In 1995 and 1996, 405 Dutch physicians, randomly sampled nationwide and stratified by specialty and region, were interviewed by over 30 specifically trained and experienced physicians using a structured questionnaire. The response rate was 89%. Euthanasia was defined as the administration of drugs with the explicit intention of ending the patient's life, at the patient's explicit request. Assisted suicide was defined as the prescribing or supplying of drugs with the explicit intention of enabling the patient to end his or her own life. All physicians were asked to describe their most recent case of a granted request (134 physicians had had such a case) and their most recent case of a refused request (148 physicians had had such a case).
Patients whose requests were refused, compared with patients whose requests were granted, were more often female and aged over 80; were less likely to have cancer; were more likely to have depression as a predominant complaint; were more likely to have a remaining life span of over six months; were less likely to have made a highly explicit request; were less likely to be competent; were less likely to be suffering utterly “hopelessly and unbearably,” and were more likely to have access to alternatives for treatment (table).
In both the refused and the granted requests “avoiding loss of dignity” (42% (95% confidence interval 31.6% to 52.4%) and 56% (46.3% to 66.2%) respectively) and “unbearable or hopeless suffering” (39% (29.0% to 48.8%) and 74% (64.9% to 82.6%)) were most often mentioned as the patient's reason for requesting euthanasia or physican assisted suicide. Only two reasons were mentioned more often in refused requests than in granted requests: “weariness of life” (40% (29.8% to 50.5%) and 18% (10.2% to 25.5%) respectively) and “not wanting to become a burden on the family” (23% (14% to 32.3%) v 13% (5.8% to 19.2%)). The most often mentioned reasons given by physicians for refusing the request were “suffering was not unbearable” (35%); “still alternatives for treatment” (32%); “the patient was depressed or had psychiatric symptoms” (31%); and “the request was not well considered” (19%) (data not shown).