Hastening death in end-of-life care: A survey of doctors

Abstract

In end-of-life care the application of medical technology to prolong life at the expense of quality of life is widely debated. A national survey of 3,733 UK doctors reporting on the care of 2,923 people who had died under their care is reported. There was no time to make an 'end-of-life decision' (deciding to provide, withdraw or withhold treatment) for 8.5%. A further 55.2% reported decisions which they estimated would not hasten death and 28.9% reported decisions they had expected to hasten death. A further 7.4% reported deaths where they had to some degree intended to hasten death (=100%). Where patients or someone else had made a request for a hastened death, doctors were more likely to report expecting or at least partly intending to hasten death. Doctors usually made these decisions in consultation with colleagues, relatives and, where feasible, with patients. Intensive care specialists were particularly likely to report a degree of intention to hasten the end of life and to have treated patients lacking the capacity to discuss these decisions. Palliative medicine specialists were the least likely to report decisions they expected or at least partly intended to end life, in spite of reporting a high incidence of requests from their patients for a hastened death. Doctors with strong religious beliefs or who opposed the legalisation of assisted dying were unlikely to report such decisions. Elderly women and those with dementia are groups considered vulnerable in societies where a permissive approach is taken to hastening death in end-of-life care, but doctors describing these deaths were no more likely to report decisions which they expected or at least partly intended to end life. The survey suggests that concerns about the sanctity of life, as well as estimates of the quality of life, enter clinical decision-making.

Influencers of ethical beliefs and the impact on moral distress and conscientious objection

“…[13][14][15] Further research is needed to better understand the impact of these intrinsic factors on the development of ethical beliefs and their consequential influence on ethical decision making.…”

How the mass media report social statistics: A case study concerning research on end-of-life decisions

“…One in ten dying patients make requests for a hastened death and these sometimes persist in spite of the care provided. A high rate of such requests occur in palliative care (Seale 2009c). …”

“…Doctors' with religious or faith beliefs are less willing to carry out (or to say they carried out) actions that were partly intended to end life, or to provide continuous deep sedation until death (which raises issues of the relative balance being struck between sanctity of life and quality of life) (Seale 2009c(Seale , 2010.…”

“…There is a relatively high rate of use of continuous deep sedation until death in UK medical practice, which deserves further investigation (Seale 2009b(Seale , 2010 (Seale 2009c(Seale , 2010.…”

How should I know? Researching attitudes and practices around hastening death

“…Seale decided to re-word the key questions for his second survey in 2009, as the old version would overestimate the prevalence of certain endof-life decisions. 8 The EURELD questionnaire does not differentiate clearly whether the intent of the physician is to shorten life or whether the intent is to stop further prolongation of life in dying patients. Withdrawing or refraining from life-prolonging treatments that are not actually prolonging life but rather prolonging dying and suffering is an accepted part of end-of-life care.…”