Family Practice Advance Access published online on October 14, 2009
Family Practice, doi:10.1093/fampra/cmp065
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Vulnerability and the ‘slippery slope’ at the end-of-life: a qualitative study of euthanasia, general practice and home death in The Netherlands
a Inclusion Research Institute, 1010 Wisconsin Avenue NW, Suite 340, Washington, DC 20007, USA
b Department of Metamedicine, Vrije Universiteit, 1081 BT Amsterdam, The Netherlands
c Department of Philosophy, University of Utah, Salt Lake City, UT 84112-9156, USA
Correspondence to Frances Norwood; E-mail: francesnorwood{at}aol.com
Received 3 April 2009; Revised 14 September 2009; Accepted 17 September 2009.
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Abstract |
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Background. One enduring criticism of the Dutch euthanasia policy is the ‘slippery slope’ argument that suggests that allowing physicians to conduct legal euthanasia or assisted suicide would eventually lead to patients being killed against their will. What we currently know about euthanasia and its practices in The Netherlands is predominantly based on retrospective quantitative or interview-based studies, but these studies fail to detail the mechanisms of day-to-day practice.
Objective. To examine the practices that surround euthanasia, particularly among vulnerable patients, using qualitative observation-based data.
Methods. A 15-month qualitative, observation-based study of home death and general practice in the greater Amsterdam region of The Netherlands. Study included observation and interviews with a sample of 15 (GPs and 650 of their patients, 192 of whom were living with terminal or life-threatening illness (with and without requests for euthanasia).
Results. Euthanasia practice typically involves extensive deliberations, the majority of which do not end in a euthanasia death. Euthanasia discussions or ‘euthanasia talk’ share at least two consequences: (i) the talk puts the onus on patients to continue discussions towards a euthanasia death and (ii) there is a socio-therapeutic component, which tends to affirm social bonds and social life.
Conclusion. While this qualitative evidence cannot disprove existence of abuse, it suggests that euthanasia practices have evolved in such a way that patients are more likely to talk about euthanasia than to die a euthanasia death.
Keywords. Assisted dying, euthanasia, general practice, palliative care, qualitative research.
Norwooda F, Kimsma G and Battin M P. Vulnerability and the ‘slippery slope’ at the end-of-life: a qualitative study of euthanasia, general practice and home death in The Netherlands. Family Practice 2009; Pages 1–9 of 9.