Physician reports of medication use with explicit intention of hastening the end of life in the absence of explicit patient request in general practice in Belgium.
BACKGROUND
Although the incidence of the use of life-ending drugs without explicit patient request has been estimated in several studies, in-depth empirical research on this controversial practice is nonexistent. Based on face-to-face interviews with the clinicians involved in cases where patients died following such a decision in general practice in Belgium, we investigated the clinical characteristics of the patients, the decision-making process, and the way the practice was conducted.


METHODS
Mortality follow-back study in 2005-2006 using the nationwide Sentinel Network of General Practitioners, a surveillance instrument representative of all GPs in Belgium. Standardised face-to-face interviews were conducted with all GPs who reported a non-sudden death in their practice, at home or in a care home, which was preceded by the use of a drug prescribed, supplied or administered by a physician without an explicit patient request.


RESULTS
Of the 2690 deaths registered by the GPs, 17 were eligible to be included in the study. Thirteen interviews were conducted. GPs indicated that at the time of the decision all patients were without prospect of improvement, with persistent and unbearable suffering to a (very) high degree in nine cases. Twelve patients were judged to lack the competence to make decisions. GPs were unaware of their patient's end-of-life wishes in nine cases, but always discussed the practice with other caregivers and/or the patient's relatives. All but one patient received opioids to hasten death. All GPs believed that end-of-life quality had been "improved considerably".


CONCLUSIONS
The practice of using life-ending drugs without explicit patient request in general practice in Belgium mainly involves non-competent patients experiencing persistent and unbearable suffering whose end-of-life wishes can no longer be ascertained. GPs do not act as isolated decision-makers and they believe they act in the best interests of the patient. Advance care planning could help to inform GPs about patients' wishes prior to their loss of competence.
Meeussen
Koen
K
End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium. koen.meeussen@vub.ac.be
Van den Block
Lieve
L
Bossuyt
Nathalie
N
Echteld
Michael
M
Bilsen
Johan
J
Deliens
Luc
L
D000328:Adult; D000368:Aged; D001530:Belgium; D003645:Death, Sudden; D003657:Decision Making; D028601:Euthanasia, Active / Q000639:trends*; D005260:Female; D006801:Humans; D007258:Informed Consent; D007407:Interviews as Topic; D008297:Male; D016743:Mental Competency / Q000523:psychology; D008875:Middle Aged; D010821:Physicians, Family / Q000523:psychology* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D055553:Prescription Drugs / Q000008:administration & dosage; D018571:Sentinel Surveillance; D013727:Terminal Care / Q000379:methods* / Q000592:standards
D055553:Prescription Drugs