Dutch Nursing Home Policies and Guidelines on Physician-Assisted Death and Decisions to Forego Treatment

The purpose of this study was to describe: the prevalence & content of policies on euthanasia or assisted suicide in 3 different types of Dutch nursing homes; specific content items of written guidelines; & the prevalence of guidelines on withholding or withdrawing treatment from severely demented patients & patients in a persistent vegetative state. A postal survey of directors of patient care was conducted. Results indicate psychogeriatric nursing homes less often had a written policy than somatic & combined nursing homes. The most frequently reported aspects in the guidelines by nursing homes with a policy that euthanasia/assisted suicide was acceptable under certain conditions were consultation by another physician, referral to another physician if the attending physician had in-principle objections, & the involvement of the nurse in the decision-making procedure. 9% reported having specific written procedures concerning withholding or withdrawing treatment from severely demented patients. It is concluded guidelines could be improved, especially with respect to withholding or withdrawing treatment from incompetent patients. (19 refs.)