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

Background: Legalizing euthanasia or physician-assisted suicide (PAS) is a current topic of debate in many countries. The Netherlands is the only country where legislation covers both. Objectives: To study physicians' experiences and attitudes concerning the choice between euthanasia and PAS. Methods: A questionnaire including vignettes was sent to a random sample of 1955 Dutch general practitioners, elderly care physicians and medical specialists. Results: In total, 793 physicians (41%) participated. There was no clear preference for euthanasia (36%) or PAS (34%). Two thirds of physicians thought that PAS underlines the autonomy and responsibility of the patient and considered this a reason to choose PAS. Reasons for not choosing PAS were expected practical problems. A minority (22%) discussed the possibility of PAS with their patient in case of a request for assistance in dying. Patients receiving PAS more often experienced psychosocial suffering in comparison with patients receiving euthanasia. In vignettes of patients with a request for assistance in dying due to psychosocial suffering, physicians agreed more often with the performance of PAS than with euthanasia. Conclusion: Dutch physicians perceive a difference between euthanasia and PAS. Although they believe PAS underlines patient autonomy and responsibility, the option of PAS is rarely discussed with the patient. The more psychosocial in nature the patient's suffering, the more physicians choose PAS. In these cases, PAS seems to fulfil physicians' preferences to emphasize patient autonomy and responsibility. Expected technical problems and unfamiliarity with PAS also play a role. Paradoxically, the choice for PAS is predominantly a physician's one.

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