Characteristics and Outcomes of Peer Consultations for Assisted Dying Request Assessments: Cross-sectional Survey Study Among Attending Physicians

Overview

Journal Front Public Health

Specialty Public Health

Date 2023 Apr 17

PMID 37064672

Authors

Stijn Vissers

Sigrid Dierickx

Luc Deliens

Freddy Mortier

Joachim Cohen

Kenneth Chambaere

Affiliations

Soon will be listed here.

Abstract

Background: In most jurisdictions where assisted dying practices are legal, attending physicians must consult another practitioner to assess the patient's eligibility. Consequently, in some jurisdictions, they can rely on the expertise of trained assisted dying consultants (trained consultants). However, these peer consultations remain under-researched. We examined the characteristics and outcomes of peer consultations to assess an assisted dying request with trained consultants, and explored how these characteristics influence the performance of assisted dying.

Methods: We conducted a cross-sectional survey in 2019-2020 in Belgium among attending physicians who had consulted a trained consultant for an assisted dying request assessment ( = 904).

Results: The valid response rate was 56% (502/903). The vast majority of attending physicians (92%) who had consulted a trained consultant were general practitioners. In more than half of the consultations (57%), the patient was diagnosed with cancer. In 66%, the patient was aged 70 or older. Reported as the patients' most important reasons to request assisted dying: suffering without prospect of improving in 49% of the consultations, loss of dignity in 11%, pain in 9%, and tiredness of life in 9%. In the vast majority of consultations (85%), the attending physician consulted the trained consultant because of the expertise, and in nearly half of the consultations (46%) because of the independence. In more than nine out of ten consultations (91%), the consultant gave a positive advice: i.e., substantive requirements for assisted dying were met. Eight out of ten consultations were followed by assisted dying. The likelihood of assisted dying was higher in consultations in which loss of dignity, loss of independence in daily living, or general weakness or tiredness were reasons for the request.

Conclusion: Our findings indicate that the peer consultation practice with trained consultants is most often embedded in a primary care setting. Moreover, our study corroborates previous research in that assisted dying is performed relatively less frequently in patients with cancer and more often in patients with general deterioration. Our findings suggest that attending physicians hold peer consultations with trained consultants to endorse their own decision-making and to request additional support.

References

. The Belgian act on euthanasia of May, 28th 2002. Eur J Health Law. 2004; 10(3):329-35. View

Jansen-van der Weide M, Onwuteaka-Philipsen B, van der Wal G . Quality of consultation and the project 'Support and Consultation on Euthanasia in the Netherlands' (SCEN). Health Policy. 2006; 80(1):97-106. DOI: 10.1016/j.healthpol.2006.03.005. View

Rada A . Spain will become the sixth country worldwide to allow euthanasia and assisted suicide. BMJ. 2021; 372:n147. DOI: 10.1136/bmj.n147. View

Bergman T, Pasman H, Onwuteaka-Philipsen B . Complexities in consultations in case of euthanasia or physician-assisted suicide: a survey among SCEN physicians. BMC Fam Pract. 2020; 21(1):6. PMC: 6953152. DOI: 10.1186/s12875-019-1063-z. View

Brinkman-Stoppelenburg A, Vergouwe Y, van der Heide A, Onwuteaka-Philipsen B . Obligatory consultation of an independent physician on euthanasia requests in the Netherlands: what influences the SCEN physicians judgment of the legal requirements of due care?. Health Policy. 2014; 115(1):75-81. DOI: 10.1016/j.healthpol.2013.12.002. View

Jansen-van der Weide M, Onwuteaka-Philipsen B, van der Wal G . Granted, undecided, withdrawn, and refused requests for euthanasia and physician-assisted suicide. Arch Intern Med. 2005; 165(15):1698-704. DOI: 10.1001/archinte.165.15.1698. View

Bender R, Lange S . Adjusting for multiple testing--when and how?. J Clin Epidemiol. 2001; 54(4):343-9. DOI: 10.1016/s0895-4356(00)00314-0. View

