(HealthDay News) – Physicians in the Netherlands are behaving responsibly when it comes to requests for euthanasia and physician-assisted suicide, a new study finds.

“Apparently a large group of physicians is willing and able to follow official requirements (for deciding whether or not to grant a request),” said Bregje D. Onwuteaka-Philipsen, an associate professor of social medicine at VU University Medical Center in Amsterdam. Onwuteaka-Philipsen is co-author of a paper on the topic appearing in the August 8/22 issue of the Archives of Internal Medicine.

The study also found that the decision-making dynamics involved in requests for euthanasia and physician-assisted suicide are extremely complex.

The Netherlands, along with Belgium and the state of Oregon, allow physicians to perform euthanasia or physician-assisted suicide (where doctors supply patients with the pharmaceutical means of death) if specific requirements are met.

According to an accompanying editorial, in the Netherlands, those requirements involve making sure the patient’s request is voluntary and informed; the patient’s suffering is unbearable; and there is no reasonable alternative.

For this study, the researchers asked all general practitioners in 18 of 23 general practice districts in the Netherlands to answer a written questionnaire about requests for euthanasia and physician-assisted suicide received in the past year, and how they had handled those requests. Respondents were also asked to give a detailed description of the most explicit request received in the previous 18 months.

In addition to granting or refusing a request for euthanasia or physician-assisted suicide, several other scenarios can and do arise: Patients can die of natural causes before the act is performed or before the decision has been made one way or another, or the patient can withdraw the request.

In all, 3,614 doctors responded to the questionnaire. Of this total, 44 percent of all requests were granted. In 13 percent of cases, the patient died before the request could be performed. In another 13 percent of cases, the patient died before a final decision had been made. In yet another 13 percent, the patient withdrew the request. And, in 12 percent of cases, the physician refused to honor the request.

Patients making the request cited “feeling bad,” “tiredness” and “lack of appetite” as their main symptoms. “Pointless suffering,” “loss of dignity” and “weakness” were the most frequently cited reasons for making the request.

Patient situations were most likely to meet official requirements when the request was granted, the study concluded.

The authors were most surprised by the finding that one out of eight patients withdrew their request.

“The requests that were included in this study were explicit requests,” Onwuteaka-Philipsen said. “This finding shows that it is really very important to keep asking the patient (until the moment of the actual administration) whether this is what he or she wants.”

The editorialist, however, was not so sure about the study’s main conclusions: that most physicians are following the rules. An important question still remains, the author of the editorial alleged: “If you permit physicians to take life deliberately by assisting suicide or performing euthanasia, can you control the practice?”

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