Dealing with requests for euthanasia in incompetent patients with dementia. Qualitative research revealing underexposed aspects of the societal debate.

This article examines the reasons and underlying motives of Dutch physicians who supported the 2017 petition "no sneaky euthanasia," which opposes performing euthanasia on incompetent dementia patients without their awareness, based on advance euthanasia directives (AEDs). Through twelve in-depth interviews, the study identifies four main reasons for support: opposition to euthanasia without patient awareness, dissatisfaction with an oversimplified societal debate, concerns about crossing physicians' personal moral boundaries, and growing societal pressure to comply with AEDs. Underlying these reasons are three key motives related to handling euthanasia requests—emphasizing the need for reciprocal communication or consensual decision-making, ensuring good end-of-life care, and recognizing the emotional and professional impact on physicians. The findings highlight moral dilemmas around patient autonomy in advanced dementia, the ambiguous role of AEDs, and the need for clearer guidance on issues such as sedative use and physician autonomy, alongside broader public education on end-of-life care in dementia.