End-of-Life decisions in The Netherlands, 1990-2001.

Once again, new information on the practice of euthanasia and other end-of-life decisions in The Netherlands has become available—information that I think is worth sharing in light of the continuing worldwide debate on the topic. Results of a 2001 nationwide survey on the practices of medical end-of-life decisions—following on from identical surveys in 1990 and 1995—have recently been published (van der Wal, van der Heide, Onwuteaka-Philipsen, & van der Maas, 2003; Onwuteaka-Philipsen et al., 2003). These surveys allow us to monitor trends in these practices and particularly to evaluate the effects of legislation that passed the Dutch parliament in 2000 as well as the notification procedure that has been in place since 1998 (see our edito-death certificates and 482 physician interviews. The methodological quality of the survey is undisputed. Here, I would like to summarize some of the most important findings. Frequencies In 2001 there were 140,000 deaths in The Netherlands. Dutch physicians in that year received 34,700 requests for euthanasia or assisted suicide later in the course of the disease , and 9,700 explicit requests for euthanasia or assisted suicide at a particular time. This demand had not increased since 1995. In 2001, in actual practice, 2.2–2.6% of all deaths involved euthanasia—the same percentage as in 1995 (2.3–2.4%). From 1990 to 1995, by contrast, there was a marked increase (from 1.7–1.9%). In 2001, around 0.1–0.2% of all deaths involved physician assisted suicide, slightly fewer than in 1995 (0.2– 0.4%) or in 1990 (0.2–0.3%). The ending of life without the patient's explicit request occurred in 0.6–0.7% of all deaths, this figure having remained more or less stable since 1995 (0.7%) and 1990 (0.8%). The frequency of physician-assisted suicide and the ending of life without the patient's explicit request has thus remained virtually unchanged throughout the years. The reduction of pain or other symptoms (while taking into account or appreciating that this may have a life-shortening effect) oc-Around 57% of all physicians have now performed euthanasia or assisted in suicide at some time during their working career, a figure not noticeably different from those obtained in 1995 (53%) or 1990 (54%). The proportion of physicians who were ever engaged in the ending of life without a patient's explicit request decreased from 27% in 1990 to 23% in 1995, and further to 13% in 2001 (Onwu-teaka-Philipsen et al., 2003, p. 397). The unwillingness to ever do so increased from 45% of all …