title: Developments in the practice of physician-assisted dying: perceptions of physicians who had experience with complex cases.
abstract: Since the enactment of the euthanasia law in the Netherlands, there has been a lively public debate on assisted dying that may influence the way patients talk about euthanasia and physician-assisted suicide (EAS) with their physicians and the way physicians experience the practice of EAS.
  
  
  
  To show what developments physicians see in practice and how they perceive the influence of the public debate on the practice of EAS.
  
  
  
  We conducted a secondary analysis of in-depth interviews with 28 Dutch physicians who had experience with a complex case of EAS. Respondents were recruited both by the network of physicians working for SCEN (Support and Consultation for Euthanasia in the Netherlands) as well as via a national questionnaire, wherein participating physicians could indicate their willingness to be interviewed.
  
  
  
  Three themes came up in analysing the interviews. First, the interviewed physicians experienced a change in what (family of) patients would expect from them: from a role as an involved caregiver to being the mere performer of EAS. Second, interviewees said that requests for EAS based on non-medical reasons came up more frequently and wondered if EAS was the right solution for these requests. Last, respondents had the impression that the standards of EAS are shifting and that the boundaries of the EAS regulation were stretched.
  
  
  
  The perceived developments could make physicians less willing to consider a request for EAS. Our results also raise questions about the role of physicians and of EAS in society.
authors: 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.|Department of General Practice, Section of Medical Ethics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Marianne C
authors: MC
authors: Snijdewind
authors: Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors: Donald G
authors: DG
authors: van Tol
authors: 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: Bregje D
authors: BD
authors: Onwuteaka-Philipsen
authors: Department of General Practice, Section of Medical Ethics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Dick L
authors: DL
authors: Willems
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010465:Perception; D010820:Physicians / Q000941:ethics / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D011368:Professional-Family Relations; D059039:Standard of Care; D017236:Suicide, Assisted / Q000941:ethics* / Q000523:psychology
keywords: End of Life Care; Euthanasia; Suicide/Assisted Suicide