Forgoing Treatment at the End of Life in 6 European Countries

Abstract

In all of the participating countries, life-prolonging treatment is withheld or withdrawn at the end of life. Frequencies vary greatly among countries. Low-technology interventions, such as medication or hydration or nutrition, are most frequently forgone. In older patients and outside the hospital, physicians prefer not to initiate life-prolonging treatment at all rather than stop it later.

The ‘natural’ endpoint of dementia: death from cachexia or dehydration following palliative care?

“…In Dutch practice, explicit communication on hastening of death is possible without fear of litigation (Bosshard et al, 2005;van der Steen et al, 2005). Dutch residents with severe dementia and pneumonia are rarely hospitalized or treated with rehydration therapy, are more frequently treated with simple oral antibiotics, and antibiotics are more frequently withheld compared with US residents (Mehr et al, 2003;van der Steen et al, 2004).…”

Intentionally hastening death by withholding or withdrawing treatment

“…Overall, an explicit intention was more common in withholding (48%) than in withdrawing (41%) treatment, mainly because in the medication group -which accounted for almost half of all treatments forgone [11] -intent to hasten the end of life was clearly more common when a treatment was not started (51%) than when it was stopped later (38%). On the other hand, in the respiration and the dialysis categories, an explicit intention of hastening the end of life was found more often when treatment was withdrawn than when it was withheld.…”

“…Approval by a research ethics committee was obtained in each country where this was required: Belgium, Italy, and Sweden, [10]. The detailed methodology and the main findings of the principal categories of medical end-of-life decisions have been published elsewhere [5,11].…”

“…However, doctors were asked to indicate by how much a life had been shortened in consequence of the treatment forgone. This showed that the highest percentages of cases with a life-shortening effect of more than one month were for dialysis and oncotherapy [11], thus there is no obvious relationship between the extent to which life was shortened and the reported intention of hastening death. In addition to the likelihood and the extent of a death-hastening effect, one could assume the immediacy of death as a consequence of the decision to withhold or withdraw treatment to be associated with an explicit intention.…”

Beratung zur Patientenverfügung

“…Vielfach können die anstehenden Entscheidungen jedoch nicht unter aktiver Mitwirkung des Patienten getroffen werden, da dieser seine Einwilligungsfähigkeit zum Zeitpunkt der Entscheidung bereits verloren hat (Silveira et al 2010;van der Heide et al 2003 (Becker et al 2010;Nauck et al 2014;Schöffner et al 2012 (Bosshard et al 2005;van Delden et al 2006). Auf Intensivstationen oder in der palliativen Versorgung werden bei bis zu 72% der dort versterbenden Menschen Entscheidungen zur Therapiezieländerung erforderlich (Sprung et al 2003;Vincent et al 2004).…”