Table 3 Overview of themes, categories and 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