Background
Methods
Design and population
Questionnaire
Analysis
Extra analyses
Results
Description of the study sample
Psychiatric disorder Total n = 183 | Dementia Total n = 803 | Accumulation of health problems Total n = 918 | All deceased patients who died non-suddenly Total n = 5361 | |||||
---|---|---|---|---|---|---|---|---|
N
| %1 |
N
| %1 |
N
| %1 |
N
| %1 | |
Patient characteristics | ||||||||
Sex | ||||||||
Male | 91 | 39.1 | 305 | 35.4 | 321 | 32.3 | 2672 | 45.9 |
Female | 92 | 60.9 | 498 | 64.6 | 597 | 67.7 | 2689 | 54.1 |
Age | ||||||||
17–64 | 63 | 19.7 | 7 | 0.8 | 2 | 0.0 | 1028 | 12.6 |
65–79 | 48 | 22.4 | 158 | 17.4 | 101 | 8.8 | 1936 | 30.6 |
80+ | 72 | 57.8 | 638 | 81.8 | 815 | 91.1 | 2397 | 56.8 |
Marital status | ||||||||
Married | 45 | 21.2 | 257 | 29.8 | 221 | 21.9 | 2538 | 41.7 |
Unmarried | 138 | 78.8 | 546 | 70.2 | 697 | 78.1 | 2823 | 58.3 |
Ethnicity* | ||||||||
Non-Western immigrants | 27 | 3.7 | 74 | 1.5 | 87 | 1.9 | 605 | 2.9 |
Dutch, Western immigrants | 133 | 96.3 | 729 | 98.5 | 829 | 98.1 | 4722 | 97.1 |
Cause of death | ||||||||
Cancer | 50 | 15.4 | 108 | 6.1 | 179 | 9.6 | 3128 | 37.1 |
Cardiovascular disorder | 13 | 8.8 | 82 | 10.4 | 197 | 22.1 | 540 | 14.9 |
Pulmonary disorder | 14 | 11.9 | 43 | 7.0 | 104 | 13.7 | 285 | 8.5 |
Neurological disorder | 27 | 16.4 | 195 | 25.3 | 138 | 15.6 | 518 | 12.5 |
Other | 79 | 47.5 | 375 | 51.2 | 300 | 38.9 | 890 | 27.0 |
Care characteristics | ||||||||
Attending physician | ||||||||
General practitioner | 92 | 30.7 | 221 | 24.0 | 514 | 52.5 | 3301 | 50.0 |
Medical specialist | 28 | 17.5 | 43 | 6.2 | 105 | 12.5 | 897 | 21.0 |
Elderly care physician | 63 | 51.8 | 539 | 69.8 | 299 | 35.0 | 1163 | 29.1 |
Involvement of palliative care consultant/team | ||||||||
No | 164 | 91.5 | 761 | 95.4 | 842 | 92.5 | 4360 | 85.1 |
Yes | 19 | 8.5 | 42 | 4.6 | 76 | 7.5 | 1001 | 14.9 |
Pain specialist | ||||||||
No | 178 | 98.5 | 801 | 99.7 | 905 | 98.9 | 5166 | 97.5 |
Yes | 5 | 1.5 | 2 | 0.3 | 13 | 1.1 | 195 | 2.5 |
Psychiatrist/psychologist | ||||||||
No | 116 | 65.3 | 689 | 86.3 | 859 | 94.3 | 5050 | 93.8 |
Yes | 67 | 34.7 | 114 | 13.7 | 59 | 5.7 | 311 | 6.2 |
Pastor | ||||||||
No | 156 | 82.3 | 676 | 84.4 | 782 | 84.6 | 4698 | 86.9 |
Yes | 27 | 17.7 | 127 | 15.2 | 136 | 15.4 | 663 | 13.1 |
Frequency of EAS requests
Factors associated with requesting EAS
Absolute number in sample | No EAS request | EAS request | Univariable logistic regression | Multivariable logistic regression | Sensitivity analysis | ||||
---|---|---|---|---|---|---|---|---|---|
N = 5361 | N = 4243 Row %† | N = 1118 Row %† | Odds ratio (95% CI) |
p
| Odds ratio (95% CI) |
p
| Odds ratio (95% CI) |
