title: Terminal sedation and euthanasia: a comparison of clinical practices.
abstract: BACKGROUND
  An important issue in the debate about terminal sedation is the extent to which it differs from euthanasia. We studied clinical differences and similarities between both practices in the Netherlands.
  
  
  METHODS
  Personal interviews were held with a nationwide stratified sample of 410 physicians (response rate, 85%) about the most recent cases in which they used terminal sedation, defined as administering drugs to keep the patient continuously in deep sedation or coma until death without giving artificial nutrition or hydration (n = 211), or performed euthanasia, defined as administering a lethal drug at the request of a patient with the explicit intention to hasten death (n = 123). We compared characteristics of the patients, the decision-making process, and medical care of both practices.
  
  
  RESULTS
  Terminal sedation and euthanasia both mostly concerned patients with cancer. Patients receiving terminal sedation were more often anxious (37%) and confused (24%) than patients receiving euthanasia (15% and 2%, respectively). Euthanasia requests were typically related to loss of dignity and a sense of suffering without improving, whereas requesting terminal sedation was more often related to severe pain. Physicians applying terminal sedation estimated that the patient's life had been shortened by more than 1 week in 27% of cases, compared with 73% in euthanasia cases.
  
  
  CONCLUSIONS
  Terminal sedation and euthanasia both are often applied to address severe suffering in terminally ill patients. However, terminal sedation is typically used to address severe physical and psychological suffering in dying patients, whereas perceived loss of dignity during the last phase of life is a major problem for patients requesting euthanasia.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. j.rietjens@erasmusmc.nl
authors.forename: Judith A C
authors.initials: JA
authors.lastname: Rietjens
authors.forename: Johannes J M
authors.initials: JJ
authors.lastname: van Delden
authors.forename: Agnes
authors.initials: A
authors.lastname: van der Heide
authors.forename: Astrid M
authors.initials: AM
authors.lastname: Vrakking
authors.forename: Bregje D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
authors.forename: Paul J
authors.initials: PJ
authors.lastname: van der Maas
authors.forename: Gerrit
authors.initials: G
authors.lastname: van der Wal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005065:Euthanasia; D028601:Euthanasia, Active; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012297:Right to Die; D019452:Terminally Ill