Background In the Netherlands, advance euthanasia directives (AED) are used to request euthanasia under specific circumstances. Although representative of patient wishes, they are not legally binding. Examining AED completion before and after the implementation of the 2002 Dutch euthanasia law can provide some insight on its influence.

Aim To describe self-reported AED completion among representative samples of Dutch older people in 1998, 2005, 2008 and  2011 and to analyse associations between personal characteristics and AED completion.

Methods Participants reported their AED completion in face-to-face interviews. AED prevalence was described and associated factors analysed with multivariable logistic regression using generalised estimating equations.

Results AED completion of 2576 older people was recorded. Prevalence was 6.8%, 4.3%, 6.4% and 6.2%, in 1998, 2005, 2008 and 2011 respectively. The odds of completion were significantly lower in 2005 compared with 1998, although there were no significant differences in 2008 and 2011 compared with 1998. Completion was associated with increasing age, female gender, higher education and income, and negatively associated with being Catholic or Protestant. Health factors had no influence on AED completion.

Discussion/conclusion Following the enactment of the 2002 Dutch euthanasia law, there was a slight decrease in AED completion which, overall, remained low. Legal recognition did not, therefore, lead to their increased use and may even have been associated with their decline in the first instance. The lack of association between AED completion and health factors indicates that older people with a range of health statuses completed AEDs, not just those with serious illness.