title: Physicians' experiences with end-of-life decision-making: survey in 6 European countries and Australia.
abstract: 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.
authors.affiliation: Centre for Bioethics at Karolinska Institutet and Uppsala Universitet, LIME, SE-171 77 Stockholm, Sweden. rurik.lofmark@telia.com
authors.forename: Rurik
authors.initials: R
authors.lastname: Löfmark
authors.forename: Tore
authors.initials: T
authors.lastname: Nilstun
authors.forename: Colleen
authors.initials: C
authors.lastname: Cartwright
authors.forename: Susanne
authors.initials: S
authors.lastname: Fischer
authors.forename: Agnes
authors.initials: A
authors.lastname: van der Heide
authors.forename: Freddy
authors.initials: F
authors.lastname: Mortier
authors.forename: Michael
authors.initials: M
authors.lastname: Norup
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Simonato
authors.forename: Bregje D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
mesh_terms: D001315:Australia; D003657:Decision Making; D005060:Europe; D006801:Humans; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D013727:Terminal Care