Intended for healthcare professionals


Effects of euthanasia on the bereaved family and friends: a cross sectional study

BMJ 2003; 327 doi: (Published 24 July 2003) Cite this as: BMJ 2003;327:189
  1. Nikkie B Swarte (n.swarte{at}, research fellow1,
  2. Marije L van der Lee, research fellow2,
  3. Johanna G van der Bom, assistant professor of clinical epidemiology3,
  4. Jan van den Bout, professor of clinical psychology2,
  5. A Peter M Heintz, professor of gynaecological oncology1
  1. 1 Department of Gynaecology, F05.829, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, Netherlands
  2. 2 Department of Clinical Psychology, University of Utrecht
  3. 3 Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht
  1. Correspondence to: Nikkie B Swarte
  • Accepted 17 June 2003


Objective To assess how euthanasia in terminally ill cancer patients affects the grief response of bereaved family and friends.

Design Cross sectional study.

Setting Tertiary referral centre for oncology patients in Utrecht, the Netherlands.

Participants 189 bereaved family members and close friends of terminally ill cancer patients who died by euthanasia and 316 bereaved family members and close friends of comparable cancer patients who died a natural death between 1992 and 1999.

Main outcome measures Symptoms of traumatic grief assessed by the inventory of traumatic grief, current feelings of grief assessed by the Texas revised inventory of grief, and post-traumatic stress reactions assessed by the impact of event scale.

Results The bereaved family and friends of cancer patients who died by euthanasia had less traumatic grief symptoms (adjusted difference −5.29 (95% confidence interval −8.44 to −2.15)), less current feeling of grief (adjusted difference 2.93 (0.85 to 5.01)); and less post-traumatic stress reactions (adjusted difference −2.79 (−5.33 to −0.25)) than the family and friends of patients who died of natural causes. These differences were independent of other risk factors.

Conclusions The bereaved family and friends of cancer patients who died by euthanasia coped better with respect to grief symptoms and post-traumatic stress reactions than the bereaved of comparable cancer patients who died a natural death. These results should not be interpreted as a plea for euthanasia, but as a plea for the same level of care and openness in all patients who are terminally ill.


  • Contributors NBS participated in designing the protocol, collected data, and participated in data analysis and interpretation. MLvdL participated in the data analysis and interpretation and in revising the manuscript. JGvdB participated in designing the protocol, data interpretation, and writing and revising the manuscript. JvdB initiated and designed the protocol, and participated in writing and revising the paper. APMH participated in the design of the protocol and revising the manuscript. APMH is guarantor for the paper.

  • Funding The study was funded by the Department of Gynaecology, University Medical Center Utrecht, and by the Research Institute for Psychology and Health.

  • Competing interests None declared.

  • Ethical approval The study was approved by the Medical Ethics Committee of the University Medical Center Utrecht.

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