Intentionally ending one's own life in the presence or absence of a medical condition: A nationwide mortality follow-back study

In the Netherlands, people who wish to intentionally end their own life can request for physician assistance in dying (PAD). Having a classifiable medical condition is a prerequisite to receive PAD. Some people, either in the presence or absence of a medical condition, choose to end life without assistance from a physician. This study estimates the frequency of people who intentionally ended their own life, and describes their demographic and medical characteristics through a nationwide mortality follow-back study based on questionnaires from certifying physicians of a stratified sample of death certificates of people drawn from the central death registry of Statistics Netherlands (n = 7277). In 1.85% of all deaths in 2015 people intentionally ended their own life; of which 0.50% by voluntarily stopping eating and drinking, 0.20% by self-ingesting self-collected medication, and 1.15% using other methods. Estimating the frequency of suicide is influenced by definitions and the information sources. The great majority of people who ended life by voluntarily stopping eating and drinking were over 80 years old and suffered from an accumulation of health problems related to old age, somatic problems, and/or dementia. People who ended their own life through other methods were mostly under 65 years old and primarily suffered from psychiatric, psychosocial and existential problems. Few people who intentionally ended their own life requested PAD, especially those who suffered from solely psychiatric diseases and those without a medical condition. PAD in the Netherlands is embedded in the medical domain as it is currently understood by Dutch law. This raises the question how to address the desire to die from people whose wish to intentionally end their own life is not rooted in a medical condition and therefore fall outside this medical framework of assistance in dying.