p
| |
Patient characteristics | |||||||||
Sex | |||||||||
Male | 2672 | 87.1 | 12.9 | Reference | |||||
Female | 2689 | 90.3 | 9.7 | 0.84 (0.74–0.96) | 0.011 | – | – | ||
Age | |||||||||
17–64 | 1028 | 80.2 | 19.8 | 2.29 (1.92–2.73) | < 0.001 | 1.65 (1.33–2.04) | < 0.001 | 2.13 (1.75–2.59) | < 0.001 |
65–79 | 1936 | 86.0 | 14.0 | 1.82 (1.56–2.12) | < 0.001 | 1.38 (1.15–1.66) | 0.001 | 1.59 (1.35–1.88) | < 0.001 |
80+ | 2397 | 92.2 | 7.8 | Reference | Reference | Reference | |||
Marital status | |||||||||
Married | 2538 | 85.9 | 14.1 | Reference | |||||
Unmarried | 2823 | 90.9 | 9.1 | 0.71 (0.63–0.81) | < 0.001 | – | – | ||
Ethnicity‡ | |||||||||
Non-Western immigrants | 605 | 96.9 | 3.1 | Reference | Reference | ||||
Dutch, Western immigrants | 4722 | 88.6 | 11.4 | 8.36 (5.38–12.98) | < 0.001 | 8.49 (5.37–13.42) | < 0.001 | 9.24 (5.91–14.44) | < 0.001 |
Cause of death | |||||||||
Cancer | 3128 | 81.1 | 18.9 | Reference | Reference | Reference | |||
Cardiovascular disorders | 540 | 94.2 | 5.8 | 0.29 (0.22–0.40) | < 0.001 | 0.64 (0.46–0.89) | 0.009 | 0.40 (0.30–0.55) | < 0.001 |
Pulmonary disorders | 285 | 87.7 | 12.3 | 0.77 (0.57–1.03) | 0.077 | 1.94 (1.37–2.76) | < 0.001 | 0.95 (0.70–1.29) | 0.772 |
Neurological disorders | 518 | 94.3 | 5.7 | 0.57 (0.45–0.73) | < 0.001 | 1.85 (1.37–2.51) | < 0.001 | 0.69 (0.53–0.89) | 0.004 |
Other | 890 | 94.2 | 5.8 | 0.42 (0.34–0.52) | < 0.001 | 1.42 (1.08–1.88) | 0.012 | 0.55 (0.43–0.69) | < 0.001 |
A psychiatric disorder | |||||||||
No | 5178 | 88.8 | 11.2 | Reference | NE | NE | |||
Yes | 183 | 88.6 | 11.4 | 0.99 (0.69–1.43) | 0.976 | ||||
An accumulation of health problems | |||||||||
No | 4443 | 87.7 | 12.3 | Reference | Reference | ||||
Yes | 918 | 92.0 | 8.0 | 0.50 (0.40–0.61) | < 0.001 | 0.69 (0.53–0.90) | 0.005 | – | |
Dementia | |||||||||
No | 4558 | 86.0 | 14.0 | Reference | Reference | ||||
Yes | 803 | 97.9 | 2.1 | 0.13 (0.09–0.19) | < 0.001 | 0.18 (0.12–0.28) | < 0.001 | NE | |
Care characteristics | |||||||||
Attending physician§ | |||||||||
General practitioner | 3301 | 81.2 | 18.8 | Reference | Reference | ||||
Medical specialist | 897 | 96.7 | 3.3 | 0.09 (0.07–0.13) | < 0.001 | 0.07 (0.05–0.11) | < 0.001 | NE | |
Elderly care physician | 1163 | 96.1 | 3.9 | 0.14 (0.10–0.18) | < 0.001 | 0.17 (0.13–0.23) | < 0.001 | NE | |
Care givers involved in the last month of life | |||||||||
Palliative care consultant/team | |||||||||
Not involved | 4360 | 90.1 | 9.9 | Reference | |||||
Involved | 1001 | 81.6 | 18.4 | 1.43 (1.22–1.68) | < 0.001 | – | – | – | |
Specialist pain control | |||||||||
Not involved | 5166 | 89.3 | 10.7 | Reference | Reference | Reference | |||
