End-of-life decisions in Australian medical practice.
OBJECTIVE
To estimate the proportion of medical end-of-life decisions in Australia, describe the characteristics of such decisions and compare these data with medical end-of-life decisions in the Netherlands, where euthanasia is openly practised.


METHODS
Postal survey, conducted between May and July 1996, using a self-administered questionnaire based on the questionnaire used to determine medical end-of-life decisions in the Netherlands in 1995.


METHODS
A random sample of active medical practitioners from all Australian States and Territories selected from medical disciplines in which there were opportunities to be the attending doctor at non-acute patient deaths, and hence to make medical end-of-life decisions.


METHODS
Proportion of Australian deaths that involved a medical end-of-life decision, using ratio-to-size estimation based on the sampled doctors' responses to the questionnaire. The response rate was 64%.


RESULTS
The proportion of all Australian deaths that involved a medical end-of-life decision were: euthanasia, 1.8% (including physician-assisted suicide, 0.1%); ending of patient's life without patient's concurrent explicit request, 3.5%; withholding or withdrawing of potentially life-prolonging treatment, 28.6%; alleviation of pain with opioids in doses large enough that there was a probable life-shortening effect, 30.9%. In 30% of all Australian deaths, a medical end-of-life decision was made with the explicit intention of ending the patient's life, of which 4% were in response to a direct request from the patient. Overall, Australia had a higher rate of intentional ending of life without the patient's request than the Netherlands.


CONCLUSIONS
Australian law has not prevented doctors from practising euthanasia or making medical end-of-life decisions explicitly intended to hasten the patient's death without the patient's request.
Kuhse
H
H
Centre for Human Bioethics, Monash University, Clayton, VIC. helga.kuhse@arts.monash.edu.au
Singer
P
P
Baume
P
P
Clark
M
M
Rickard
M
M
D000328:Adult; D000368:Aged; D001315:Australia; D003657:Decision Making; D005065:Euthanasia; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D009426:Netherlands; D010820:Physicians / Q000523:psychology; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000706:statistics & numerical data*