Objective: To explore what Dutch general practitioners (GPs) need and what their felt responsibilities and considerations are during (decision-making for) physician assisted dying (PAD) in the context of palliative care in the home-setting.
Design: A qualitative interview study was performed as part of a larger interview-study exploring the experiences of patients, relatives, and other care-professionals with PAD.
Method: Purposive sampling was adopted to select eleven GPs with experience in end-of-life decision-making and with sufficient variety on the domains of age, gender, work setting and additional expertise. Narrative interviews were conducted by a GP-researcher. Interviews were transcribed, anonymized and analyzed through narrative thematic analysis. A member check with participants was performed.
Results: GPs mentioned corresponding needs on the personal level, in the interaction with patients and families, and on an organizational/societal level. Similar examples of complicating family-dynamics were described. Meanwhile, different considerations emerged in relation to how to act and what to take responsibility for during PAD, such as GPs' own life views, sort/duration of treatment relationships, and care for relatives. Last, casuistry of PAD-requests of patients with metastasized cancer emerged - in theory the least controversial cases - in which specific circumstances made GPs again (re)consider their responsibilities and boundaries.
Conclusion: This study provides new insight into what matters for Dutch GPs while trying to realize 'good euthanasia-care' in the home-setting. The study raises important questions about the position of GPs, the conditions under which they need to operate, and what reasonably may be expected of them.