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Prevalence and Content Analysis of Guidelines on Handling Requests for Euthanasia or Assisted Suicide in Dutch Nursing Homes
Ilinka Haverkate, PhD;
Martien T. Muller, PhD;
Mirjam Cappetti, MSc;
Freerk J. Jonkers, MSc;
Gerrit van der Wal, MD, PhD
Arch Intern Med. 2000;160:317-322.
Background The growing number of requests for euthanasia or assisted suicide (EAS) makes it imperative for health care institutions, such as nursing homes, to have written guidelines on how to handle requests for EAS. The objective of this study was to determine the prevalence of EAS guidelines in Dutch nursing homes and to analyze the content.
Methods Directors of patient care in 324 Dutch nursing homes were asked, by means of a mailed short list of questions, if they had an institutional guideline on EAS and, if so, to provide a copy. Guidelines were analyzed according to a structured list of items based on current jurisprudence, model documents, and opinions of experts.
Results Of the 324 directors, 313 (97%) responded. In 58% of the nursing homes that responded, there existed written guidelines for EAS. Of those guidelines, 74% concerned EAS; in 26%, EAS was integrated in a guideline on terminal care. Of the guidelines, 165 (90%) were based on the policy that EAS is acceptable under specific conditions, and 18 (10%) banned EAS completely. Of the first-mentioned guidelines, 81% described one or more procedures for in-principle objections. In 65% of these guidelines, all official requirements for prudent practice were described.
Conclusions Despite the rapidly growing number of nursing-home guidelines on EAS and the existence of model documents, there is still considerable variation in the guidelines, and they can be improved in many aspects. A basic prerequisite is that the guidelines include all the official requirements for prudent practice.
From the Institute for Research in Extramural Medicine (Dr Haverkate, Ms Cappetti, and Mr Jonkers) and the Department of General Practice, Nursing Home Medicine and Social Medicine (Drs Muller and van der Wal), Vrije Universiteit, Amsterdam; and the Center for Geriatric Rehabilitation and Nursing Naarderheem, Naarden (Dr Muller), the Netherlands.
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