Euthanasia or physician-assisted suicide? A survey from the Netherlands

Figures & data

Table 1. Background characteristics of respondents.

	General practitioners n = 224	Elderly care physicians n = 131	Medical specialists n = 389	Total^a n = 793
Age
Mean ± SD	50 ± 8	48 ± 9	53 ± 8	51 ± 8
Gender (%)
Female	39^c	64^d	22^e	35
Years of working experience (%)^b
2–5 years	4	17	6	6
5–10 years	18	18	14	16
> 10 years	79	66	80	78
Attitude towards euthanasia and physician-assisted suicide (%)
Liberal	49	30	44	45
Reserved	44	62	50	48
Against	7	8	6	7
Performance of euthanasia or physician-assisted suicide (%)
Ever performed	81	41	44	63^f
Performance thinkable	11	45	45	28
Performance unthinkable	8	14	11	10

^aWeighted percentages, the specialty of 49 physicians was unknown.

^bRespondents: (1) work in the Netherlands, (2) have at least two years of experience in their current specialty, (3) if retired, have been retired no longer than two years prior to participation or be under 67 years of age.

^c40% female general practitioners in the Netherlands (Nivel, Netherlands Institute for Health Services Research, 2010).

^d61% female elderly care physicians in the Netherlands (Dutch Capacity Organ, 2009).

^e34% female medical specialists of all specialties in the Netherlands (Dutch Capacity Organ, 2010).

^f51% ever performed and 33% thinkable (Report on the evaluation of the Dutch euthanasia act, 2005).

Table 2. Physicians’ attitudes on reasons for choosing PAS or euthanasia (percentages).

	General practitioners	Elderly care physicians	Medical specialists	Total^a
	n = 224	n = 131	n = 389	n = 793	P-value
Reasons for choosing PAS over euthanasia^b
I think PAS underlines the autonomy/free choice/own responsibility of the patient	69/68/71	73/65/67	67/67/64	69/67/68	0.601/0.246/0.225
I consider PAS psychologically less burdensome for the physician	37	42	41	39	0.347
PAS can provide a less abrupt dying process	42	29	28	35	0.002
I consider the performance of PAS less burdensome for the physician	32	39	36	34	0.142
I consider PAS legally less burdensome for the physician	18	18	20	19	0.075
Reasons for choosing euthanasia over PAS^c
It can take a long time until death occurs in PAS (for the patient)	66	42	39	53	0.000
I think many patients cannot take the lethal drink by themselves	55	53	38	48	0.000
It can take a long time until death occurs in PAS (for the physician)	62	39	28	46	0.000
I think the lethal drink in PAS is unreliable	50	41	24	39	0.000
I think the lethal drink in PAS is patient-unfriendly	34	24	15	26	0.000
I think many patients do not want to take the lethal drink by themselves	18	16	20	19	0.105

^aWeighted percentages, the specialty of 49 physicians was unknown.

^bThe question was: ‘Which of the following statements could be a reason for you to choose PAS over euthanasia?’

^cThe question was: ‘Which of the following statements could be a reason for you to choose euthanasia over PAS?’

Table 3. Reasons for not discussing the possibility of physician-assisted suicide instead of euthanasia.^a

	Physicians^b n = 154^c (%)	Number of times mentioned^b n = 222 (%)
Physical inability of the patient to take the lethal drink in PAS	31	56 (25)
Unfamiliarity with PAS	20	36 (16)
Unreliability of the method and lack of control	19	35 (16)
Moral considerations of the physician	18	33 (15)
Patient's wish	15	28 (13)
Institutional setting	4	8 (3)
Miscellaneous	15	26 (12)
Total	100	222 (100)

^aConcerning the most recent case of a patient with an actual request for euthanasia or physician-assisted suicide in the last five years, only if euthanasia has been performed and the option of physician-assisted suicide had not been discussed

(more than one answer possible).

^bWeighted percentages.

^cOf whom 63% general practitioners.

Table 4. Characteristics of cases of euthanasia and physician-assisted suicide.

	Euthanasia n = 250 % (weighted)	Physician-assisted suicide n = 27 % (weighted)
Diagnosis^a
Cancer^b	85	67
Physical disease but not cancer^c	16	37
Main cause of suffering^d
Physical complaint such as pain or dyspnoea	37	36
Fear for future suffering	7	7
Care dependency	6	11
Loss of dignity	9	18
Fear of losing control	2	7
Absence of prospect of relief	33	11

^aMore than one answer was possible, in < 4% of cases it concerned a non-physical disease.

^bP = 0.014.

^cP = 0.007.

^dP = 0.029 (χ²-test); respondents were asked to choose one answer, if they gave more than one answer results are not shown.

Table 5. Interchangeability of physician-assisted suicide with euthanasia in different cases of suffering.

	A Cancer with loss of control and severe pain	B Cancer with loss of control, without physical symptoms	C Severe depression	D Early dementia	E Old age and tired of living
Respondents personally agreeing with performing physician-assisted suicide in this case	n = 118	n = 55	n = 61	n = 43	n = 24
Would you assess the situation differently if it would concern euthanasia instead of physician-assisted suicide?
Yes (%)	15 (13)	9 (17)	28 (45)	19 (43)	21 (87)
No (%)	97 (84)	38 (69)	26 (43)	21 (47)	2 (10)
Don't know (%)	4 (3)	7 (13)	7 (12)	4 (10)	1 (3)