77 Attitudes towards end-of-life decision making among the Dutch population

<h3>Background</h3> Advance care planning is aimed at respecting patients’ autonomy and enabling them to self-determine their care in the last phase of life. Physician-assistance in dying could be seen as an ultimate expression of self-determination at the end of life and is a legalized option in the Netherlands. <h3>Aim</h3> The aim of this study was to gain insight into citizens’ views on end-of-life decision-making and to explore which characteristics are associated with their preferences for self-direction at the end of life. <h3>Methods</h3> We conducted a cross-sectional questionnaire study among a representative sample of the Dutch population aged 18 years and older. The questionnaire included 18 statements (5-point Likert scale) about end-of-life decision-making. Through factor analysis, statements were selected that, in conjunction, represented the degree of preference for ‘self-direction in end-of-life decisions’ [range 14–70]. A Two-way ANOVA test was performed to see which characteristics were associated with citizens’ preference for self-direction. <h3>Results</h3> The response rate was 75%, (n=1097). The majority of citizens agreed that every person has the right to make their own decisions about their life and death (60%) and that every person should have the right to receive physician-assistance in dying if that is what they want (68%). Citizens were less likely to agree that assistance in suicide requires less stringent rules than euthanasia (18%) and that someone other than a physician may provide assistance in suicide (21%). The majority also approved the Euthanasia Expertise Center to provide physician-assistance in dying in case one’s own physician is unwilling to do so (69%). Citizens with a higher education level, no migration background and no religion had a significantly stronger preference for self-direction in end-of-life decision making than citizens with a lower education level, a migration background and a religion, respectively. <h3>Discussion</h3> Citizens generally value self-direction in end-of-life decisions, but also consider the physician’s role in carrying out the termination of life important. <h3>Unique Contribution</h3> Advance care planning is often focused at enabling people to self-determine the treatment and care they receive in the last phase of life. The option of physician-assistance in dying is a far-reaching form of self-termination that is discussed in many countries. The Netherlands has a relatively long history of providing that option, which enables us to study citizens’ preferences in this area. <h3>Implications</h3> Preferences to self-determine the end of life do not preclude citizens’ appreciation of involvement of physicians in end-of- life decision making.