Skip header and navigation

Refine By

3 records – page 1 of 1.

End-of-life decision-making in six European countries: descriptive study.

https://arctichealth.org/en/permalink/ahliterature30801
Source
Lancet. 2003 Aug 2;362(9381):345-50
Publication Type
Article
Date
Aug-2-2003
Author
Agnes van der Heide
Luc Deliens
Karin Faisst
Tore Nilstun
Michael Norup
Eugenio Paci
Gerrit van der Wal
Paul J van der Maas
Author Affiliation
Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, Netherlands. a.vanderheide@erasmusmc.nl
Source
Lancet. 2003 Aug 2;362(9381):345-50
Date
Aug-2-2003
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Cause of Death
Child
Child, Preschool
Comparative Study
Decision Making
Denmark
Europe
Euthanasia - statistics & numerical data
Female
Humans
Infant
Italy
Male
Middle Aged
Physician's Practice Patterns
Questionnaires
Refusal to Treat - statistics & numerical data
Research Support, Non-U.S. Gov't
Right to Die
Suicide, Assisted - statistics & numerical data
Sweden
Switzerland
Treatment Refusal - statistics & numerical data
Abstract
BACKGROUND: Empirical data about end-of-life decision-making practices are scarce. We aimed to investigate frequency and characteristics of end-of-life decision-making practices in six European countries: Belgium, Denmark, Italy, the Netherlands, Sweden, and Switzerland. METHODS: In all participating countries, deaths reported to death registries were stratified for cause (apart from in Switzerland), and samples were drawn from every stratum. Reporting doctors received a mailed questionnaire about the medical decision-making that had preceded the death of the patient. The data-collection procedure precluded identification of any of the doctors or patients. All deaths arose between June, 2001, and February, 2002. We weighted data to correct for stratification and to make results representative for all deaths: results were presented as weighted percentages. FINDINGS: The questionnaire response rate was 75% for the Netherlands, 67% for Switzerland, 62% for Denmark, 61% for Sweden, 59% for Belgium, and 44% for Italy. Total number of deaths studied was 20480. Death happened suddenly and unexpectedly in about a third of cases in all countries. The proportion of deaths that were preceded by any end-of-life decision ranged between 23% (Italy) and 51% (Switzerland). Administration of drugs with the explicit intention of hastening death varied between countries: about 1% or less in Denmark, Italy, Sweden, and Switzerland, 1.82% in Belgium, and 3.40% in the Netherlands. Large variations were recorded in the extent to which decisions were discussed with patients, relatives, and other caregivers. INTERPRETATION: Medical end-of-life decisions frequently precede dying in all participating countries. Patients and relatives are generally involved in decision-making in countries in which the frequency of making these decisions is high.
Notes
Comment In: Lancet. 2003 Oct 25;362(9393):1419-20; author reply 142014585656
PubMed ID
12907005 View in PubMed
Less detail

Forgoing treatment at the end of life in 6 European countries.

https://arctichealth.org/en/permalink/ahliterature29878
Source
Arch Intern Med. 2005 Feb 28;165(4):401-7
Publication Type
Article
Date
Feb-28-2005
Author
Georg Bosshard
Tore Nilstun
Johan Bilsen
Michael Norup
Guido Miccinesi
Johannes J M van Delden
Karin Faisst
Agnes van der Heide
Author Affiliation
Institute of Legal Medicine, University of Zurich, Zurich, Switzerland. bosh@irm.unizh.ch
Source
Arch Intern Med. 2005 Feb 28;165(4):401-7
Date
Feb-28-2005
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Cause of Death - trends
Child
Child, Preschool
Comparative Study
Decision Making
Europe - epidemiology
Female
Health Knowledge, Attitudes, Practice
Humans
Infant
Life Support Care - statistics & numerical data
Male
Middle Aged
Physician's Practice Patterns - statistics & numerical data
Physician-Patient Relations
Questionnaires
Refusal to Treat - statistics & numerical data
Registries - statistics & numerical data
Research Support, Non-U.S. Gov't
Retrospective Studies
Terminally ill
Treatment Refusal - statistics & numerical data
Abstract
BACKGROUND: Modern medicine provides unprecedented opportunities in diagnostics and treatment. However, in some situations at the end of a patient's life, many physicians refrain from using all possible measures to prolong life. We studied the incidence of different types of treatment withheld or withdrawn in 6 European countries and analyzed the main background characteristics. METHODS: Between June 2001 and February 2002, samples were obtained from deaths reported to registries in Belgium, Denmark, Italy, the Netherlands, Sweden, and Switzerland. The reporting physician was then sent a questionnaire about the medical decision-making process that preceded the patient's death. RESULTS: The incidence of nontreatment decisions, whether or not combined with other end-of-life decisions, varied widely from 6% of all deaths studied in Italy to 41% in Switzerland. Most frequently forgone in every country were hydration or nutrition and medication, together representing between 62% (Belgium) and 71% (Italy) of all treatments withheld or withdrawn. Forgoing treatment estimated to prolong life for more than 1 month was more common in the Netherlands (10%), Belgium (9%), and Switzerland (8%) than in Denmark (5%), Italy (3%), and Sweden (2%). Relevant determinants of treatment being withheld rather than withdrawn were older age (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.31-1.79), death outside the hospital (death in hospital: OR, 0.80; 95% CI, 0.68-0.93), and greater life-shortening effect (OR, 1.75; 95% CI, 1.27-2.39). CONCLUSIONS: In all of the participating countries, life-prolonging treatment is withheld or withdrawn at the end of life. Frequencies vary greatly among countries. Low-technology interventions, such as medication or hydration or nutrition, are most frequently forgone. In older patients and outside the hospital, physicians prefer not to initiate life-prolonging treatment at all rather than stop it later.
PubMed ID
15738368 View in PubMed
Less detail