PubMed Health⌕ Search

Biomedical subjects

G van der Wal

Publications and source records attributed to G van der Wal.

At least 91 records · Page 5Linked to original sources
PubMed1997

Euthanasia and old age.

OBJECTIVE: to obtain insight into the relationship between euthanasia/physician-assisted suicide (EAS) and the age of patients to whom it was administered. DESIGN: a descriptive retrospective study. SAMPLE: cases of EAS reported between 1984 and 1993, in the province of North Holland in The Netherlands. These data are not available for the rest of The Netherlands. RESULTS: between 1984 and 1993, 1707 cases of EAS were reported to the Public Prosecutor in North Holland. The average age of the female patients to whom EAS was administered was 65 years; for men the average age was 62. For both men and women EAS was most frequently performed in the age-categories of 60-69 years and 70-79 years. Cancer and cerebrovascular accidents were positively related to age, while AIDS and multiple sclerosis were negatively related to age. In all physician reports the number of cases of EAS increased until the age-category of 70-79 years, after which EAS was less frequently performed by general practitioners, but more frequently by nursing-home physicians. In the age-groups of 70-79 years and 80 years and over the number of cases of EAS increased over the years. There were differences in the distribution of age between the patients to whom EAS was administered and all deaths. In the younger age-groups EAS was performed relatively more frequently, while the lowest percentage was found in the group aged 85 years and over. CONCLUSION: the suggestion that EAS is mainly performed among elderly people in The Netherlands is not supported by our study.

Age Factors↗
PubMed1997

Late termination of pregnancy in North Holland.

OBJECTIVES: To estimate the extent to which late termination of pregnancy (gestational period > 24 weeks) is practised, to find out what fetal diseases and abnormalities lead to termination and to obtain insight into the clinical judgement and decision-making process by gynaecologists with regard to termination. DESIGN: A retrospective study. PLACE: Province of North Holland, The Netherlands. METHODS: An anonymous printed questionnaire, was sent to all associations or departments of gynaecology in the 21 hospitals in North Holland. The period of study covered the years 1990 to 1994. RESULTS: Completed questionnaires were received from 19 associations or departments in the 21 hospitals (90% response). In the five-year period under study in 14 of these hospitals had terminated 103 pregnancies beyond the 24th week of gestation. Antenatal sonography had been performed on all these pregnancies. Anencephaly was diagnosed before termination in 21% and severe chromosomal defects in a further 21%. Other severe abnormalities were neural groove defects, such as hydrocephaly and/or spina bifida (16%), no renal function (12%) and skeletal abnormalities (11%). In 87% the antenatal diagnosis was verified postnatally; in 78% this was done by autopsy. The diagnosis was confirmed in all these cases ('almost confirmed' in two cases). In every case the pregnant woman herself had asked for her pregnancy to be terminated. In 78% the prognosis was discussed with other medical specialists and the professionals concerned with management; there was a consultation about the termination in 91% of the cases. A report was always compiled for the medical records. CONCLUSION: Late termination of pregnancy is practised on a substantial scale in North Holland. The reasons for termination were severe structural abnormalities which, in most cases, were not compatible with survival. The gynaecologists in North Holland dealt prudently and responsibly with late termination of pregnancy, although they did not always adhere to the guidelines set out in the 1994 report of the Netherlands Association for Obstetrics and Gynaecology.

Abortion, Induced↗
PubMed1997

Active voluntary euthanasia or physician-assisted suicide?

OBJECTIVE: To find out why Dutch general practitioners (GPs) and nursing home physicians (NHPs), and patients (according to their physician) opt for active voluntary euthanasia rather than for physician-assisted suicide, or vice-versa. DEFINITIONS: The following definitions were used in the study: Euthanasia is the intentional termination of life, by someone other than the patient, at the patient's request; physician-assisted suicide is intentionally helping a patient to terminate his or her life at his or her request. DESIGN: Two descriptive, retrospective studies. SETTING: The Netherlands. METHOD: Data were collected by means of anonymous questionnaires sent to a random sample of 521 GPs from the province of North Holland, 521 GPs from the rest of the Netherlands, and all 713 NHPs who were members of the Dutch Association of Nursing Home Physicians. Data were collected over the period 1986-1989 (inclusive) for GPs and the period 1986-June 1990 (inclusive) for NHPs. RESULTS: Forty-eight percent of the Gps, 78% of the NHPs, and about half of the patients who opted for euthanasia did so because of the physical condition of the patient. The reason GPs, NHPs, and patients gave most often for opting for physician-assisted suicide was that they wanted 'as far as possible to let the patient bear the responsibility.' CONCLUSION: In 38% of all cases for GPs and 57% of all cases for NHPs, only active voluntary euthanasia could be performed because of the patient's condition. In the other cases, where there was a choice, most GPs performed euthanasia, while most NHPs assisted in suicide. Active voluntary euthanasia was chosen primarily for medico-technical reasons, whereas physician-assisted suicide was selected primarily for moral reasons.

