title: A comparison of physicians' end-of-life decision making for non-western migrants and Dutch natives in the Netherlands.
abstract: BACKGROUND
  Non-western migrants have a different cultural background that influences their attitudes towards healthcare. As the first wave of this relatively young group is growing older, we investigated, for the first time, whether end-of-life decision-making practices for non-western migrants differ from Dutch natives.
  
  
  METHODS
  In 2005, we sent questionnaires to physicians who attended deaths identified from the central death registry of Statistics Netherlands (n = 9651; non-western migrants: n = 627, total response: 78%). We performed multivariate logistic regression analyses adjusted for age, sex and cause of death.
  
  
  RESULTS
  Of all deaths of non-western origin, 54% were non-sudden, whereas 67% of all deaths with a Dutch origin were non-sudden (P = 0.00). A relatively large number of non-suddenly deceased persons of non-western origin had died under the age of 65 (53%) as compared to Dutch natives (15%). Euthanasia was performed in 2.4% of all non-suddenly deceased persons in the non-western migrant group as compared to 2.7% in the native Dutch group (adjusted odds ratio = 0.82, P = 0.63). Alleviation of symptoms with a potential life-shortening effect was somewhat lower for non-western migrants (30% vs. 38%; adjusted odds ratio = 0.78, P = 0.07). Physicians decided to forgo potentially life-prolonging treatment in comparable rates (26% vs. 23%; adjusted odds ratio = 1.1, P = 0.73). Yet, the type of treatments forgone and underlying reasons differed.
  
  
  CONCLUSIONS
  Euthanasia was not less common among non-suddenly deceased non-western migrants as compared to Dutch natives. However, intensive symptom alleviation was used less frequently and forgoing potentially life-prolonging treatment involved different characteristics. These findings suggest that cultural factors may affect end-of-life decision making.
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, The Netherlands. h.buiting@erasmusmc.nl
authors.forename: Hilde M
authors.initials: HM
authors.lastname: Buiting
authors.forename: Judith A C
authors.initials: JA
authors.lastname: Rietjens
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: Johannes J M
authors.initials: JJ
authors.lastname: van Delden
authors.forename: Agnes
authors.initials: A
authors.lastname: van der Heide
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005065:Euthanasia; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010166:Palliative Care; D010820:Physicians; D013727:Terminal Care / Q000379:methods*; D014171:Transients and Migrants; D055815:Young Adult