title: Can physicians conceive of performing euthanasia in case of psychiatric disease, dementia or being tired of living?
abstract: BACKGROUND
  Euthanasia and physician-assisted suicide (EAS) in patients with psychiatric disease, dementia or patients who are tired of living (without severe morbidity) is highly controversial. Although such cases can fall under the Dutch Euthanasia Act, Dutch physicians seem reluctant to perform EAS, and it is not clear whether or not physicians reject the possibility of EAS in these cases.
  
  
  OBJECTIVE
  To determine whether physicians can conceive of granting requests for EAS in patients with cancer, another physical disease, psychiatric disease, dementia or patients who are tired of living, and to evaluate whether physician characteristics are associated with conceivability. A cross-sectional study (survey) was conducted among 2269 Dutch general practitioners, elderly care physicians and clinical specialists.
  
  
  RESULTS
  The response rate was 64% (n=1456). Most physicians found it conceivable that they would grant a request for EAS in a patient with cancer or another physical disease (85% and 82%). Less than half of the physicians found this conceivable in patients with psychiatric disease (34%), early-stage dementia (40%), advanced dementia (29-33%) or tired of living (27%). General practitioners were most likely to find it conceivable that they would perform EAS.
  
  
  CONCLUSIONS
  This study shows that a minority of Dutch physicians find it conceivable that they would grant a request for EAS from a patient with psychiatric disease, dementia or a patient who is tired of living. For physicians who find EAS inconceivable in these cases, legal arguments and personal moral objections both probably play a role.
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VUmc Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Eva Elizabeth
authors.initials: EE
authors.lastname: Bolt
authors.affiliation: Section of Medical Ethics, Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Marianne C
authors.initials: MC
authors.lastname: Snijdewind
authors.affiliation: Section of Medical Ethics, Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Dick L
authors.initials: DL
authors.lastname: Willems
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Agnes
authors.initials: A
authors.lastname: van der Heide
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VUmc Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Bregje D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D003430:Cross-Sectional Studies; D003657:Decision Making; D003704:Dementia / Q000523:psychology*; D033101:Euthanasia, Active, Voluntary / Q000941:ethics / Q000523:psychology; D015673:Fatigue Syndrome, Chronic / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D009735:Nursing Homes; D010361:Patients / Q000523:psychology*; D010819:Physician's Role; D010817:Physician-Patient Relations / Q000941:ethics*; D010820:Physicians / Q000523:psychology* / Q000706:statistics & numerical data; D011788:Quality of Life
keywords: Attitudes Toward Death; Euthanasia; Living Wills/Advance Directives