The current practice of physician-assisted suicide in psychiatry

Under certain conditions, the Netherlands allows a doctor to perform euthanasia
or physician-assisted suicide (hereafter: euthanasia). These conditions are
formulated in the Dutch euthanasia-act (WTL). After the Chabot-arrest in 1994,
it became clear that not only patients with somatic conditions are eligible for
euthanasia, because it was decided that not the nature of the suffering, but
the severity of the suffering was the guiding principle. This provided the
possibility for psychiatric patients to request euthanasia. This research will
focus on this category of patients.
The number of psychiatric patients who received euthanasia has grown from 0 in
2002 to 83 in 2016. Also the estimated number of requests has risen, from 320
in 1995 to 1100 in 2016. Although the numbers are relatively low and most of
the requests are denied, euthanasia in psychiatry has evoked a strong debate.
Literature on the subject is mostly ethically argumentative or quantitative in
nature, qualitative empirical data is lacking. The reason that this research
was set up, is to gain insight into the experiences and views of those directly
involved: patients with a psychiatric disorder, their relatives and general
practitioners. Research among psychiatrists has already been conducted within
the framework of the third evaluation of the WTL, so this group will not be
included in this research. Although a lot has been said about the patients
involved, nobody spoke with them about the subject matter. Scientific
literature into the experiences and views of the category patients that the
debate revolves around is lacking. This research will therefore primarily focus
on the main parties involved: the patient and his environment. In addition to
providing information about the patient's experiences, the family members and
other relatives themselves also have an interest, they are to a large extent
affected by the death wish and the request for euthanasia of their family
member or relative. It is also important to gain insight into the experiences
and views of general practitioners in the Netherlands. They are faced with
requests from psychiatric patients (a quarter of the euthanasia requests in
2016 were carried out by the general practitioner), but little or nothing is
known about their views on this, their experiences and how they assess these
requests. Moreover, they usually also take care of the relatives of psychiatric
patients with a death wish (sometimes they are both the general practitioner of
the patient and the family). This research will provide insight into the
practice of life termination in psychiatric patients, which contributes to the
quality of care around their end of life. Doctors and patients all benefit from
a good quality of end-of-life decisions and this research meets the need for
knowledge that is needed for this.

The number of psychiatric patients who received euthanasia has grown from 0 in
2002 to 83 in 2016. Also the estimated number of requests has risen, from 320
in 1995 to 1100 in 2016. Although the numbers are relatively low and most of
the requests are denied, euthanasia in psychiatry has evoked a strong debate.
Literature on the subject is mostly ethically argumentative or quantitative in
nature, qualitative empirical data is lacking. The reason that this research
was set up, is to gain insight into the experiences and views of those directly
involved: patients with a psychiatric disorder, their relatives and general
practitioners. This research will provide insight into the practice of life
termination in psychiatric patients, which contributes to the quality of care
around their end of life. Doctors and patients all benefit from a good quality
of end-of-life decisions and this research meets the need for knowledge that is
needed for this.

This is an observational study with qualitative interviews.
We will conduct qualitative research by means of in-depth interviews with
psychiatric patients, their relatives and general practitioners. The interviews
will last approximately 1 to 1.5 hours, and will focus on the experiences and
views of the aforementioned groups.

This is a non-therapeutic study, so there is no risk regarding physical or
physiological aspects. This study will also not focus on incapacitated or
underage persons. However, this study does involve psychiatric patients with a
death wish. Although we focus on legally competent psychiatric patients, we
will nevertheless have to consider any incapacity to cooperate in the study. In
addition, there is the risk of emotional distress following the interview. We
believe that these risks can be minimized by means of the precautions that have
been taken, in the form of training the researcher on legal competence and
informing the attending physician in advance about cooperation in the
interview.
The attending doctor will be informed about the risk of emotional disorder, so
that the respondent can turn to this doctor for any help. Cooperation in the
interview without informing the doctor will not take place.