Adult↗
PubMed1997

Euthanasia in family practice in The Netherlands. Toward a better understanding.

OBJECTIVE: To describe the incidence of euthanasia and assisted suicide in family practice in the Netherlands, the reasons for its practice, and the characteristics of patients and physicians involved. DESIGN: Cross-sectional survey of a random sample of Dutch family physicians. SETTING: General practices in The Netherlands. PARTICIPANTS: An anonymous questionnaire was mailed to 1042 general practitioners. Of the 996 eligible physicians, 667 (67%) completed the questionnaire. MAIN OUTCOME MEASURES: Reported practices and beliefs concerning euthanasia and assisted suicide. RESULTS: In the course of an average year, 24% of Dutch family physicians had practised euthanasia or assisted suicide. Most deaths took place at home in the presence of others. According to the physicians, the most important reasons for the request were futile suffering, fear or avoidance of loss of dignity, and unbearable suffering. Euthanasia or assisted suicide was mostly (85%) administered to patients with malignant neoplasms. Physicians were more opposed to euthanasia and assisted suicide if they had never practised it, if they had a religious affiliation, and if they were older. CONCLUSIONS: This study presents empiric data about euthanasia and assisted suicide in the context of a permissive euthanasia policy. Understanding Dutch practices could be helpful for Canadians. However, each country needs to resolve these issues in its own way.

Adult↗
PubMed1996

[Medical disciplinary jurisprudence in The Netherlands; a 10-year review].

OBJECTIVE: To obtain information about the nature and the number of complaints, the complainants and the accused health professionals and about the sanctions imposed by the Dutch medical disciplinary courts. DESIGN: Descriptive, retrospective study. SETTING: Inspectorate for Health Care, Rijswijk, the Netherlands. METHODS: All verdicts (n = 5333) given by the 5 medical disciplinary courts of first instance in the period 1983-1992 and the appeals arising from these verdicts were studied using the data of the Inspector in chief. These were related to the total number of practising clinicians obtained from the Inspectorate, the Royal Dutch Medical Association and Statistics Netherlands. The year of each verdict was noted, the number and nature of the verdicts, the categories of complainants and accused, the number of appeal cases and their consequences. RESULTS: The number of complaints doubled in the period under study, rising from 379 to 720 per annum. Most of the complaints (92%) were against doctors, but the number of complaints were divided very unevenly over the clinical specialists. A large number of the complaints concerned 'lack of care or inadequate care' (27%), or 'incorrect treatment' (22%). Of all complaints 20% led to a sanction, mostly a warning (62%). Appeals were lodged against 29% of the verdicts. In 22 cases the licence to practice was withdrawn definitively. CONCLUSIONS: Although the number of complaints increased over the study period, there was no reduction in the seriousness of the complaints. The effect of the disciplinary jurisdiction on the quality of care has not yet been adequately investigated.

Humans↗
PubMed1996

Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands, 1990-1995.

