Unexplained variation in regional euthanasia rates in the Netherlands.

Is it underuse, overuse or misuse?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The British Medical Journal (BMJ) recently published a study showing that there is an unexplained 7-fold variation in euthanasia rates across the Netherlands. 

According to the BMJ report, the researchers were not sure if the differences related to "underuse, overuse, or misuse."

The BMJ reported that there were also striking differences between the three largest cities in the Netherlands. The report stated that:

In Amsterdam, in the three districts with highest rates of euthanasia, the proportion of these deaths was between nearly 12% and around 14.5% higher than in Rotterdam, where the proportion remained more or less static at around 6%.

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

Throughout the five years, the rate in the top three municipalities was 25 times higher than that of the bottom three.

The NL Times based their article on postal codes and reported:

Euthanasia was most often used in postcode area 13, the area around Almere, in 2017. In that area, euthanasia was involved in 7.37 percent of all deaths. Almost the entire Kop van Noord-Holland is in the top 10 of most granted euthanasia requests. Postcode area 91, which includes Ameland, Schiermonnikoog and Dokkum, had the lowest percentage of euthanasia deaths at 2.15 percent.

The NL Times reported researchers Theo Boer and Stef Groenewoud saying:

"If we were to do this research for other medical procedures, say cataract operations, you'd rather think of a factor of two or one and a half,"

Researcher did not find a clear explanation for the differences in euthanasia rates but they suggested to the NL Times that it could be based on regional customs. They said: "it may be that in certain parts of the Netherlands people use euthanasia more."

 

According to research 20% - 23% of the Netherlands euthanasia deaths are not reported. A 5 year study sponsored by the Netherlands government that was released in August 2017 showed continued abuse of the law.

Researchers need to further examine the under-reporting, and the development of lax attitudes towards euthanasia in regions of the Netherlands.