Talking to your huisarts about end-of-life
Your huisarts (general practitioner) is the gatekeeper for palliative care, hospice referral and the euthanasia process — and starting the conversation early shapes what is possible later. They coordinate referrals to specialists, to palliative care teams, to hospices, to mental health support, and, for the small share of patients who request it, to the euthanasia process. They also know your history, often over many years, in a way that hospital specialists rarely do.
For end-of-life decisions, this matters more than people realise. The huisarts is the person most likely to be present in the last weeks at home. They are the person who signs the doodsverklaring (death certificate). They are usually the person who, after a request for euthanasia, makes the first assessment of whether the request meets the legal criteria.
Talking to them about end-of-life early — long before any of this is urgent — changes what becomes possible later. This guide explains why, when, and how.
Why this conversation matters
The KNMG (Royal Dutch Medical Association) and the Dutch palliative care guidelines on proactieve zorgplanning (published on Palliaweb) both recommend that conversations about end-of-life wishes start well before they are clinically necessary. Three reasons stand out.
Coordination. A huisarts who knows your wishes can refer to the right palliative team, the right hospice, the right specialist. They can flag your file so the practice knows your situation. They can communicate with the assistente and the waarnemer (the GP who covers nights and weekends) so your wishes do not have to be re-explained in a crisis.
Speed when it matters. A request for palliative sedation, a referral to a hospice, an emergency consultation about pain management — each of these moves faster when the huisarts has heard your wishes before the moment of need.
The euthanasia question. Euthanasia in the Netherlands is a long process, not a single decision. The huisarts is usually the doctor who takes the request, makes the first assessment, and (if they support it) carries it out or refers you to the Expertisecentrum Euthanasie. Not every huisarts is willing to perform euthanasia. Knowing your huisarts's stance, well in advance, lets you plan.
When to start the conversation
The KNMG and the palliative care guidelines do not recommend waiting until you are terminal. Common moments to begin are:
- After 65. Some practices proactively offer a "future planning" conversation around this age.
- After a serious diagnosis — cancer, heart failure, COPD, dementia, chronic kidney disease, neurological illness.
- After a hospitalisation, especially an intensive-care admission. The experience tends to clarify what you do and do not want.
- After a close family member's death, if it raised questions for you.
- When you write or update your wilsverklaring or levenstestament. Bringing the document lets your huisarts record your wishes in your file.
- At any time, simply because you want to. You do not need a medical reason.
The conversation does not commit you to anything. It is a conversation.
Four things the huisarts wants to know
In our summary, these four topics usually come up in an end-of-life planning conversation with a Dutch GP. You do not have to answer them all in one visit.
1. Your wishes for treatment intensity. What do you want done if you become seriously ill? Aggressive treatment in hospital, with intensive care if needed? Maximum quality-of-life-focused care at home, with no hospitalisation? Something in between? The huisarts is not asking for a final answer; they are asking for a direction.
2. Your stance on resuscitation (reanimatie). Do you want CPR if your heart stops? The default in Dutch practice is to attempt it. If you do not want it — for example, in advanced age or serious illness — this needs to be recorded. The huisarts can document a niet-reanimeren wish in your file. For situations outside the home, a niet-reanimeren penning (medallion, available from NVVE, also to non-members) carries the same legal weight.
3. Your stance on euthanasia. Whether you want it on the table as an option later, whether you do not want it under any circumstances, or whether you are uncertain. Each is a valid answer. The huisarts will tell you their own position so you know what is and is not possible with them as your doctor.
4. Your wishes for your last days. Where you would want to die — at home, in a hospice, in a nursing home. Who you would want present. What kinds of intervention you would and would not accept (artificial nutrition, IV fluids, pain medication that may shorten consciousness). A wensenboekje (wish booklet) or NVVE's written directives give a structured format for these.
Four things to ask them
The conversation goes both ways. The following questions help you understand who your huisarts actually is on these topics.
"How do you handle requests for end-of-life care in your practice?" Some practices have a structured ACP (advance care planning) process. Some do not. Knowing how your practice works tells you what to expect.
"What is your experience with palliative sedation?" Palliative sedation — using medication to relieve unbearable suffering by reducing consciousness in the last days — is a standard part of Dutch palliative care, not euthanasia. Most huisartsen perform it. Asking about their experience signals that you understand the difference and want them to be candid.
"Would you be willing to carry out euthanasia, or would you refer me to the Expertisecentrum Euthanasie?" Not every huisarts performs euthanasia. If you may want to consider it as an option later, ask now. (A separate, independent SCEN doctor always gives the required second opinion; this is never your own huisarts.)
"What happens at night and on weekends? Who covers, and do they know my situation?" Dutch GP care outside office hours is usually delivered by the huisartsenpost. In the last weeks of life, your wishes need to be transferable. Many practices use a structured zorgoverdracht (care handover) document. Asking about this in advance prevents painful surprises in a crisis.
How to book the conversation
A standard huisarts appointment is 10 minutes. An end-of-life conversation needs more. Ask for a dubbel consult (double appointment, usually 20 minutes instead of 10) to talk about wishes around the end of life.
To book: call the practice and tell the assistent that you want a longer appointment to discuss end-of-life wishes or advance care planning. The phrasing matters: "Ik wil een gesprek over wensen rond het levenseinde" or "een gesprek over advance care planning." The assistent will block the right amount of time.
Most practices do not charge separately for this; it is part of the basisverzekering (basic insurance) coverage of huisartsenzorg.
Bringing your wensenboekje or wilsverklaring
A written document changes the conversation. Bringing it lets your huisarts record your wishes in your file, so they are known when it matters.
A wensenboekje (wish booklet) is a structured worksheet that walks you through preferences for treatment intensity, resuscitation, euthanasia, last days, and place of death. A wensenboekje is not legally binding, but it gives the huisarts a starting point and a record.
A wilsverklaring (advance directive) is a legally relevant document that you sign and date yourself. Bringing it to the huisarts does not change its legal status, but the huisarts can add it to your medisch dossier (medical file) so that the wishes are visible to whoever covers for them. NVVE members can draft and store its three directives (medical power of attorney, treatment ban, euthanasia request) free in MijnNVVE.
If you have a levenstestament (continuing power of attorney for finances and care), bring that too. It tells the huisarts who can make decisions for you if you cannot.
After the conversation, ask the huisarts to confirm in writing what they have recorded in your file, and what they will do (and not do) in the situations you discussed. This is the document you can bring to the next conversation.
Plan it
- ☐ Next call to the practice: ask for a dubbel consult (double appointment) to talk about wishes around the end of life, not a standard ten-minute slot.
- ☐ Before you go: write down your four answers (treatment intensity, resuscitation, euthanasia stance, last-days wishes).
- ☐ On the day: bring any existing wilsverklaring, so your huisarts can record your wishes in your file.
The next time I contact my huisarts, I will ask for the longer appointment instead of waiting for "a better moment".
In the app
In the Legal Papers module you note, at your own pace, whether you have a wilsverklaring and where it is kept; in Guide for Your Family you can add your huisarts to the people your family should contact. Everything becomes part of your Zorgmap, a private PDF you print or hand over to the person you trust; your family cannot open the app itself.
Closed beta — access by invitation.
Sources
- KNMG — Tijdig praten over het levenseinde, professional and patient guidance on starting end-of-life conversations with the huisarts. https://www.knmg.nl
- NVVE — the three written directives in MijnNVVE and the niet-reanimerenpenning. https://www.nvve.nl/wilsverklaringen
- Palliaweb (PZNL) — Dutch palliative care guidelines, including proactieve zorgplanning. https://palliaweb.nl