Involved | 195 | 69.7 | 30.2 | 2.31 (1.71–3.11) | < 0.001 | 2.08 (1.47–2.93) | < 0.001 | 1.82 (1.32–2.50) | < 0.001 |
Psychiatrist/psychologist | |||||||||
Not involved | 5050 | 89.1 | 10.9 | Reference | Reference | Reference | |||
Involved | 311 | 84.6 | 15.4 | 1.44 (1.11–1.86) | 0.006 | 4.50 (3.15–6.41) | < 0.001 | 2.05 (1.54–2.73) | < 0.001 |
Pastor | |||||||||
Not involved | 4698 | 88.5 | 11.5 | Reference | Reference | Reference | |||
Involved | 663 | 90.9 | 9.1 | 0.55 (0.44–0.70) | < 0.001 | 0.77 (0.59–1.00) | 0.050 | 0.53 (0.42–0.68) | < 0.001 |
Reasons to grant or refuse the request
Deceased with a psychiatric disorder (n = 183) %1 | Deceased with dementia (n = 803) %1 | Deceased with an accumulation of health problems (n = 918) %1 | All deceased patients who died non-suddenly (n = 5361) %1 | |
---|---|---|---|---|
Reasons for the physician to grant the request and perform euthanasia* | N = 24 | N = 22 | N = 80 | N = 845 |
No prospect of improvement | 87.3 | 94.6 | 83.4 | 81.9 |
Autonomy of the patient | 85.8 | 72.4 | 81.0 | 80.7 |
(Severe) symptoms other than pain | 75.4 | 26.2 | 48.7 | 61.2 |
Loss of dignity | 32.0 | 73.7 | 54.8 | 59.1 |
(Severe) pain | 20.3 | 12.6 | 34.9 | 40.4 |
Expected suffering of the patient | 53.5 | 49.1 | 30.9 | 44.3 |
Further treatment would be too burdensome | 21.6 | 21.4 | 22.2 | 14.5 |
Other | 11.0 | 15.5 | 4.1 | 1.8 |
Reasons for the request not resulting in euthanasia* | N = 14 | N = 9 | N = 36 | N = 273 |
Patient died before the request could be granted | 13.0 | 8.1 | 23.5 | 53.1 |
The criteria for due care were not met* | 44.4 | 76.1 | 70.6 | 32.1 |
No well-considered request | 34.8 | 59.8 | 32.4 | 16.2 |
No unbearable suffering | 18.1 | 16.3 | 40.5 | 12.0 |
No hopeless suffering | 16.8 | 16.3 | 13.5 | 5.1 |
No voluntary request | 0 | 4.3 | 0 | 0.7 |
Generally | 8.3 | 10.1 | 5.6 | 4.3 |
Patient withdrew the request | 18.7 | 13.9 | 15.7 | 17.4 |
Physician never willing to perform euthanasia | 0 | 0 | 5.5 | 2.1 |
Other | 29.0 | 21.5 | 14.7 | 9.4 |
Factors associated with receiving EAS
Absolute number in the sample | Request did not result in EAS | Request did result in EAS | Univariable logistic regression | Multivariable logistic regression | Sensitivity analysis | ||||
---|---|---|---|---|---|---|---|---|---|
N = 1118 | N = 273%1 | N = 845%1 | Odds ratio (95% CI) |
p
| Odds ratio (95% CI) |
p
| Odds ratio (95% CI) |
p
| |
Patient characteristics | |||||||||
Sex | |||||||||
Male | 595 | 42.9 | 57.1 | Reference | |||||
Female | 523 | 44.7 | 55.3 | 1.14 (0.87–1.50) | 0.349 | NE | NE | ||
Age | |||||||||
17–64 | 294 | 42.1 | 57.9 | 1.07 (0.76–1.53) | 0.690 | – | – | ||
