percentage of 63% of all reported psychiatric euthanasia cases between 2011 and 2014. Between 2015 and 2017, the publication percentage lowered to 22%. Categorization of patient characteristics The 35 included reports were analyzed on the patient’s age, sex, psychiatric classification, and somatic comorbidity. We used the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition Text Revision (DSM-IV-TR) criteria to classify the psychiatric disorders because this was still the most frequently used version in the Netherlands between 2015 and early 2017. However, in anticipation of the DSM-5, we did not count obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) under the anxiety disorders because they are currently part of different chapters. (American Psychiatric Association, 2000, 2013) Although dementia is in the DSM, it lies beyond the scope of this study. On the RTE website, dementia is a separate domain, and in our results, we categorize it as a comorbid somatic disorder. The RTE reports are in essence non-medical documents, meaning that often psychiatric and medical terms got translated. When terms like ‘complaints’ or ‘traits’ were used, we did factor them in, reasoning that only clinically relevant information will make it into these highly condensed summaries. We do, however, mention them separately in Table 1. Categorization of physician involvement We looked at the number of independently consulted physicians and psychiatrists, and the involvement of the EOL-clinic. We also screened the reports for disagreement among physicians about the prospect of improvement and mental competence. The reports were only categorized as containing disagreement if both screening authors agreed that this was clear from the text (SvV and FW). Selection of case reports We selected the highlighted cases by means of discussion between the authors. The first case was selected for being a ‘typical’ example, based on its patient and process characteristics. The second case was the only one not meeting due diligence requirements according to the RTE. The third case shows how complicated the PAD process can be and how this affects the RTE judgment. All reports can be found on the RTE website. (RTE, 2017) RESULTS Patient characteristics 77% of the patients were women. 74% were older than 50. 51% of all patients were between 50 and 70 years old and 17% were between 80 and 90 (Figure 1). Patients were EUTHANASIA OF DUTCH PATIENTS WITH PSYCHIATRIC DISORDERS BETWEEN 2015 AND 2017 | 41 3
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