Abstract
This thesis is based on the KOPPEL-study: Knowledge and Opinions of Professionals and the Public about End-of-Life decisions. The Netherlands is one of the few countries where euthanasia and physician-assisted suicide (PAS) are regulated by law: in the Termination of Life on Request and Assisted Suicide (Review Procedures) Act (WTL) (2002). Questions remain about the ethical en legal boundaries of medical decision-making at the end of life. The KOPPEL-study aimed to gain more insight into the knowledge and opinions of different stakeholders about what is en what is not possible and desirable in end-of-life care and decision-making. It involved a cross-sectional survey among Dutch physicians, nurses and members of the general public, followed by a qualitative interview study among a selection of the respondents.
We found that there is ample support for the Dutch euthanasia law, however all stakeholders choose to interpret the law in a predominantly restrictive way.Both professionals and the public are reticent about euthanasia and PAS in case of mental suffering: early dementia, depression and being tired of living. An exception is advanced dementia, particularly for members of the general public. When a patient’s suffering is more physical in nature, physicians tend to choose for euthanasia. Especially in case of psychosocial suffering, a preference for PAS seems to fulfil a need for more active involvement of the patient and to emphasize patient autonomy and responsibility. Paradoxically, the choice for PAS remains predominantly a physician’s one and PAS is not often discussed with the patient and hardly ever practised. Advance care planning (ACP) is a process of communication among patients, health care providers and relatives regarding end-of-life care and decision-making. The majority of the general public has thought about ACP-issues and discussed ACP with relatives. However, a minority discussed their ideas about end-of-life care and decision-making with their physician or has an advance directive. Physicians could play a more active role by initiating conversations and dialogue regarding end-of-life care and decision-making.
There seems to be a shift happening from a conflict of duties of the physician to the autonomy of the patient as the basis for euthanasia. This has consequences for the role and interpretation of the physician’s duties. We distinguish autonomy as a right (freedom from external interference in one’s own life) and as an ideal (freedom to develop and evolve through the clarification of wishes and desires). The shift in emphasis towards the autonomy of the patient seems to correspond to the approach of autonomy as a right. Patients and members of the general public who request euthanasia however can benefit more from an approach of autonomy as an ideal. The assessment and treatment of unbearable suffering by the physician are crucial in such an approach. This way, the patient has the best chance of receiving the care he needs in a broader context. It is all about discovering, or rediscovering, the right balance between the physician's professional responsibility and the patient's autonomy.
We found that there is ample support for the Dutch euthanasia law, however all stakeholders choose to interpret the law in a predominantly restrictive way.Both professionals and the public are reticent about euthanasia and PAS in case of mental suffering: early dementia, depression and being tired of living. An exception is advanced dementia, particularly for members of the general public. When a patient’s suffering is more physical in nature, physicians tend to choose for euthanasia. Especially in case of psychosocial suffering, a preference for PAS seems to fulfil a need for more active involvement of the patient and to emphasize patient autonomy and responsibility. Paradoxically, the choice for PAS remains predominantly a physician’s one and PAS is not often discussed with the patient and hardly ever practised. Advance care planning (ACP) is a process of communication among patients, health care providers and relatives regarding end-of-life care and decision-making. The majority of the general public has thought about ACP-issues and discussed ACP with relatives. However, a minority discussed their ideas about end-of-life care and decision-making with their physician or has an advance directive. Physicians could play a more active role by initiating conversations and dialogue regarding end-of-life care and decision-making.
There seems to be a shift happening from a conflict of duties of the physician to the autonomy of the patient as the basis for euthanasia. This has consequences for the role and interpretation of the physician’s duties. We distinguish autonomy as a right (freedom from external interference in one’s own life) and as an ideal (freedom to develop and evolve through the clarification of wishes and desires). The shift in emphasis towards the autonomy of the patient seems to correspond to the approach of autonomy as a right. Patients and members of the general public who request euthanasia however can benefit more from an approach of autonomy as an ideal. The assessment and treatment of unbearable suffering by the physician are crucial in such an approach. This way, the patient has the best chance of receiving the care he needs in a broader context. It is all about discovering, or rediscovering, the right balance between the physician's professional responsibility and the patient's autonomy.
| Original language | English |
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| Award date | 7 Dec 2017 |
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| Print ISBNs | 978-90-393-6835-8 |
| Publication status | Published - 7 Dec 2017 |
Keywords
- end-of-life decisions
- euthanasia
- physician-assisted suicide
- autonomy