Object: In the Netherlands, euthanasia is only permitted when certain requirements for prudent practice are met. One of the requirements implies the absence of palliative alternatives. In this study, palliative alternatives that are present at the moment of patient's request and the way general practitioners (GPs) apply these alternatives are investigated.
Method: In an observational study, 70% of all GPs registered in the Netherlands (n=6607) received a questionnaire in which they described their most recent request for euthanasia (if any).
Results: In 24% of requests palliative alternatives were available, less often in granted (11%) than in refused requests (55%). Palliative alternatives most often mentioned were: medication (65%), artificial administration of food and fluid (19%) and hospitalisation (11%). In 61% of the requests the alternative was applied, more often in refused (68%) than in granted requests (22%). When the alternative was applied 53% of patients persisted in their request. For granted and refused request this percentage was respectively 100% and 60%. Most frequently mentioned reasons for persistence were: suffering remained (45%), patient's wish (20%), and loss of dignity (8%). Most mentioned reasons of GPs for not applying alternatives were: medically futility (46%), patient refused the treatment (14%) and respect for the patient's wish (8%). Reasons of the patient (according to the GP) were: refusing treatment (58%), medically futility (14%) and preferred (dignified) dying (12%).
Conclusions: GPs use the availability of palliative alternatives as a requirement for prudent practice, since they more frequently refuse requests when there still are palliative options. In deciding not to apply options, medical futility and the patient's autonomy are important.