title: Trajectories to seeking demedicalised assistance in suicide: a qualitative in-depth interview study.
abstract: In the Netherlands, people can receive (limited) demedicalised assistance in suicide (DAS)-an option less well known than physician-assisted dying (PAD).
  
  
  
  This study explores which trajectories people take to seek DAS, through open-coding and inductive analysis of in-depth interviews with 17 people who receive(d) DAS from counsellors facilitated by foundation De Einder.
  
  
  
  People sought DAS as a result of current suffering or as a result of anticipating possible prospective suffering. People with current suffering were unable or assumed they would be unable to obtain PAD. For people anticipating possible prospective suffering, we distinguished two trajectories. In one trajectory, people preferred PAD but were not reassured of help by the physician in due time and sought DAS as a backup plan. In the other trajectory, people expressed a preference for DAS mainly as a result of emphasising self-determination, independence, taking their own responsibility and preparing suicide carefully. In all trajectories, dissatisfaction with physician-patient communication-for instance about (a denied request for) PAD or fearing to discuss this-influenced the decision to seek DAS.
  
  
  
  While PAD is the preferred option of people in two trajectories, obtaining PAD is uncertain and not always possible. Dissatisfaction with physician-patient communication can result in the physician not being involved in DAS, being unable to diagnose diseases and offer treatment nor offer reassurance that people seem to seek. We plea for more mutual understanding, respect and empathy for the limitations and possibilities of the position of the physician and the patient in discussing assistance in dying.
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU Medical Centre, Amsterdam, The Netherlands.
authors.forename: Martijn
authors.identifier: 0000-0001-9616-2685
authors.initials: M
authors.lastname: Hagens
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU Medical Centre, Amsterdam, The Netherlands.
authors.forename: Bregje D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU Medical Centre, Amsterdam, The Netherlands.
authors.forename: H Roeline W
authors.initials: HRW
authors.lastname: Pasman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001290:Attitude; D003142:Communication; D003657:Decision Making; D033101:Euthanasia, Active, Voluntary; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D026684:Personal Autonomy; D010817:Physician-Patient Relations; D010820:Physicians; D036301:Qualitative Research; D013315:Stress, Psychological / Q000517:prevention & control; D017236:Suicide, Assisted; D011795:Surveys and Questionnaires
keywords: Autonomy; End of Life Care; End-of-life; Euthanasia; Suicide/Assisted Suicide