[Forgoing life-sustaining measures in patients at the end of life in the German-speaking part of Switzerland: results of a death certificate study].
OBJECTIVE
There have not been any comprehensive data from German-speaking countries on the medical practice of withholding or withdrawing treatment at the end of life. This study from the German-speaking part of Switzerland provides the first in-depth analysis in this field. This study is based on data from this region and is a contribution to a large empirical research project on medical end-of-life decisions in 6 European countries (EURELD).


METHODS
Continuous random samples (n = 4991) were taken from all deaths in the German-speaking part of Switzerland that had been reported to the Swiss Federal Office of Statistics between June and October 2001. Doctors who had been attending the deceased person were asked to complete mailed questionnaires, their replies being kept strictly anonymous.


RESULTS
The response rate was 67 %. Medications were withheld or withdrawn in 48 % of all treatments forgone: among these, antibiotics accounted for 17 %. Other potentially life-sustaining medical measures forgone included artificial hydration (12 %), surgery (7 %), artificial feeding (6 %), chemotherapy (6 %), diagnostic tests (4 %), hospital admissions (3 %), renal dialysis (2 %), blood product infusions (2 %), intubation (2 %), ventilation (2 %), resuscitation (2 %), and radiotherapy (1 %). 43 % of all treatments were forgone in patients who died in hospital, 42 % in nursing homes, and 15 % at home. In almost three-quarters (73 %) of the treatments forgone, a primary-care doctor had ordered the treatment to be withheld or withdrawn. On average, forgoing treatment led to a life-shortening effect of more than one month in 8 % of all cases. The proportion was higher for renal dialysis (25 %), blood products infusion (18 %), and diagnostic tests (16 %).


CONCLUSIONS
Forgoing life-sustaining medical treatment comprises a wide range of decisions taken in many different clinical settings. In most cases the likely lifespan is only slightly shortened.
Bosshard
G
G
Institut für Rechtsmedizin der Universität Zürich, Zürich. bosch@irm.unizh.ch
Faisst
K
K
Fischer
S
S
Minder
R
R
Zellweger
U
U
Tschopp
A
A
Gutzwiller
F
F
Bär
W
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003644:Death Certificates; D005260:Female; D006701:Home Nursing / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D008020:Life Support Care / Q000706:statistics & numerical data*; D008297:Male; D018447:Medical Futility; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data; D012494:Sampling Studies; D011795:Surveys and Questionnaires; D013557:Switzerland; D013727:Terminal Care / Q000706:statistics & numerical data*; D028761:Withholding Treatment / Q000706:statistics & numerical data*