According to a study recently published in the Journal of Medical Ethics, the decision of whether to perform euthanasia or physician-assisted suicide (EAS) puts pressure on physicians due to the patient-physician relationship, the relationship between the physician and the patient’s relatives, and the circumstances and difficulty of the decision.

This explorative study included interviews with 22 Dutch general practitioners, though saturation was achieved after 15 interviews in terms of the number of types of pressure. These physicians completed a short questionnaire exploring aspects of their practice and themselves, how much experience they had with EAS, and their willingness to take part in an interview. Interviews were semistructured and in-depth, focusing on individual cases in which general practitioners felt pressure when handling a request for EAS. The framework method was used to analyze transcribed interviews.

Most general practitioners reported feeling pressure in cases of EAS and this pressure appears to be increasing. The 15 interviews focused on 36 cases, in which all types of pressure were recorded and categorized as follows: emotional blackmail, direction and control by others, worries about not fulfilling the criteria, pressure against EAS by relatives of the patient, pressure from time constraints, and pressure from organization.

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These results are limited by the exclusive focus on Dutch practices on euthanasia, which do not apply in many other countries.

The study researchers conclude that “the pressure experienced by [general practitioners] in dealing with EAS requests can be attributable to factors associated with the patient-physician relationship and/or the relationship between the physician and the patient’s relative(s), the inherent complexity of the decision itself and the circumstances under which they have to make the decision to (not) grant EAS requests or perform EAS. Our results and the reported increase in the pressure [general practitioners] experience in granting EAS requests call for further investment into raising awareness on this topic in order to prevent physicians to cross their own personal boundaries in dealing with EAS request.”


de Boer ME, Depla MFIA, den Breejen M, Slottje P, Onwuteaka-Philipsen BD, Hertogh CMPM. Pressure in dealing with requests for euthanasia or assisted suicide. Experiences of general practitioners [published online May 15, 2019]. J Med Ethics. doi:10.1136/medethics-2018-105120