BMJ Podcast 20th November 2009

End of life care. The conversation between patients and the end of life decisions within the community is currently not as good as it could be. What happens when patient's ideas differ from those of their patients? Unbearable suffering may be interpreted differently. Euthanasia is legalised under strict conditions in the Netherlands. GPs are the most common to carry this out in patient's homes and the decision comes about after long discussion. Physicians who have objects are free to make these known and are able to refuse but should refer the patient to another doctor. The advantage in the Netherlands is more openness and discussion about the topic in the country. Still two thirds of requests are not accepted. Physicians may be more likely to focus on the physical perceptions of suffering whilst patients are more likely to focus on the psycho-social aspects. The law does not specify the definition. Society does find it difficult to approach this subject and equally doctors and nurses do not like to approach the topic. End of life care pathways are tools with stages of care to assist the process, having a role particularly in hospitals for doctos who may not have as much experience in end-of-life care. Audits of end-of-life care and research into the use of pathways will help to identify areas which are being dealt with effectively and places where care can be improved.

Concept of unbearable suffering in context of ungranted requests for euthanasia: qualitative interviews with patients and physicians. Published 16 November 2009, doi:10.1136/bmj.b4362
Cite this as: BMJ 2009;339:b4362

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