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Table 3 Overview of themes, categories and codes
| THEMES | CATEGORIES | CODES |
|---|---|---|
| Evaluation of the euthanasia request | Reasons for rejection | ⋅ too late in the dementia trajectory |
| ⋅ no repeated clear request | ||
| ⋅ mental incompetence | ||
| Reasons for acceptance | ⋅ unbearable suffering in future | |
| ⋅ has to feel right | ||
| ⋅ repeated clear convincing request | ||
| Difficulties experienced by doctors | Timing | ⋅ different timing and agenda’s of doctors and patients |
| ⋅ diagnosis takes too long | ||
| Workload | ⋅ work pressure | |
| ⋅ long preparation | ||
| ⋅ labor-intensive | ||
| Pressure by relatives | ⋅ pressure by family | |
| ⋅ request from family | ||
| ⋅ part of the suffering lies with the family | ||
| Influence from society | ⋅ society not dementia-friendly | |
| ⋅ euthanasia is considered a good death | ||
| ⋅ negative perspective on dementia | ||
| ⋅ slippery slope regarding granting euthanasia | ||
| ⋅ changed perspective on death and dying | ||
| ⋅ autonomy is leading | ||
| Patient-doctor communication | ⋅ difficult communication due to dementia | |
| ⋅ conversation with or without family | ||
| Law, due care criteria and the guidelines | ⋅ unbearable suffering is unclear | |
| ⋅ judging mental competence difficult | ||
| ⋅ vague guidelines | ||
| ⋅ AED not useful in dementia cases | ||
| ⋅ AED are complicated | ||
| Expertise | Individual (GPs + elderly care physicians) | ⋅ improves quality on care |
| ⋅ experiences reduces fear | ||
| ⋅ infrequency | ||
| Organizational (SCEN and end-of-life clinic) | ⋅ pros: more time for patients, safety net, legal support | |
| ⋅ cons: stigmatization, contributes to slippery slope, no negative view on euthanasia | ||
| Support and coping | Improvement of existing conditions | ⋅ colleagues and other professionals |
| ⋅ buddy system | ||
| ⋅ emotional support by own family | ||
| ⋅ too costly to implement | ||
| Alternatives to euthanasia | ⋅ assisted suicide | |
| ⋅ palliative care (palliative sedation) | ||
| Doctor’s emotions | Negative | - nervous |
| ⋅ frustrated | ||
| ⋅angriness | ||
| ⋅ restless· | ||
| Positive | ⋅ relief and satisfaction | |
| ⋅ feeling of control | ||
| ⋅ heroism |
