Euthanasie in de thuissituatie

Objective

To explore what Dutch general practitioners (GPs) need and what their felt responsibilities and considerations are during (decision-making for) physician assisted dying (PAD) in the context of palliative care in the home-setting.

Design

A qualitative interview study was performed as part of a larger interview-study exploring the experiences of patients, relatives, and other care-professionals with PAD.

Method

Purposive sampling was adopted to select eleven GPs with experience in end-of-life decision-making and with sufficient variety on the domains of age, gender, work setting and additional expertise. Narrative interviews were conducted by a GP-researcher. Interviews were transcribed, anonymized and analyzed through narrative thematic analysis. A member check with participants was performed.

Results

GPs mentioned corresponding needs on the personal level, in the interaction with patients and families, and on an organizational/societal level. Similar examples of complicating family-dynamics were described. Meanwhile, different considerations emerged in relation to how to act and what to take responsibility for during PAD, such as GPs’ own life views, sort/duration of treatment relationships, and care for relatives. Last, casuistry of PAD-requests of patients with metastasized cancer emerged – in theory the least controversial cases – in which specific circumstances made GPs again (re)consider their responsibilities and boundaries.

Conclusion

This study provides new insight into what matters for Dutch GPs while trying to realize ‘good euthanasia-care’ in the home-setting. The study raises important questions about the position of GPs, the conditions under which they need to operate, and what reasonably may be expected of them.

Conflict of interest and financial support: none declared.