Survey on end-of-life practices in the Netherlands in The Lancet: no evidence of slippery slope

Dutch researchers on the end-of-life practices in the Netherlands published the results of their 5th Survey in The Lancet this week.  Main conclusion can be that the practice of euthanasia stabilised, and that the feared slippery slope could not be  established. The article describing trends in these practices is based on a repeated cross-sectional survey of a stratified sample from the death registry of Statistics Netherlands.

The method used was the same as in 1990, 1995, 2001 and 2005 (nationwide, stratified sample study on all registered deaths in a certain year), and therefore the outcomes and trends can and may be compared.

The researchers described study as:  ... our study provides insight in consequences of regulating euthanasia and physician-assisted suicide within the broader context of end-of-life practices. In the Netherlands the euthanasia law resulted in a relatively transparent practice. Although translating these results to other countries is not straightforward, they can inform the debate on legalisation of assisted dying in other countries.

Major numbers:

The full article and comment can be read here.

Comment from webmaster Rob Jonquière:

• Reasons for rise in number of euthanasia cases: 8 years after the enactment of the law patients probably know better that a request is taken serious and feasible, while doctors have required more trust in the legal procedures; and doctors and patients talk in general and in earlier stages of a disease in particular about the possibilities at the end-of-life.
• The increase in the number of instances of euthanasia is related to both increase in the number of explicit requests from 4,8 % of all deaths in 2005 (6547) to  6,7 % in 2010 (9115),  in combination with a larger proportion of those request being granted: 37 % in 2005 to 45 % in 2010.
• The characteristics of instances where euthanasia or physician assisted suicide was practiced did not change: mostly younger cancer patients, attended by their GP
• Reasons for the sharp decrease in number of cases of termination of life without request:  from this and earlier research into this category these cases concern immediate actions at the last moment. Because of the changed 'culture' - end of life decisions are more frequently discussed - these last moment actions are averted. The decrease in total numbers is from 0,8 % = 1000 (1990, the "Remmelink" numbers) to 0,1 % = 300 (2010). Above all this research tells that in 50 % of these cases euthanasia had been discussed earlier with the patient (but apparently did not [yet] result in a concrete request), and 75 % had at that moment a life expectancy of less then a week.
• Not reported cases (20 % = 800) are situations in which the doctor on the one hand did not consider this situation as being "euthanasia" (and thus thought not to have to report!), probably also because he did not use "euthanatic" medication, but on the other hand told the researchers - when asked in the scope of this survey -  "intended hastening of death" (and thus was included in the results as "euthanasia").
• Intentional stopping eating and drinking - a procedure practiced as DIY methode - occurred in 0,4 % of all deaths: less then recently calculated (Chabot, 2009); almost half of those did so after a request for euthanasia was not granted.