Continuous deep sedation for patients nearing death in the Netherlands: descriptive study

Requests for euthanasia in general practice before and after implementation of the Dutch Euthanasia Act

“…It is quite possible that the growing use of continuous deep sedation in the Netherlands to cope with pain, anxiety, and dyspnoea in the terminal phase of life is responsible for this decrease. 8,15 This theory is supported by the finding that the use of continuous deep sedation in the Netherlands increased from 5.6% of deaths in 2001 to 7.1% in 2005, mostly in patients treated by GPs. 8 The Dutch Sentinel stations did not find an increase in the application of palliative sedation in more recent years.…”

“…8,15 This theory is supported by the finding that the use of continuous deep sedation in the Netherlands increased from 5.6% of deaths in 2001 to 7.1% in 2005, mostly in patients treated by GPs. 8 The Dutch Sentinel stations did not find an increase in the application of palliative sedation in more recent years. 9 Unbearable suffering was used in the current investigation as a separate item, although it is actually a general term (just like the term hopelessness), covering the multiple reasons for a request for euthanasia.…”

“…7 Improved palliative care, including the use of deep continuous sedation at the end of life, is a possible explanation for this decrease. 8 Nevertheless, an interesting question remains, namely whether implementation of the Euthanasia Act has influenced the number of requests for euthanasia and/or may have led to changes in the underlying reasons for such a request. These subjects, and possible differences by sex, are addressed in the current study.…”

The Traditional Account of Ethics and Law at the End of Life—and its Discontents

“…Since only 4.2% of the same sample had administered a bolus dose (a lethal injection), it seems plausible that the administration of sedating infusions was not uncommon in this sample, with only the intention of the clinician to distinguish these reported practices from what might otherwise be regarded as good palliative care. In the Netherlands in 2005, 7.1% of dying patients received continuous deep sedation; most were cancer patients being treated by family practitioners, as commonly occurs in that country (Rietjens et al 2008). In 2008, Parker and colleagues reported that 26% of their sample of Australian specialists would be willing to provide terminal sedation of their own initiative, in response to a hypothetical case scenario (Parker et al 2008).…”

Die richtigen Worte für medizinische Entscheidungen am Lebensende finden

“…Mit einer emotional aufgeladenen bis irreführenden Terminologie kann dies jedoch nicht gelingen.Die klassische Differenzierung in der Sterbehilfedebatte ist somit aus folgenden Gründen abzulehnen: Ländern mit über 30 000 Patienten durchgeführt wurde, definieren die Autoren folgende Sterbenskategorien[29]:-unsuccessful cardiopulmonary resuscitation (CPR):Tod trotz Herzmassage und Beatmung; -brain death: Verwirklichung aller Hirntodkriterien; -withholding: Entscheidung, eine lebenserhaltende Maßnahme nicht zu beginnen oder zu intensivieren; beinhaltet auch den Verzicht auf CPR; -withdrawing: Entscheidung, eine derzeit aufrecht erhaltene Maßnahme zu limitieren, reduzieren oder zu beenden; -active shortening of the dying process: beschreibt eine Handlung mit der speziellen Intention, den Sterbensprozess zu verkürzen; beinhaltet nicht Verzicht (withholding) oder Zurücknahme (withdrawing) einer lebenserhaltenden Maßnahme; ein Beispiel für eine aktive Verkürzung wäre die vorsätzli-che Überdosis an Sedativa oder Analgetika.Die Ethics Task Force der European Association for Palliative Care[30] verwendet in ihrem Positionspapier neben den Kategorien "withholding futile treatment" und "withdrawing futile treatment" auch den Begriff "terminal sedation" für die Verabreichung von Sedativa, um das Leiden in den letzten Lebenstagen des Patienten zu lindern und belastende Symptome zu minimieren[31,32]. Der deutsche Nationale Ethikrat weist in diesem Zusammenhang zu Recht darauf hin, diese Intention besser mit dem Begriff "palliative Sedierung" zu bezeichnen, da ‚terminale Sedierung' den Anschein erwecken könne, der Tod des Betroffenen sei das Ziel der Sedierung[11].…”