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How euthanasia rates vary across The Netherlands

Friday January 15th 2021

Regions of The Netherlands have recorded a seven-fold unexplained variation in euthanasia rates, according to new analysis published today.

Researchers from the Radboud Institute for Health Sciences/Scientific Centre for Quality of Healthcare at Radboud University Medical Centre, Nijmegen, say it is not clear if the different rates identified across the country are due to underuse, overuse, or even misuse.

The Netherlands was the first country in the world to legalise euthanasia and physician-assisted suicide, introducing preliminary legislation in 1994, which was followed by a fully fledged law in 2002.

Official data show that the number of euthanasia cases has risen since 2006, reaching 6,361 in 2019, accounting for 4% of deaths. This has more than doubled since 2002.

Researchers analysed national insurance data, covering all healthcare claims for the 12 months preceding the deaths of Dutch residents between 2013 and 2017, and found 25,979 claims for euthanasia that was carried out by family doctors, which accounted for 85% of all euthanasia cases.

They found that slightly more men than women opted for the procedure every year and the average age increased from 71 in 2013 to 73 in 2017.

Writing in BMJ Supportive & Palliative Care, the authors say the regions with the highest proportion of euthanasia cases as a proportion of all deaths had about five times more euthanasia deaths than in the regions with the lowest.

The ratio decreased over the five-year study period - but, they say, this is due to a sharper increase in the ratio in areas with relatively low rates of euthanasia than in regions with higher rates.

They also found differences between the three largest cities in the Netherlands: in Amsterdam, in the three districts with highest rates of euthanasia, the proportion of these deaths was between just under 12% and about 14.5%, higher than in Rotterdam, where the proportion remained at about 6%.

In The Hague, the proportion of euthanasia deaths in the three districts with the highest rates rose from nearly 7.5% to more than 11%.

The rate in the top three municipalities was 25 times higher than that of the bottom three over the five year analysis period.

After accounting for a number of factors, including household income, religious beliefs and political views, the researchers found a seven-fold geographical difference in rates of euthanasia across the country, for which there was no obvious explanation.

“The unexplained part of the variation may include the possibility that part of the euthanasia practice may have to be understood in terms of underuse, overuse or misuse,” write the researchers.

Although this is an observational study, they add: “We think our findings have potential relevance for countries that have already legalised assisted dying — Belgium, Luxembourg, Columbia, Canada, Western Australia and ten US states — and for countries currently considering legalising it, such as Spain, New Zealand, Germany and Portugal.”

Groenewoud AS, Atsma F, Arvin M et al. Euthanasia in the Netherlands: a claims data cross-sectional study of geographical variation. BMJ Supportive & Palliative Care 15 January 2021; doi 10.1136/bmjspcare-2020-002573


Tags: Europe | General Health

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