Table 1 Examples of close-reading the ‘Who?’ combined with cross-case analysis

Example 1: multiple GPs instead of one Close-reading of interviews guided by the Who?-question showed that in many cases, there was not just one GP, but many GPs involved. While the incurably ill patients ‘traveled through time and space’ towards their death, GPs retired, got sick, and went on holiday. Sometimes the patient and partner where connected to different GP offices or they were living in an area with a shortage of GPs

Reflection A long-lasting relationship with the GP, who knows both the patient and his/her family, is one of the cornerstones of both the practice of euthanasia and home-based palliative care in the Netherlands. The above mentioned findings challenge this cornerstone and the ideal of ‘the’ GP, although an examination of contrary-cases, scrutinizing sources of selection-bias and further (quantitative) research is warranted. The following ethical question to answer is whether this ‘multitude’ of GPs is actually a problem for ‘good’ euthanasia decision-making or not (and according to whom)

Example 2: a change of perspective An even closer-reading and comparative analysis of patients’ interviews revealed a remarkable change in perspective in many patients’ stories: although they spoke at length in the first person perspective (‘I want/go’ etc.), many of them changed to the second person perspective (‘you…’) when approaching the subject of the last days of their lives and the possibly hardships it may include. The same phenomenon was observed in interviews conducted as part of another empirical study about advance care planning [56]

Reflection To (be able to) talk openly about end-of-life preferences is an important theme in both the euthanasia- and palliative care movements in the Netherlands. The above mentioned results pose the question whether patients are capable and/or willing to talk in detail about the end of life, especially in a first person perspective. Ethically and practically, we may ask ourselves if and how we should push for open conversations about the end of life and whether another type of ACP-conversation (e.g. guided by fictional examples) may be more accessible for patients