Euthanasia in the case of dementia: a survey among Flemish GPs

Jasper Cleemput; Birgitte Schoenmakers

doi:10.3399/bjgpopen19X101677

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Figure 1. Acceptability of performing euthanasia at different stages of dementia.
Stage 1 = early dementia (moments of forgetfulness, fear of what will come, and sickness awareness); stage 2 = progressive dementia (disorientation, reduced awareness of time, increasingly worse recognition of loved ones); stage 3 = advanced dementia (complete withdrawal, without any sense of time, place, or person, endlessly engaged in certain movements and/or sounds); stage 4 = end-stage dementia (contactless, hardly any reaction, only physically present).

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Table 1. Characteristics of participating GPs

Characteristic	n (%)
Age , years
26–40	48 (42)
41–55	23 (20)
≥56	42 (37)
Sex
Male	60 (53)
Female	53 (47)
Religious
Yes	46 (41)
No	67 (59)
Ha s or had a family member with dementia
Yes	63 (56)
No	50 (44)
Has performed euthanasia in the past
Yes	71 (63)
No	42 (37)
Has previously performed euthanasia in patient with psychological suffering
Yes	24 (21)
No	89 (79)

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Table 2. Participant responses to statements regarding dementia and euthanasia (5-point Likert scale)

Statement	‘Rather not’ to ‘not agree’, n (%)	‘Rather agree’ to ‘completely agree’, n (%)
Euthanasia in patients without dementia is more acceptable than in patients with dementia	17 (19)	59 (69)
Euthanasia in patients with dementia and concomitant diseases is more acceptable than in cases of 'healthy' dementia patients	21 (24)	51 (59)
A medically classifiable condition (that is, more than a medical basis) is a requirement to perform euthanasia or assisted suicide	29 (33)	40 (43)
In an older person, who suffers unbearably due to an accumulation of medical and non-medical problems, euthanasia or medically assisted suicide may be acceptable to me	18 (20)	63 (70)
Euthanasia or medically assisted suicide is only acceptable to me if the patient suffers from a terminal illness	54 (59)	28 (30)
At the first^a stage of dementia, euthanasia is acceptable	40 (46)	32 (44)
At the progressive^b stage of dementia, euthanasia is acceptable	22 (39)	44 (51)
At the progressed^c stage of dementia, euthanasia is acceptable	25 (29)	56 (65)
At the final^d stage of dementia, euthanasia is acceptable	21 (24)	63 (72)
Legislation on euthanasia in patients with dementia needs adjustment	20 (34)	49 (56)
The current euthanasia law offers no room for assistance with a request for termination of life in patients with dementia	8 (9)	75 (85)
With regards to legislation of euthanasia, dementia and coma patients are to be treated equally	24 (28)	58 (67)
It is important that the patient gives their consent at the decisive moment	26 (30)	44 (51)
If legislation allows euthanasia in case of dementia, relatives will put pressure on at the decisive moment	14 (16)	63 (72)

Category 'neutral’: omitted. ^aMoments of memory loss, fear of future, aware of disease. ^bDisorientation in time and space, problems recognising relatives. ^cRegression, no awareness of time and space, repetition of actions and noises. ^dNo interaction, no communication, no active reactions.

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Table 3. Free-text comments to question: 'If legislation allows euthanasia in later than the beginning stages of dementia, would you carry out euthanasia (if advance directive available)?'

Answer label	n = 86 (completed answers)
Yes (if legal)	36
No, never	18
Only if complicated with physical comorbidities or other threatening conditions	3
No, since you cannot judge quality of life and meaning to others	2
No, since I want a clear ‘yes’ from the patient	5
Yes, if patient, family, relatives, and other carers are extensively involved and consulted in a shared decision-making	11
Yes, but considering that an advance directive does not necessarily reflect today's beliefs or wishes and that dementia was specified in the directive	4
Yes, if you know the patient, their life lifecycle, and their life view very well	4
No opinion	3