7-Fold Unexplained Variation in Death Rates in the Netherlands

March 20, 2024

There's a 7-fold unexplained variation in rates of euthanasia across the Netherlands, reveals an analysis of health insurance claims published online in BMJ Supportive & Palliative Care. It's not yet clear whether these differences relate to underuse, overuse or misuse.

In countries where euthanasia is legal, the vast majority of people who receive a euthanasia request are diagnosed with terminal illness (for example cancer or heart disease). However, a small number of euthanasia cases aren't for medical reasons. Instead, they may be for personal or economic reasons. For instance, a study in Switzerland found that the university hospital's limited palliative care staff was pressured to offer euthanasia for some patients in order to free up beds for others.

This is a clear violation of the Hippocratic Oath, an ancient oath that all doctors take to "first do no harm." In this case, if a patient's condition is not curable and they will never have quality of life, a doctor should first explore palliative care options.

A recent study of euthanasia data in the Netherlands, a country that legalised euthanasia in 1994, showed that it is most often performed for people with a terminal disease and a poor prognosis. It is less commonly used for psychiatric disorders, for which it has only been tested in one trial. It is also rarely used for children or the elderly. The authors suggest that these variations reflect regional differences in the availability of care and cultural values.


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