The regional differences in euthanasia are large. The percentage of deaths preceded by euthanasia is 25 times higher in some municipalities than in others. That is the outcome of research from the Radboudumc in Nijmegen and the Protestant Theological University in Groningen.
The most recent figures are from 2017. At the time, euthanasia was used in 4.4 percent of deaths in the Netherlands. The researchers wanted to know whether in certain areas more or less euthanasia occurs. And those differences are obvious.
Almere and Dokkum
The researchers included all euthanasia cases reported by GPs. In order not to make the data traceable to individuals, they only publish data on zip code areas. Some small municipalities only have two or three general practices.
If you take the first two digits of all zip codes, you will reach 90 areas. The map below shows how often euthanasia was used in those areas in 2017:
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In the area around Almere, postcode area 13, euthanasia was most often used in 2017: 7.37 percent of all deaths. Furthermore, almost the entire Kop van Noord-Holland is in the top ten. At the bottom of the list is postcode area 91, including Ameland, Schiermonnikoog and Dokkum. Only 2.15 percent of deaths were preceded by euthanasia.
The differences between these areas are much smaller than at municipal level, but still remarkably large, according to the researchers. In Almere, euthanasia is about four times more common from 2013 to 2017 than around Dokkum. “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,” says health scientist and medical ethicist Stef Groenewoud.
Less euthanasia in Biblebelt
He and ethicist Theo Boer wanted to gain insight into where these differences come from. The map above clearly shows that religion plays a role. The Bible Belt is a lot lighter colored. “You see that euthanasia is less common in the entire region of Zeeland, South Holland, across the Veluwe to the northeast of the Netherlands,” says Groenewoud.
In addition to religiosity (how often people go to church), the researchers also found a connection with, among other things, political preference (voting behavior) and the health of residents and the social cohesion in an area. After they corrected their results for all these matters, there was still a difference of factor 7 (instead of 25) between the municipalities at the top and those at the bottom of the list at municipal level.
Boer and Groenewoud cannot yet explain that difference. It may be that they have not taken enough account of religion, for example, Groenewoud emphasizes. “Going to church does not of course say everything about your religious beliefs.”
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If a doctor offers euthanasia more often, patients are more likely to say ‘yes’.
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“Regional customs” may have arisen around euthanasia, says Boer. “Just as people, so to speak, drink Berenburg in Friesland and eat boluses in Zeeland, it may be that in certain parts of the Netherlands people use more euthanasia.”
The main hypothesis the researchers have is that GPs in different regions handle euthanasia differently. Boer: “One explanation could be that doctors in some postal code areas more often offer euthanasia. Then a patient will probably say ‘yes’ more often than if a doctor does not offer it.”
‘Doctors must be cautious’
If that statement is correct, it would be alarming, says Boer. “The pillar on which euthanasia policy rests is the question from the patient. That is sacred. Euthanasia is not normal medical practice, so doctors have to be careful and reserved about it.”
The researchers call for further research, together with general practitioners. Boer: “It is important to understand why people resort to euthanasia quite en masse in certain areas and not in other areas.”
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