Health Policy 97 (2010) 166–172 Contents lists available at ScienceDirect Health Policy journal homepage: www.elsevier.com/locate/healthpol Judgment of unbearable suffering and willingness to grant a euthanasia request by Dutch general practitioners Donald van Tol a,*,1 , Judith Rietjens b , Agnes van der Heide b a Metamedica, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30 001, 9700 RB Groningen, The Netherlands b Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, The Netherlands article info Keywords: Euthanasia Suffering Netherlands General practitioners End of life abstract ‘Unbearable suffering’ is a pivotal criterion for lawful euthanasia in the Netherlands. The due-care criterion is not defined in the law and could refer to conditions varying from physical pain to psychological forms of suffering. It is unknown, however, what doctors consider ‘unbearable suffering’ and for what kind of suffering they are willing to grant a euthanasia request. We conducted a vignette-study among Dutch general practitioners (n = 115, response 38%). We found high concordance between the classification of a patient’s suffering as ‘unbearable’ and the willingness to grant a euthanasia request. Most doctors are only inclined to classify a patient’s suffering as ‘unbearable’ when suffering is directly related to untreatable and actual pain or physical symptoms. Doctors’ judgment of suffering varied strongly in cases in which physical symptoms are absent and a patient suffers from a combination of irreversible functional loss and ‘existential’ kinds of suffering. Although some doctors (17%) stick to the idea that physical symptoms are a necessary condition for ‘unbearable suffering’, a majority is willing to occasionally make an exception. When and for which case an individual doctor will make such an exception, is highly unpredictable. Various explanations for the findings are discussed. © 2010 Elsevier Ireland Ltd. All rights reserved. 1. Introduction In the Netherlands euthanasia is defined as termina- tion of life by a doctor at the patient’s request. The Dutch Euthanasia Act (2002) allows a medical doctor to grant a request for euthanasia by a patient under strict circum- stances The Act does not entail a ‘right to euthanasia’, since doctors may always refuse a request. Neither did the Act change the legal status of euthanasia, which remains a criminal offence except for a doctor who complied with all six statutory criteria for due care (see Box 1 ). * Corresponding author. Tel.: +31 50 363 2848; fax: +31 50 363 3059. E-mail address: d.g.van.tol@med.umcg.nl (D. van Tol). 1 Part of the study was done while he worked at Erasmus MC, University Medical Center Rotterdam, Departments of Medical Ethics/Public Health, Rotterdam, The Netherlands. When a doctor decides to grant a euthanasia request, strict procedures must be followed afterwards. First, the coroner has to be notified. The coroner then reports the case to one of the five regional review committees (RRCs), who assess if the due-care criteria were met. If this is not the case, the public prosecutor is notified who in the end may decide to prosecute the doctor. In the years 2003–2005 the RRCs decided not all criteria were met in 0.3% of all reported cases (15 of 5.634 cases). None of these led to actual prosecution [1]. A pivotal due-care criterion for lawful euthanasia is that the doctor must reach the conclusion that the patient who requests his life to be ended, suffers ‘unbearably’ (‘ondraaglijk’) and hopeless (‘uitzichtloos’). The criterion has not been defined in the law text. Despite its importance, surprisingly little is written about the suffering criterion. The annual reports of the RRCs give some clues about 0168-8510/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.healthpol.2010.04.007