Euthanasia and other end of life decisions and care provided in final three months of life: nationwide retrospective study in Belgium.
OBJECTIVE
To explore the relation between the care provided in the final three months of life and the prevalence and types of end of life decisions in Belgium. Design Two year nationwide retrospective study, 2005-6 (SENTI-MELC study).


METHODS
Data collection via the sentinel network of general practitioners, an epidemiological surveillance system representative of all general practitioners in Belgium.


METHODS
1690 non-sudden deaths in practices of the sentinel general practitioners.


METHODS
Non-sudden deaths of patients (aged >1 year) reported each week. Reported care provided in the final three months of life and the end of life decisions made. Multivariable regression analysis controlled for age, sex, cause, and place of death.


RESULTS
Use of specialist multidisciplinary palliative care services was associated with intensified alleviation of symptoms (odds ratio 2.1, 95% confidence interval 1.6 to 2.6), continuous deep sedation forgoing food/fluid (2.9, 1.7 to 4.9), and the total of decisions explicitly intended to shorten life (1.5, 1.1 to 2.1) but not with euthanasia or physician assisted suicide in particular. To a large extent receiving spiritual care was associated with higher frequencies of euthanasia or physician assisted suicide than receiving little spiritual care (18.5, 2.0 to 172.7).


CONCLUSIONS
End of life decisions that shorten life, including euthanasia or physician assisted suicide, are not related to a lower use of palliative care in Belgium and often occur within the context of multidisciplinary care.
Van den Block
Lieve
L
Vrije Universiteit Brussel, End-of-Life Care Research Group, Laarbeeklaan 103, 1090 Brussels, Belgium. lvdblock@vub.ac.be
Deschepper
Reginald
R
Bilsen
Johan
J
Bossuyt
Nathalie
N
Van Casteren
Viviane
V
Deliens
Luc
L
D000293:Adolescent; D000328:Adult; D032722:Advance Care Planning / Q000458:organization & administration*; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D003695:Delivery of Health Care; D005065:Euthanasia / Q000706:statistics & numerical data*; D005194:Family Practice / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008875:Middle Aged; D012189:Retrospective Studies; D013727:Terminal Care / Q000458:organization & administration*; D055815:Young Adult