A Study of the First Year of the End-of-Life Clinic for Physician-Assisted Dying in the Netherlands

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Abstract
In 2002, the Termination of Life on Request and Assisted Suicide Act came into force in the Netherlands, allowing euthanasia, the administering of lethal medication by a physician at the request of the patient, and physician-assisted suicide, providing lethal medication by a physician to a patient at his or her request, to patients who meet the legal due care criteria (Box 1).1,2 These criteria include a voluntary and well-considered request from the patient, who must be suffering unbearably without the prospect of improvement. Of all deaths in the Netherlands, 1.7% to 2.8% result from euthanasia or physician-assisted suicide according to a study3 published in 2012. Certainly, not all requests are granted; studies3-6 conducted between 1990 and 2011 report rates of granting requests between 32% and 45%. Because some of these studies were based on a sample of patients who had already died, the percentage of requests granted in the general population may be lower. The reasons that requests did not result in euthanasia or physician-assisted suicide were that the patient died before a decision could be made, the patient withdrew the request, and the treating physician refused to provide euthanasia or physician-assisted suicide based on principle or because in his or her opinion the due care criteria had not been met.6-8 A prior study9 indicated that patients whose requests were rejected continue to have a wish to die.

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