• Nikkie B Swarte, Marije L van der Lee, Johanna G van der Bom, Jan van den Bout, and A Peter M Heintz.
• Department of Gynaecology, F05.829, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, Netherlands. n.swarte@azu.nl
• BMJ. 2003 Jul 26;327(7408):189.

ObjectiveTo assess how euthanasia in terminally ill cancer patients affects the grief response of bereaved family and friends.DesignCross sectional study.SettingTertiary referral centre for oncology patients in Utrecht, the Netherlands.Participants189 bereaved family members and close friends of terminally ill cancer patients who died by euthanasia and 316 bereaved family members and close friends of comparable cancer patients who died a natural death between 1992 and 1999.Main Outcome MeasuresSymptoms of traumatic grief assessed by the inventory of traumatic grief, current feelings of grief assessed by the Texas revised inventory of grief, and post-traumatic stress reactions assessed by the impact of event scale.ResultsThe bereaved family and friends of cancer patients who died by euthanasia had less traumatic grief symptoms (adjusted difference -5.29 (95% confidence interval -8.44 to -2.15)), less current feeling of grief (adjusted difference 2.93 (0.85 to 5.01)); and less post-traumatic stress reactions (adjusted difference -2.79 (-5.33 to -0.25)) than the family and friends of patients who died of natural causes. These differences were independent of other risk factors.ConclusionsThe bereaved family and friends of cancer patients who died by euthanasia coped better with respect to grief symptoms and post-traumatic stress reactions than the bereaved of comparable cancer patients who died a natural death. These results should not be interpreted as a plea for euthanasia, but as a plea for the same level of care and openness in all patients who are terminally ill.

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