Verhofstadt M, Chambaere K, Pardon K, Mortier F, Liegeois A, Deliens L . The impact of the euthanasia assessment procedure: a qualitative interview study among adults with psychiatric conditions. BMC Psychiatry. 2022; 22(1):435. PMC: 9235145. DOI: 10.1186/s12888-022-04039-2. View

Van Wesemael Y, Cohen J, Bilsen J, Smets T, Onwuteaka-Philipsen B, Deliens L . Process and outcomes of euthanasia requests under the belgian act on euthanasia: a nationwide survey. J Pain Symptom Manage. 2011; 42(5):721-33. DOI: 10.1016/j.jpainsymman.2011.02.011. View

10.

Dierickx S, Deliens L, Cohen J, Chambaere K . Euthanasia in Belgium: trends in reported cases between 2003 and 2013. CMAJ. 2016; 188(16):E407-E414. PMC: 5088089. DOI: 10.1503/cmaj.160202. View

11.

Evenblij K, Pasman H, Pronk R, Onwuteaka-Philipsen B . Euthanasia and physician-assisted suicide in patients suffering from psychiatric disorders: a cross-sectional study exploring the experiences of Dutch psychiatrists. BMC Psychiatry. 2019; 19(1):74. PMC: 6381744. DOI: 10.1186/s12888-019-2053-3. View

12.

Snijdewind M, Willems D, Deliens L, Onwuteaka-Philipsen B, Chambaere K . A Study of the First Year of the End-of-Life Clinic for Physician-Assisted Dying in the Netherlands. JAMA Intern Med. 2015; 175(10):1633-40. DOI: 10.1001/jamainternmed.2015.3978. View

13.

Dierickx S, Onwuteaka-Philipsen B, Penders Y, Cohen J, van der Heide A, Puhan M . Commonalities and differences in legal euthanasia and physician-assisted suicide in three countries: a population-level comparison. Int J Public Health. 2019; 65(1):65-73. DOI: 10.1007/s00038-019-01281-6. View

14.

Snijdewind M, van Tol D, Onwuteaka-Philipsen B, Willems D . Developments in the practice of physician-assisted dying: perceptions of physicians who had experience with complex cases. J Med Ethics. 2016; 44(5):292-296. DOI: 10.1136/medethics-2016-103405. View

15.

De Hert M, Loos S, Sterckx S, Thys E, Van Assche K . Improving control over euthanasia of persons with psychiatric illness: Lessons from the first Belgian criminal court case concerning euthanasia. Front Psychiatry. 2022; 13:933748. PMC: 9343580. DOI: 10.3389/fpsyt.2022.933748. View

16.

Dierickx S, Deliens L, Cohen J, Chambaere K . Comparison of the Expression and Granting of Requests for Euthanasia in Belgium in 2007 vs 2013. JAMA Intern Med. 2015; 175(10):1703-6. DOI: 10.1001/jamainternmed.2015.3982. View

17.

Wiebe E, Shaw J, Green S, Trouton K, Kelly M . Reasons for requesting medical assistance in dying. Can Fam Physician. 2018; 64(9):674-679. PMC: 6135145. View

18.

Vissers S, Dierickx S, Chambaere K, Deliens L, Mortier F, Cohen J . Assisted dying request assessments by trained consultants: changes in practice and quality - Repeated cross-sectional surveys (2008-2019). BMJ Support Palliat Care. 2022; . DOI: 10.1136/spcare-2021-003502. View

19.

Kusmaul N, Cheon J, Gibson A . A Policy Mapping Analysis of the U.S. Congressional Approach to Medical Aid-in-Dying. Omega (Westport). 2021; 88(1):139-156. DOI: 10.1177/00302228211043694. View

20.

von Elm E, Altman D, Egger M, Pocock S, Gotzsche P, Vandenbroucke J . The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007; 4(10):e296. PMC: 2020495. DOI: 10.1371/journal.pmed.0040296. View