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| End-of-life decisions in medical practice in Flanders, Belgium: a nationwide survey |
Luc Deliens, Freddy Mortier, Johan Bilsen, Marc Cosyns, Robert Vander Stichele, Johan Vanoverloop, Koen Ingels
Department of Medical Sociology and Health Sciences, Free University of Brussels, Brussels, Belgium (L Deliens PhD, J Bilsen MSc); Centre for Environmental Philosophy and Bioethics (L Deliens, F Mortier PhD); and Department of General Practice (M Cosyns MD), Ghent University, Ghent; Flemish Institute of General Practice, Antwerp (R Vander Stichele MD); Preventive and Social Health Care Division, Ministry of Flanders, Brussels (J Vanoverloop MSc); Ear, Nose and Throat Surgery, Academic Hospital, Catholic University of Nijmegen, Nijmegen, Netherlands (K Ingels MD)
Correspondence to: Dr Luc Deliens, Department of Medical Sociology and Health Sciences, Free University of Brussels, Laarbeeklaan 103, B-1090 Brussels, Belgium (e-mail:Luc.Deliens@vub.ac.be)
| Summary
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Background Our study is a repeat of the Dutch
death-certificate study on end-of-life decisions (ELDs). The main objective
was to estimate the frequency of euthanasia (the administration of lethal
drugs with the explicit intention of shortening the patient's life at the
patient's explicit request), physician-assisted suicide (PAS), and other
ELDs in medical practice in Flanders, Belgium.
Methods A 20% random sample of 3999 deaths was selected from all deaths recorded between Jan 1 and April 30, 1998. The physicians who signed the corresponding death certificates received one questionnaire by post per death.
Findings The physicians' response rate was 1355 (52%). 1925 deaths were described. The results were corrected for non-response bias, and extrapolated to estimated annual rates after seasonal adjustment for death causes, and we estimate that 705 (1·3%, 95% CI 1·0-1·6) deaths resulted from euthanasia or PAS. In 1796 (3·2%, 2·7-3·8) cases, lethal drugs were given without the explicit request of the patient. Alleviation of pain and symptoms with opioids in doses with a potential life-shortening effect preceded death in 10416 (18·5%, 17·3-19·7) cases and non-treatment decisions in 9218 (16·4%, 15·3-17·5) cases, of which 3261 (5·8%, 5·1-6·5) with the explicit intention of ending the patient's life.
Interpretation ELDs are prominent in medical practice in Flanders. The frequency of deaths preceded by an ELD is similar to that in the Netherlands, but lower than that in Australia. However, in Flanders the rate of administration of lethal drugs to patients without their explicit request is similar to Australia, and significantly higher than that in the Netherlands.