[Written advance euthanasia directives in mentally incompetent patients with dementia: a systematic review of the literature].

OBJECTIVE

To present the knowledge, experiences and attitudes of the general population, patients, relatives and health care professionals concerning written advance euthanasia directives in patients who have become mentally incompetent.

DESIGN

Systematic review of the literature.

METHOD

We systematically searched Medline, Cochrane Library and Embase for articles published in the period 2002-2016.

RESULTS

The search yielded 775 articles, of which 11 met the inclusion criteria. Six studies had a quantitative design, four studies had a qualitative design and one a combination of both. Nine articles included patients with advanced dementia, two included patients with Huntington's disease. Patients, their relatives and the general population appear to have limited knowledge about written advance euthanasia directives. However, most of them were open to the practice of euthanasia based on a written advance directive. Few persons and patients had written a euthanasia directive and if they had, it was not always discussed with health care professionals. The majority of health care professionals thought - incorrectly - that euthanasia based on a written advance euthanasia directive is not permitted. Some of them had a positive attitude towards written advance euthanasia directives, and a very small number would be prepared to carry out euthanasia on the basis of a written directive. In practice, there are very few who have actually done so.

CONCLUSION

There is fairly wide support from the general population and empathy from health care professionals for the idea that euthanasia based on a written advance euthanasia directive of a mentally incompetent patient should be possible. Even so, there is a discrepancy between the expectations of the general population and what health care professionals think they can actually do in this situation.