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29-06-2011 | Article

Dutch practice guidelines for euthanasia are not always complete

Abstract

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MedWire News: Practice guidelines for euthanasia and assisted suicide (EAS) are not always the optimal source of information for physicians practicing in The Netherlands, report Dutch researchers.

Furthermore, nursing home guidelines are often more strict than the law (and compared with hospital guidelines) concerning exclusion of particular patient groups, and the role of the nurse deserves more attention in many guidelines, they add, in the Journal of Medical Ethics.

"We recommend that healthcare institutions accurately state the boundaries of the law, also if they prefer to set stricter boundaries for their own institution," write Berniek Hesselink (VU University Medical Center, Amsterdam) and colleagues.

"Only guidelines that provide adequate information and sufficient practical details with regard to the procedure that must be followed after a request for EAS can provide adequate support for physicians and nurses in the difficult EAS decision-making process," they add.

The team analyzed the content of 99 nursing home and hospital practice EAS guidelines collected between 2005 and 2006, separating them into pre- and post-enactment of the 2002 Dutch euthanasia law.

The majority of guidelines (94%) contained a description of how to react to requests for EAS, while only 4% stated that the family of the patient should always be informed, say the researchers.

Nursing home guidelines described the patient's family as possible participants in decision-making more frequently than hospital guidelines did, at 66 versus 43%, while 81% of guidelines stipulated that the physician was responsible for the decision-making regarding EAS, with nurses and nursing aids as the group next most frequently mentioned in the process (86%).

Hospital guidelines stated that only the physician is allowed the administer drugs for euthanasia in 83% of cases compared with 62% of nursing home guidelines. However, post-2002, the need for a physician to be present during administration of the drug was less frequently stated (31 vs 57% for post- and pre-2002).

In all, 41% of guidelines were stricter than the 2002 euthanasia law regarding exclusion of certain patient groups, with nursing home guidelines more strict than hospital guidelines concerning exclusion of patients with dementia (30 vs 4%) and incompetent patients (25 vs 4%).

With regard to the six due care criteria set by the 2002 law, the most frequently described was consultation (99%), followed by voluntary and well-considered request (98%), and hopeless and unbearable suffering (95%).

Mere description of the due care criteria is not of much value if not "operationalized" in enough detail to be useful in practice, say Hesselink et al. "

[Guidelines] should describe which aspects must be taken into consideration in assessing a due care criterion in order to be really helpful for [physicians]," they add.

The team concludes that guidelines can only be supportive for decision-making, and that individual interpretation per individual patient is essential.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Sarah Guy