Presence and procedure: Experiencing relationality between patients, relatives and healthcare professionals in Dutch euthanasia requests

BACKGROUND: In Dutch euthanasia practice, the relationship between healthcare professionals, patients, and, when present, the patient's close circle plays an important role. However, neither the Dutch Euthanasia Act nor current guidelines or empirical studies provide detailed insight into how these actors navigate the process or experience decision-making. Therefore, we aim to explore how these relationships are experienced throughout the euthanasia process. METHODS: We conducted a phenomenologically inspired, multiperspective and longitudinal study. Nine groups consisting of a patient, relative and one or two healthcare professionals were included (n = 31). A total of 43 interviews and 18 observations of the assessment of the euthanasia request were conducted. Analysis was done using a phenomenological guide for multiperspective and longitudinal research. RESULTS: Participants experienced the emerging relationship in diverse ways, reflecting an ongoing process of relational enactment rather than fixed outcomes. They reported experiences of feeling support, care, empowerment, instrumentalization, guidance, and legal or procedural framing. These experiences varied in intensity and could shift over time, differing between participants and across groups. DISCUSSION: Participants' experiences were shaped by how the euthanasia request was assessed, rather than by what was assessed. Euthanasia practice should thus not solely be understood in terms of compliance with legal criteria, but shaped by how these criteria are enacted and experienced within relational encounters. This highlights that the euthanasia process unfolds within a relational field in which legal, professional, and interpersonal dimensions are inextricably intertwined, and is best understood as a triadic configuration involving patients, their close circle, and healthcare professionals.