The practice of continuous deep sedation until death in Flanders (Belgium), the Netherlands, and the U.K.: a comparative study.
BACKGROUND
Existing empirical evidence shows that continuous deep sedation until death is given in about 15% of all deaths in Flanders, Belgium (BE), 8% in The Netherlands (NL), and 17% in the U.K.


OBJECTIVE
This study compares characteristics of continuous deep sedation to explain these varying frequencies.


METHODS
In Flanders, BE (2007) and NL (2005), death certificate studies were conducted. Questionnaires about continuous deep sedation and other decisions were sent to the certifying physicians of each death from a stratified sample (Flanders, BE: n=6927; NL: n=6860). In the U.K. in 2007-2008, questionnaires were sent to 8857 randomly sampled physicians asking them about the last death attended.


RESULTS
The total number of deaths studied was 11,704 of which 1517 involved continuous deep sedation. In Dutch hospitals, continuous deep sedation was significantly less often provided (11%) compared with hospitals in Flanders, BE (20%) and the U.K. (17%). In U.K. home settings, continuous deep sedation was more common (19%) than in Flanders, BE (10%) or NL (8%). In NL in both settings, continuous deep sedation more often involved benzodiazepines and lasted less than 24 hours. Physicians in Flanders combined continuous deep sedation with a decision to provide physician-assisted death more often. Overall, men, younger patients, and patients with malignancies were more likely to receive continuous deep sedation, although this was not always significant within each country.


CONCLUSIONS
Differences in the prevalence of continuous deep sedation appear to reflect complex legal, cultural, and organizational factors more than differences in patients' characteristics or clinical profiles. Further in-depth studies should explore whether these differences also reflect differences between countries in the quality of end-of-life care.
End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium. Livia.Anquinet@vub.ac.be
Livia
L
Anquinet
Judith A C
JA
Rietjens
Clive
C
Seale
Jane
J
Seymour
Luc
L
Deliens
Agnes
A
van der Heide
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D054810:Deep Sedation / Q000706:statistics & numerical data*; D005065:Euthanasia / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D017236:Suicide, Assisted / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000706:statistics & numerical data*; D006113:United Kingdom