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 |