• Pauline S C Kouwenhoven, Natasja J H Raijmakers, Johannes J M van Delden, Judith A C Rietjens, Donald G van Tol, Suzanne van de Vathorst, Nienke de Graeff, Heleen A M Weyers, Agnes van der Heide, and Ghislaine J M W van Thiel.
• Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Room number STR.5.133, Internal post number STR.6.131, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands. p.s.c.kouwenhoven@umcutrecht.nl.
• Bmc Med Ethics. 2015 Jan 28; 16: 7.

BackgroundThe Dutch law states that a physician may perform euthanasia according to a written advance euthanasia directive (AED) when a patient is incompetent as long as all legal criteria of due care are met. This may also hold for patients with advanced dementia. We investigated the differing opinions of physicians and members of the general public on the acceptability of euthanasia in patients with advanced dementia.MethodsIn this qualitative study, 16 medical specialists, 19 general practitioners, 16 elderly physicians and 16 members of the general public were interviewed and asked for their opinions about a vignette on euthanasia based on an AED in a patient with advanced dementia.ResultsMembers of the general public perceived advanced dementia as a debilitating and degrading disease. Physicians emphasized the need for direct communication with the patient when making decisions about euthanasia. Respondent from both groups acknowledged difficulties in the assessment of patients' autonomous wishes and the unbearableness of their suffering.ConclusionLegally, an AED may replace direct communication with patients about their request for euthanasia. In practice, physicians are reluctant to forego adequate verbal communication with the patient because they wish to verify the voluntariness of patients' request and the unbearableness of suffering. For this reason, the applicability of AEDs in advanced dementia seems limited.

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