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Table 5 Impact of the euthanasia procedure on APC’s social life, also in the context of their euthanasia request being neglected (N), rejected (R), assessed (A), granted (G) and put ‘on hold’ (P)

From: The impact of the euthanasia assessment procedure: a qualitative interview study among adults with psychiatric conditions

IMPACT ON SOCIAL LIFE
Favourable Unfavourable
Receiving understanding & more emotional support
- Increased attention, compassion (R, A)
- More serene talks about death (A, G) (with respect, honesty and integrity)
- Opportunity to share the emotional experience (A, G)
- Received blessing (A, G)
- Additional support/understanding from ‘similar’ peers (eg. from experts by experience) (A, G)
- Ability to learn from ‘similar’ peers (eg. joined forces to make life more bearable/to see alternative options) (A, G)
Not being supported or understood
- No/little understanding for APC’s perspective (A, G)
- Adverse attempts to change APC’s mind (R, A)
- Negative reactions/conflicts (R, A, G)
- Non-committal approaches/reactions (R, A)
- No mutual understanding due to conceptual confusion (legal terminology) (A)
Rebuilding social relationships
- Opportunity for rehabilitation of existing social relationships (deeper connection) (A, G)
- Empowered to open-up/build new relationships (G, P)
Crumbling relationships
- Resignation from family and other ‘social obligations’/ further erosion of the network (R, A)
- Decreased sense of belongingness (R, A)
- Increased feeling of being ‘alienated’ (R, A)
Receiving more practical support
- Offering eg. transport and shelter after consultations with physicians (A)
- Suggesting potential helpful/comforting books/movies (A)
 
Support for important others possible
- Opportunity for loved ones to receive support (A)
 
  Difficulties with involving and managing interactions with important others
- No/little advice/guidance on how to inform the inner circle
- Informing relatives is deemed unfair (A)
*wrong as it is only a measure to protect physicians from deontological/ juridical complaints
*unjust to exclude (eligible) APC from euthanasia if someone/some members would strongly oppose to it
*it puts a heavy burden on the few one’s involved
*it may provoke conflicts/ruptures after APC’s death
- Reluctance to hurt loved ones needlessly (eg. when informed in an early stage) (R, A)
- Incompatible objectives patient versus relatives or among relatives (A)
- Practical difficulties of informing the inner circle (i.e. how, when and where to inform whom) (A)
- Emotional difficulties:
• to cope with mixed reactions/stages of grief (A, G)
• when reactions within the social circle (A, G)
• fear of/difficulties to cope with meddlers outside the close inner circle (A)
  Comparing own situation with fellow peers (mirror-window)
- Concerns regarding fellow APC making precarious use of the euthanasia procedure (A, P)
- Difficulties to cope with the loss of fellow peers in inpatient settings (suicide and euthanasia), especially in case of omerta rulegiving (P) ie. APC were ‘forbidden' to talk to fellow peers about their own or another fellow peer’s euthanasia request/euthanasia procedure/attempted suicide/suicide)