Physician commitment in end of life care--perspectives from New Zealand and the Netherlands

A social constructionist approach is taken to analyse the accounts of experiences of doctors who have provided end of life care, comprising five Dutch doctors and six New Zealand doctors who had not provided physician-assisted death, and five Dutch doctors who had. A core theme of 'commitment' to the patient crossed all interviews and when a request for assisted death was received this theme altered and evolved differently between the groups. All respondents reacted by exploring reasons for the request and offering palliative care. When the request persisted, those who had provided euthanasia entered into a 'contractual commitment', constructing another "vulnerable" self in the negotiations that invited the sympathy of the hearer. This evolved to 'sacrificial commitment' when the physician provided euthanasia despite negative personal psychological effects. Constructing a self who is willing to sacrifice personal comfort to relieve the suffering of another is useful in silencing criticism of actions. The two groups who had not provided euthanasia, intensified their efforts to find an alternative to assisted death in a 'pledged commitment' to the patient, constructing themselves as deeply committed to the patient in an intimate struggle to meet his/her need. While New Zealand doctors denied that euthanasia had ever been an option, some Dutch doctors evolved their commitment to 'potential sacrificial commitment', constructing an open-minded and accepting self, willing to consider euthanasia despite fears of negative personal consequences. The construction of alternative 'selves' in accounts is useful in inviting sympathy and silencing potential criticism of actions that may be construed negatively (because the patient was assisted to die, or because assistance to die was refused).