number STR.6.131, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands. g.j.m.w.vanthiel@umcutrecht.nl.
authors: Ghislaine J M W
authors: GJ
authors: van Thiel
mesh_terms: D000328:Adult; D016223:Advance Directives / Q000331:legislation & jurisprudence; D001290:Attitude; D001291:Attitude of Health Personnel; D003142:Communication; D003657:Decision Making / Q000941:ethics; D003704:Dementia; D004992:Ethics, Medical; D005065:Euthanasia / Q000941:ethics / Q000331:legislation & jurisprudence; D005260:Female; D006801:Humans; D007258:Informed Consent; D008297:Male; D016743:Mental Competency; D008875:Middle Aged; D009426:Netherlands; D026684:Personal Autonomy; D010820:Physicians; D011639:Public Opinion; D036301:Qualitative Research; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D055815:Young Adult
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