title: Influence of the metropolitan environment on end-of-life decisions: A population-based study of end-of-life decision-making in the Brussels metropolitan region and non-metropolitan Flanders.
abstract: Research is beginning to show differences between end-of-life care in metropolitan and non-metropolitan areas. Using population-based post-mortem surveys this article compares medical end-of-life decisions in the Brussels metropolitan area and non-metropolitan Flanders (Belgium). In Brussels, administering lethal drugs without an explicit patient request occurred more often, intensification of symptom alleviation and non-treatment decisions less often, and end-of-life treatment was more often aimed at cure or life prolongation, than in non-metropolitan Flanders. This paper argues that these differences in end-of-life decisions are related to characteristics of the metropolitan environment and hence may also apply in other metropolitan regions worldwide. Specific approaches to end-of-life decisions in metropolitan areas need to be considered.
authors.affiliation: Vrije Universiteit Brussel, End-of-Life Care Research Group, Laarbeeklaan 103, 1090 Brussels, Belgium. jcohen@vub.ac.be
authors.forename: Joachim
authors.initials: J
authors.lastname: Cohen
authors.forename: Kenneth
authors.initials: K
authors.lastname: Chambaere
authors.forename: Johan
authors.initials: J
authors.lastname: Bilsen
authors.forename: Dirk
authors.initials: D
authors.lastname: Houttekier
authors.forename: Freddy
authors.initials: F
authors.lastname: Mortier
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
mesh_terms: D000367:Age Factors; D001530:Belgium; D003657:Decision Making; D028601:Euthanasia, Active / Q000706:statistics & numerical data; D006801:Humans; D008020:Life Support Care / Q000706:statistics & numerical data; D010166:Palliative Care / Q000706:statistics & numerical data; D057240:Patient Preference; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D013727:Terminal Care / Q000706:statistics & numerical data*; D014504:Urban Health