Flemish healthcare providers’ attitude towards tiredness of life and euthanasia: a survey study

Abstract

Objectives

To explore the legal understanding and attitudes of nurses and physicians in both acute and chronic geriatric care (Flanders, Belgium) regarding euthanasia in the context of tiredness of life in older people.

Method

Healthcare providers employed in acute care (59 geriatricians and 75 nurses of acute geriatric wards), as well as chronic care (135 general practitioners (GPs) and 76 nurses employed in nursing homes and home care services) were sent a survey with four case vignettes. For each case vignette, respondents were asked the following questions: (1) ‘Does this case fit the due-care criteria of the euthanasia law?’, (2) ‘Do you consider this person to be tired of life?’, (3) ‘Can you comprehend this person’s euthanasia request?’.

Results

In cases of severe and life-limiting physical suffering, where the patient meets the legal criteria for euthanasia in Belgium, only 50% of physicians and nurses are aware of this legal basis. In case of tiredness of life without underlying pathology, nurses showed more comprehension for the euthanasia request compared to physicians (43.0% vs. 10.8%, p < 0.001). Physicians tend to assess the legal base of an euthanasia-request depending on the severity of physical morbidity, whereas nurses show a greater comprehension towards euthanasia-requests even in absence of severe illness. Geriatricians are more reserved regarding performing euthanasia themselves as compared to GPs, regardless of underlying pathology or reason for the euthanasia-request (p < 0.001).

Conclusion

The legal understanding and attitude of Flemish physicians and nurses towards tiredness of life and euthanasia in older patients differed to a great extent. This study showed (1) a lack of awareness of the legal basis for euthanasia in the context of ToL among all HCPs, (2) differences in the extent of comprehension between nurses and physicians and (3) differences in willingness to actually perform euthanasia between geriatricians and GPs. So even with the formulation of strict due-care criteria there is still room for interpretation. This creates a gray area and a discussion point between healthcare providers.

KEYWORDS:

• Euthanasia
• tiredness of life
• survey
• nurses
• physicians
• attitude

Acknowledgements

The authors would like to thank Françoise De Vreeze, Carine Nemann and Maxime Benoot for their help in recruiting and questioning respondents. The authors would like to thank all the respondents for their contribution to this study and the members of the steering committee for their advice and support. The authors would like to thank Dr. Jo Hockley for language editing this article.

Disclosure statement

No conflict of interest has been declared by the authors.

Additional information

Funding

This research received no specific grant from any funding agency in the public, commercial, or non-profit sector.