|
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 |