BACKGROUND: In 1991 a new procedure for reporting physician-assisted deaths was introduced in the Netherlands that led to a tripling in the number of reported cases. In 1995, as part of an evaluation of this procedure, a nationwide study of euthanasia and other medical practices concerning the end of life was begun that was identical to a study conducted in 1990. METHODS: We conducted two studies, the first involving interviews with 405 physicians (general practitioners, nursing home physicians, and clinical specialists) and the second involving questionnaires mailed to the physicians attending 6060 deaths that were identified from death certificates. The response rates were 89 percent and 77 percent, respectively. RESULTS: Among the deaths studied, 2.3 percent of those in the interview study and 2.4 percent of those in the death-certificate study were estimated to have resulted from euthanasia, and 0.4 percent and 0.2 percent, respectively, resulted from physician-assisted suicide. In 0.7 percent of cases, life was ended without the explicit, concurrent request of the patient. Pain and symptoms were alleviated with doses of opioids that may have shortened life in 14.7 to 19.1 percent of cases, and decisions to withhold or withdraw life-prolonging treatment were made in 20.2 percent. Euthanasia seems to have increased in incidence since 1990, and ending of life without the patient's explicit request to have decreased slightly. For each type of medical decision except those in which life-prolonging treatment was withheld or withdrawn, cancer was the most frequently reported diagnosis. CONCLUSIONS: Since the notification procedure was introduced, end-of-life decision making in the Netherlands has changed only slightly, in an anticipated direction. Close monitoring of such decisions is possible, and we found no signs of an unacceptable increase in the number of decisions or of less careful decision making.

Data Collection↗
PubMed1996

Evaluation of the notification procedure for physician-assisted death in the Netherlands.

BACKGROUND: In the Netherlands, a notification procedure for physician-assisted death has been in use since 1991. It requires doctors to report each case to the coroner, who in turn notifies the public prosecutor. Ultimately, the Assembly of Prosecutors General decides whether to prosecute. Although physician-assisted death remains technically illegal, doctors are extremely unlikely to be prosecuted if they comply with the requirements for accepted practice. In 1995, the ministers of health and justice commissioned an evaluation to determine the adequacy of the notification procedure. METHODS: A random sample of 405 physicians were interviewed. We also interviewed 147 physicians who had reported cases of physician-assisted death and 116 coroners, and we reviewed 353 judicial files of reported cases. In addition, we interviewed 48 public prosecutors and reviewed the minutes of the Assembly of Prosecutors General for 1991 to 1995 and all published court decisions from 1981 through 1995. RESULTS: In 1995, about 41 percent of all cases of euthanasia and physician-assisted suicide were reported. There were no major differences between reported and unreported cases in terms of the patients' characteristics, clinical conditions, or reasons for the action. Most patients had cancer and were described as suffering "unbearably" and 'hopelessly." Of the 6324 cases reported during the period from 1991 through 1995, only 13 involved prosecution of the physician. The majority of respondents in the groups interviewed thought that all cases of physician-assisted death should be reviewed, although most doctors thought the review should be performed by other doctors, and there was substantial concern about the burden associated with the reporting procedure. CONCLUSIONS: Substantial progress in the oversight of physician-assisted death has been achieved in the Netherlands. The reporting procedure could be more streamlined and less threatening.

Attitude of Health Personnel↗
PubMed1996

[Late pregnancy interruption in Noord-Holland. I. Incidence and abnormalities].

OBJECTIVE: To gain insight into the extent to which late termination of pregnancy (gestational age > 24 weeks) is practised and to find out what foetal diseases and abnormalities lead to termination. DESIGN: An exploratory, descriptive, retrospective study. SETTING: Province of North Holland, the Netherlands. METHODS: An investigation, based on an anonymous printed questionnaire, was conducted among all associations/departments of gynaecologists in the 21 hospitals in North Holland. The period of study covered the years 1990 to 1994 inclusive. RESULTS: Replies, in the form of completed questionnaires, were received from 19 associations/departments in the 21 hospitals (90% response). In the five-year period under study 103 pregnancies in 14 of the hospitals were terminated beyond the 24th week. In 21% of the cases anencephaly was diagnosed prior to the termination; another 21% of the foetuses were diagnosed as having severe chromosomal defects. Other severe abnormalities were neural groove defects like hydrocephaly and/or spina bifida (16%), no renal function (12%) and skeletal abnormalities (11%). CONCLUSION: Late termination of pregnancy appears to be practised on a substantial scale, at any rate in North Holland. The reasons for termination are severe structural abnormalities which in most of the cases are not compatible with extrauterine survival.

Abnormalities, Multiple↗
PubMed1996

[Late pregnancy interruption in Noord-Holland. II. Carefulness before and review afterwards].

