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Package of articles and podcast focus on end-of-life, physician-assisted suicide

JAMA Internal Medicine has published a package of articles, along with an author interview podcast, focused on end-of-life, . The original investigation, research letter, special communication and commentaries are detailed below.

In the first article, , M.A., of the , Amsterdam, and coauthors1 looked at outcomes of requests for euthanasia or received by a clinic founded in 2012 to provide the option of euthanasia or for patients who met all legal requirements but whose regular physicians rejected their request.

The Termination of Life on Request and Assisted Suicide Act went into force in the Netherlands in 2002. In 2012, the group Right to Die NL founded the End-of-Life Clinic, which operates throughout the country with mobile teams consisting of a physician and nurse. The authors examined 645 requests made by patients to the clinic from March 2012 to March 2013.

Of the 645 requests, the authors found that 162 requests (25.1 percent) were granted, 300 requests (46.5 percent) were refused, 124 patients (19.2 percent) died before their request could be assessed and 59 patients (9.1 percent) withdrew their requests.

Patients with a somatic condition (113 of 344 [32.8 percent] i.e., patients who had as their condition cancer, cardiovascular diseases, neurologic [physical], pulmonary, rheumatoid, other physical discomfort or a combination thereof) or with cognitive decline (21 of 56 [37.5 percent]) had the highest percentage of granted requests. Patients with a (i.e. patients whose only medical condition was a psychiatric or ) had the smallest percentage of granted requests; six (5 percent) of 121 requests from patients with a were granted. Also granted were 11 (27.5 percent) of 40 requests from patients who were tired of living.

“Our findings suggest that physicians in the Netherlands have more reservations regarding less common reasons that patients request euthanasia and physician-assisted suicide than the medical staff working for the End-of-Life Clinic. The physicians and nurses employed by the clinic, however, often confirmed the assessment of the physician who previously cared for the patient; they rejected nearly half of the requests for euthanasia and physician-assisted suicide, possibly because the legal due care criteria had not been met,” the authors conclude.

In a related research letter, Sigrid Dierickx, M.Sc., of Vrije Universiteit Brussel and Ghent University, Belgium, and coauthors2 conducted a survey in 2013 to examine shifts in euthanasia requests and the reasons physicians granted or denied those requests. Physicians certified a random sample of 6,871 deaths that occurred from January through June 2103 in Flanders, Belgium. The authors compared results to 2007 when a similar survey was conducted. Belgium legalized euthanasia in 2002.