Major regional differences in approved euthanasia requests

There are major regional differences in how many euthanasia requests are granted in the Netherlands, according to research by Radboud UMC in Nijmegen and the Protestant Theological University in Groningen. The percentage of euthanasia deaths in some municipalities is 25 percent higher than others, Nieuwsuur reports. 

The researchers looked at euthanasia figures up to 2017, the most recent available. In that year, euthanasia was used in 4.4 percent of deaths in the Netherlands. 

Euthanasia was most often used in postcode area 13, the area around Almere, in 2017. In that area, euthanasia was involved in 7.37 percent of all deaths. Almost the entire Kop van Noord-Holland is in the top 10 of most granted euthanasia requests. Postcode area 91, which includes Ameland, Schiermonnikoog and Dokkum, had the lowest percentage of euthanasia deaths at 2.15 percent. 

The differences are even greater at municipal level. In Almere, euthanasia was about four times more common between 2013 and 2017 than in 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," health scientist and medical ethicist Stef Groenewoud said to the program. He did this study with ethicist Theo Boer.

The researchers found that religion clearly plays a role in how common euthanasia is in an area. The Bible Belt, a strip of municipalities with many Christian residents, had much fewer cases of euthanasia than less religious municipalities. "You see that euthanasia is less common in the entire region of Zeeland, Zuid-Holland, across the Veluwe to the northeast of the Netherlands," Groenewoud said.

In addition to religion, the researchers also found a correlation between euthanasia and political preference, the health of the residents, and the social cohesion in an area. After they correct their results for these factors, euthanasia was still 7 percent more likely in in the municipalities at the top of the list and those at the bottom. 

Groenewoud and Boer did not find a clear explanation for that difference. "Regional customs" may have developed around euthanasia, Boer speculated. "Just as people, so to speak, drink Berenburg in Friesland and it boluses in Zeeland, it may be that in certain parts of the Netherlands people use euthanasia more."

They would like to continue this study, working with general practitioners. "It is important to understand why people resort to euthanasia quite en masse in certain areas and not in other areas," Boer said.