OBJECTIVE: To gain insight into the carefulness of medical activity in late termination of pregnancy, and into gynaecologists' relevant views. DESIGN: A descriptive, partly cross-sectional, partly retrospective study. SETTING: Province of North Holland, The Netherlands. METHOD: An anonymous written inquiry was conducted among all individual obstetrically active gynaecologists and all associations/departments of gynaecology in the 21 hospitals in North Holland. The study period covered the years 1990-1994 inclusive. RESULTS: Replies were obtained from 19 associations/departments of the 21 hospitals and from 83% of the obstetrically active gynaecologists (77/93). Activity had been careful in the vast majority (93%) of the 103 reported cases of late termination of pregnancy: the diagnosis was definite prenatally and verified postnatally; consultation about termination was conducted in 91%; reports were made in all cases. Most responding gynaecologists had performed late termination of pregnancy (44/77). Sixty-eight percent of these were of the opinion that a death certificate had to be issued, as against 30% of those who had not performed late terminations of pregnancy (9/30). A death certificate was issued in 88% of the cases of termination. Sixty-eight percent of the respondents with a view to external quality control and subsequent review had opted for a national committee of experts from the profession, in some cases supplemented with experts from outside the profession, plus supervision by the Health Care Inspectorate. CONCLUSION: Gynaecologists in North Holland in general acted carefully regarding late termination of pregnancy, although they did not always observe the guidelines issued by their professional association.

Abortion, Eugenic↗
PubMed1996

Policies on medical decisions concerning the end of life in Dutch health care institutions.

OBJECTIVE: To describe the prevalence and some features of policies on medical decisions concerning the end of life (MDELs) in Dutch hospitals, nursing homes, and institutions for the mentally disabled. DESIGN: A cross-sectional descriptive postal survey of 558 Dutch health care institutions. SETTING: All Dutch hospitals, nursing homes, and general institutions for the mentally disabled. PARTICIPANTS: Directors of patients care of the institutions. MAIN OUTCOME MEASURES: Respondents' reports on the existence of policies and guidelines on the following MDELs: euthanasia/assisted suicide (EAS), life-terminating acts without explicit request of the patient, refusal of treatment by patient, withholding or withdrawing treatment, symptom and pain control, and do-not-resuscitate (DNR) decisions. RESULTS: Of 558 health care institution managers, 86% responded. Most of the hospitals (69.2%) and nursing homes (73.9%) but only 16.3% of the institutions for the disabled had a written EAS policy. Nursing homes with a ban on EAS often had religious affiliations. In 37% of nursing homes, 15% of hospitals, and 15% of institutions for the disabled, the management had written policies on terminating life without request. Sixty percent of the hospitals, 35% of the nursing homes, and 17% of the institutions for the disabled had guidelines for one or more of four other distinct MDELs. Forty-five percent, 20%, and 8% of hospitals, nursing homes, and institutions of mentally disabled, respectively, had guidelines on DNR decisions. The management of 89% of the hospitals and 94% of the nursing homes communicated their policies on EAS to physicians and nurses in their institutions without being asked. Far fewer of these hospitals (3.9%) and nursing homes (30.5%) made their policies on EAS known to patients without being asked. CONCLUSIONS: This study indicates that an important step toward policy development on EAS has been made by Dutch hospitals and nursing homes. Particularly with respect to policies on such decisions as withholding or withdrawing treatment, symptom and pain control, and DNR orders, an unexplored field is open to management for policy development in the Netherlands.

Cross-Sectional Studies↗
PubMed1996

The role of the social network in active euthanasia and physician-assisted suicide.

OBJECTIVE: To obtain insight into the involvement of a patient's social network in the process leading to the administration of euthanasia and assisted suicide (EAS). DESIGN: Descriptive, retrospective. METHOD: Data were collected by means of anonymous questionnaires sent to a random sample of 521 general practitioners (GPs) in the Province of North Holland and 521 GPs from the rest of the Netherlands and all 713 Dutch nursing home physicians (NHPs). The data were collected over the period 1986 to June 1990 inclusive. RESULTS: GPs and NHPs had discussions most often with the partner of the patient about the patient's request for EAS, the doctor's intention to administer EAS and the actual administering of EAS. According to both the GPs and the NHPs the social network practically always agreed with the doctor's decision to administer EAS. The persons who were most often present at the patient's bedside when EAS was administered were the patient's partner and children (29%). Often, especially in the cases of GPs, the decision not to report EAS was determined by the desire of relatives and/or the physician not to involve the relatives in a judicial inquiry. CONCLUSION: To a large extent the social network was involved in the patient's request for EAS, the doctor's intention to administer EAS and the actual administering of EAS. This seems to be important both for good decision-making with regard to EAS and for helping relatives to come to terms with the loss of a dear one.

