Talking to your huisarts about end-of-life

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 Pallialine clinical guidelines 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

Pallialine and the KNMG 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 to the huisarts is part of giving it weight.
• 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

Pallialine's communicatie module identifies the topics a Dutch GP will want to cover in an end-of-life planning conversation. 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) 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). The KNMG and NVVE wensenboekjes (wish booklets) provide 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.

"Are you SCEN-trained, or do you refer for euthanasia?" SCEN doctors are independent consultants who provide the second opinion required by Dutch euthanasia law. Not every huisarts is SCEN-trained, and not every huisarts performs euthanasia. If you may want to consider it as an option later, ask now whether they would carry out the procedure or refer you to the Expertisecentrum Euthanasie.

"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. Most Dutch GP practices offer a dubbele afspraak (double appointment) of 20 to 30 minutes, sometimes called an anders praten consult or a planningsgesprek when the topic is end-of-life or chronic illness.

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. The KNMG and NVVE both recommend bringing one to the visit.

A wensenboekje (wish booklet) is a structured worksheet — NVVE publishes one, as does Patiëntenfederatie Nederland. It walks you through preferences for treatment intensity, resuscitation, euthanasia, last days, and place of death. It is not a legal document, but it gives the huisarts a starting point and a record.

A wilsverklaring (advance directive) is a legally relevant document signed by you, often by hand, sometimes on a notarial form. It carries more weight than a wensenboekje, and the huisarts can add it to your medisch dossier (medical file) so that the wishes are visible to whoever covers for them.

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 longer "anders praten" appointment, 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; a written document carries legal weight.

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 Personal Portal, Stage 4 (Legal Papers) records your wilsverklaring and your huisarts contact. Bring both to the conversation — the document gives the huisarts a starting point, and the recorded contact ensures coordination.

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Sources

1. KNMG — Tijdig praten over het levenseinde, professional and patient guidance on starting end-of-life conversations with the huisarts. https://www.knmg.nl
2. NVVE — Wilsverklaringen en wensen rond het levenseinde, including the wensenboekje and the niet-reanimeren penning. https://www.nvve.nl
3. Pallialine / IKNL — Communicatie in de palliatieve fase, clinical guideline used by Dutch GPs. https://palliaweb.nl