Physicians' experiences with end-of-life decision-making: survey in 6 European countries and Australia.
BACKGROUND
In this study we investigated (a) to what extent physicians have experience with performing a range of end-of-life decisions (ELDs), (b) if they have no experience with performing an ELD, would they be willing to do so under certain conditions and (c) which background characteristics are associated with having experience with/or being willing to make such ELDs.


METHODS
An anonymous questionnaire was sent to 16,486 physicians from specialities in which death is common: Australia, Belgium, Denmark, Italy, the Netherlands, Sweden and Switzerland.


RESULTS
The response rate differed between countries (39-68%). The experience of foregoing life-sustaining treatment ranged between 37% and 86%: intensifying the alleviation of pain or other symptoms while taking into account possible hastening of death between 57% and 95%, and experience with deep sedation until death between 12% and 46%. Receiving a request for hastening death differed between 34% and 71%, and intentionally hastening death on the explicit request of a patient between 1% and 56%.


CONCLUSIONS
There are differences between countries in experiences with ELDs, in willingness to perform ELDs and in receiving requests for euthanasia or physician-assisted suicide. Foregoing treatment and intensifying alleviation of pain and symptoms are practiced and accepted by most physicians in all countries. Physicians with training in palliative care are more inclined to perform ELDs, as are those who attend to higher numbers of terminal patients. Thus, this seems not to be only a matter of opportunity, but also a matter of attitude.
Löfmark
Rurik
R
Centre for Bioethics at Karolinska Institutet and Uppsala Universitet, LIME, SE-171 77 Stockholm, Sweden. rurik.lofmark@telia.com
Nilstun
Tore
T
Cartwright
Colleen
C
Fischer
Susanne
S
van der Heide
Agnes
A
Mortier
Freddy
F
Norup
Michael
M
Simonato
Lorenzo
L
Onwuteaka-Philipsen
Bregje D
BD
D001315:Australia; D003657:Decision Making; D005060:Europe; D006801:Humans; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D013727:Terminal Care