65–79 | 467 | 38.3 | 61.7 | 1.32 (0.96–1.81) | 0.093 | – | – | ||
80+ | 357 | 50.0 | 50.0 | Reference | |||||
Marital status | |||||||||
Married | 604 | 44.7 | 55.3 | Reference | |||||
Unmarried | 514 | 42.8 | 57.2 | 1.21 (0.92–1.59) | 0.184 | NE | NE | ||
Ethnicity | |||||||||
Non-Western immigrants | 21 | 25.0 | 75.0 | Reference | |||||
Dutch, Western immigrants | 1091 | 43.8 | 56.2 | 1.27 (0.49–3.31) | 0.622 | NE | NE | ||
Cause of death | |||||||||
Cancer | 808 | 40.7 | 59.3 | Reference | Reference | Reference | |||
Cardiovascular disorders | 50 | 65.3 | 34.7 | 0.56 (0.31–1.01) | 0.054 | 0.72 (0.37–1.41) | 0.332 | 0.70 (0.37–1.35) | 0.291 |
Pulmonary disorders | 60 | 57.6 | 42.4 | 0.87 (0.48–1.55) | 0.628 | 1.53 (0.77–3.03) | 0.221 | 1.02 (0.55–1.90) | 0.942 |
Neurological disorders | 86 | 22.5 | 77.5 | 3.34 (1.58–7.03) | 0.002 | 4.70 (2.09–10.58) | < 0.001 | 3.92 (1.81–8.47) | 0.001 |
Other | 114 | 45.5 | 54.5 | 1.35 (0.83–2.20) | 0.220 | 2.38 (1.34–4.26) | 0.003 | 1.83 (1.06–3.14) | 0.029 |
A psychiatric disorder | |||||||||
No | 1080 | 43.3 | 56.7 | Reference | Reference | Reference | |||
Yes | 38 | 56.5 | 43.5 | 0.54 (0.28–1.06) | 0.074 | 0.38 (0.18–0.82) | 0.013 | 0.38 (0.18–0.79) | 0.010 |
An accumulation of health problems | |||||||||
No | 1002 | 41.7 | 58.3 | Reference | Reference | Reference | |||
Yes | 116 | 54.1 | 45.9 | 0.69 (0.45–1.05) | 0.081 | 0.62 (0.36–1.05) | 0.073 | 0.63 (0.38–1.04) | 0.070 |
Dementia | |||||||||
No | 1087 | 43.1 | 56.9 | Reference | |||||
Yes | 31 | 59.3 | 40.7 | 0.78 (0.36–1.72) | 0.545 | NE | NE | ||
Care characteristics | |||||||||
Attending physician | |||||||||
General practitioner | 1016 | 37.8 | 62.2 | Reference | Reference | ||||
Medical specialist | 36 | 66.7 | 33.3 | 0.13 (0.06–0.27) | < 0.001 | 0.13 (0.06–0.27) | < 0.001 | NE | |
Elderly care physician | 66 | 79.4 | 20.6 | 0.19 (0.12–0.32) | < 0.001 | 0.16 (0.09–0.28) | < 0.001 | NE | |
Care givers involved in the last month of life | |||||||||
Palliative care consultant/team | |||||||||
Not involved | 872 | 42.3 | 57.7 | Reference | Reference | Reference | |||
Involved | 246 | 48.4 | 51.6 | 0.65 (0.48–0.89) | 0.007 | 0.70 (0.50–0.98) | 0.037 | 0.65 (0.48–0.90) | 0.008 |
Specialist pain control | |||||||||
Not involved | 1046 | 43.4 | 56.6 | Reference | |||||
Involved | 72 | 48.8 | 51.2 | 0.90 (0.52–1.54) | 0.688 | NE | NE | ||
Psychiatrist/psychologist | |||||||||
Not involved | 1034 | 42.8 | 57.2 | Reference | |||||
Involved | 84 | 54.7 | 45.3 | 0.75 (0.46–1.21) | 0.237 | NE | NE | ||
Pastor | |||||||||
Not involved | 1029 | 42.1 | 57.9 | Reference | |||||
Involved | 89 | 58.2 | 41.8 | 0.49 (0.31–0.77) | 0.002 | – | 0.49 (0.30–0.78) | 0.003 |