Communication↗
PubMed1996

Voluntary active euthanasia and doctor-assisted suicide: knowledge and attitudes of Dutch medical students.

The objective of the study was to gain insight into the knowledge of and attitudes towards voluntary active euthanasia and doctor-assisted suicide (EEDAS) of Dutch medical students, and to determine whether knowledge and attitudes change after a 1-day informative conference about EDAS. Data were collected by means of two self-administered questionnaires. Questionnaire 1 had to be completed before the start of the conference and questionnaire 2 after the conference. In both questionnaires, students were asked by means of two open-ended questions to define euthanasia and doctor-assisted suicide. They were also asked to indicate which of eight statements met with the requirements for prudent practice. Finally, the students were asked to what extent they agreed or disagreed with each of seven statements about attitudes towards EDAS. To determine if a selection occurred among students who returned both questionnaires, their background characteristics, and knowledge and attitudes towards EDAS were compared with those who returned only the first questionnaire. Forty-seven students returned only the first questionnaire, while both questionnaires were returned by 137 students. No differences were found between students who returned both questionnaires and those who returned only the first questionnaire with regard to age, religion, knowledge of and attitudes towards EDAS. Students' knowledge of the definitions of EDAS and the requirements for prudent practice improved significantly. Students' reactions to the statements on attitudes towards EDAS showed that a large majority had a fairly positive attitude towards EDAS. There was no significant difference before and after the conference. Male students and students with a religion were more opposed to EDAS than female students and students without a religion. The fact that the students' knowledge of EDAS improved after a 1-day conference does not imply sufficient understanding of the issue. Because EDAS is allowed only under strict conditions in the Netherlands, medical students require special training. Only then will they be equipped to deal with requests for EDAS during their future careers.

Adolescent↗
PubMed1995

Attitudes of Dutch general practitioners and nursing home physicians to active voluntary euthanasia and physician-assisted suicide.

OBJECTIVE: To gain insight into the attitudes of Dutch general practitioners and nursing home physicians to voluntary active euthanasia and physician-assisted suicide. DESIGN: Descriptive study. METHOD: Data were collected by means of anonymous postal questionnaires to be completed by a random sample of 521 general practitioners from the province of North Holland, 521 general practitioners from the rest of the Netherlands, and 713 Dutch nursing home physicians who were members of the Dutch Association of Nursing Home Physicians. RESULTS: The written responses of general practitioners and nursing home physicians to six statements about voluntary active euthanasia and physician-assisted suicide showed that a large majority had a fairly positive attitude to euthanasia and suicide. This finding also emerged from the scores obtained on a scale compiled on the basis of the statements. General practitioners and nursing home physicians were more opposed to euthanasia and physician-assisted suicide if they had never performed it, if they belonged to a religious group, or if they were older. CONCLUSION: Dutch general practitioners and nursing home physicians have a fairly positive attitude toward euthanasia and physician-assisted suicide. However, the majority of these physicians favor a policy of voluntary active euthanasia and physician-assisted suicide under strict conditions.

Age Factors↗
PubMed1995

Handling complaints in hospitals.

GOAL: To find out about complaints procedures in hospitals in North-Holland and to determine to what extent they function independently. METHOD: All 21 hospitals were visited between the spring of 1992 and the autumn of 1993. Before the visit took place the hospital management had to complete and return a questionnaire relating to the complaints procedure in that hospital. RESULTS: All except two hospitals had rules for dealing with complaints. In 18 hospitals there was a complaints committee; in 12 of these the management was not--or was no longer--involved. The element of independence was expressed in a great variety of ways. In a quarter of the hospitals complaints were often not dealt with within two months. DISCUSSION: The situation with regard to complaints procedures in hospitals in North-Holland is definitely improving. Some hospitals, however, are much more successful than others in meeting the criteria for an adequate complaints procedure. There is room for improvement in two particular areas; complaints should be handled more promptly and independently.

Communication↗