Physician reports of terminal sedation without hydration or nutrition for patients nearing death in the Netherlands.
BACKGROUND
Terminal sedation in patients nearing death is an important issue related to end-of-life care.


OBJECTIVE
To describe the practice of terminal sedation in the Netherlands.


METHODS
Face-to-face interviews.


METHODS
The Netherlands.


METHODS
Nationwide stratified sample of 482 physicians; 410 responded and 211 of these reported characteristics of their most recent terminal sedation case.


METHODS
Physician reports of frequency of terminal sedation (defined as the administration of drugs to keep the patient in deep sedation or coma until death, without giving artificial nutrition or hydration), characteristics of the decision-making process, drugs used, the estimated life-shortening effect, and frequency of euthanasia discussions.


RESULTS
Of respondents, 52% (95% CI, 48% to 57%) had ever used terminal sedation. Of the 211 most recent cases, physicians used terminal sedation to alleviate severe pain in 51% of patients (CI, 44% to 58%), agitation in 38% (CI, 32% to 45%), and dyspnea in 38% (CI, 32% to 45%). Physicians reported discussing with patients the decision to use deep sedation in 59% of the 211 most recent cases (CI, 52% to 66%) and the decision to forgo artificial nutrition or hydration in 34% (CI, 28% to 41%). Hastening death was partly the intention of the physician in 47% (CI, 41% to 54%) of cases and the explicit intention in 17% (CI, 13% to 22%) of cases.


CONCLUSIONS
The generalizability of physician reports about their most recent cases to all terminal sedation cases is uncertain. In addition, the findings are subject to recall bias and may not apply to other geographic settings.


CONCLUSIONS
Terminal sedation precedes a substantial number of deaths in the Netherlands. In about two thirds of most recently reported cases, physicians indicated that in addition to alleviating symptoms, they intended to hasten death.
Department of Public Health, Erasmus MC, Rotterdam, The Netherlands. j.rietjens@erasmusmc.nl
Judith A C
JA
Rietjens
Agnes
A
van der Heide
Astrid M
AM
Vrakking
Bregje D
BD
Onwuteaka-Philipsen
Paul J
PJ
van der Maas
Gerrit
G
van der Wal
D001569:Benzodiazepines / Q000008:administration & dosage; D005066:Euthanasia, Passive; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007407:Interviews as Topic; D008297:Male; D009020:Morphine / Q000008:administration & dosage; D009426:Netherlands; D018529:Nutritional Support; D010820:Physicians; D013727:Terminal Care / Q000379:methods*; D028761:Withholding Treatment
D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D009020:Morphine