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Table 3 Overview of themes, categories and codes

From: Euthanasia requests in dementia cases; what are experiences and needs of Dutch physicians? A qualitative interview study

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
  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
  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
  Positive relief and satisfaction
feeling of control