Trends in the use of opioids at the end of life and the expected effects on hastening death
Humans; Survival Rate; Analgesics; Attitude of Health Personnel; Questionnaires; Euthanasia; Survival Analysis; Risk Assessment; Risk Factors; decision making; Administration; Oral; Opioid/administration & dosage; Terminal Care/statistics & numerical data; Active/statistics & numerical data/trends; Netherlands/epidemiology; Pain/mortality/prevention & control; Physician's Practice Patterns/statistics & numerical data/trends; Physicians/statistics & numerical data
The aim of our study was to describe trends in opioid use and perceptions of having hastened the end of life of a patient. In 2005, a questionnaire was sent to 6860 physicians in The Netherlands who had attended a death. The response rate was 78%. In 1995 and 2001 similar studies were done. Physicians less often administered opioids with the intention to hasten death in 2005 (3.1% of the non-sudden deaths) than in 2001 and in 1995 (7% and 10%, respectively). Physicians gave similar dosages of opioids in 2005, 2001, and 1995, but physicians in 2005 less often thought that life was actually shortened than in 2001 and 1995 (37% in 2005, 50% in 2001, and 53% in 1995). Of the physicians in 2005 who did think that the life of the patient was shortened by opioids, 94% did not give higher dosages than were, in their own opinion, required for pain and symptom management. Physicians in 2005 more often took hastening death into account when they gave higher dosages of opioids when the patient experienced more severe symptoms and with female patients. In older patients (>or=80 years), physicians took the hastening of death into account more often, but the actual dosages of opioids were lower. These data indicate that physicians in The Netherlands less often thought that death was hastened by opioids and less often gave opioids, with the intention to hasten death in 2005 than in 2001 and 1995.
2009
Rurup ML; Borgsteede SD; van der Heide A; van der Maas PJ; Onwuteaka-Philipsen BD
Journal Of Pain And Symptom Management
2009
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/j.jpainsymman.2008.02.010" target="_blank" rel="noreferrer">10.1016/j.jpainsymman.2008.02.010</a>
End-of-life practices in the Netherlands under the Euthanasia Act
Female; Humans; Male; Analgesics; Questionnaires; Follow-Up Studies; Aged; Middle Aged; Netherlands; Suicide; 80 and over; cause of death; Opioid/administration & dosage; Hypnotics and Sedatives/administration & dosage; Assisted/legislation & jurisprudence/statistics & numerical data/trends; Euthanasia/legislation & jurisprudence/statistics & numerical data/trends; Withholding Treatment/statistics & numerical data/trends
BACKGROUND: In 2002, an act regulating the ending of life by a physician at the request of a patient with unbearable suffering came into effect in the Netherlands. In 2005, we performed a follow-up study of euthanasia, physician-assisted suicide, and other end-of-life practices. METHODS: We mailed questionnaires to physicians attending 6860 deaths that were identified from death certificates. The response rate was 77.8%. RESULTS: In 2005, of all deaths in the Netherlands, 1.7% were the result of euthanasia and 0.1% were the result of physician-assisted suicide. These percentages were significantly lower than those in 2001, when 2.6% of all deaths resulted from euthanasia and 0.2% from assisted suicide. Of all deaths, 0.4% were the result of the ending of life without an explicit request by the patient. Continuous deep sedation was used in conjunction with possible hastening of death in 7.1% of all deaths in 2005, significantly increased from 5.6% in 2001. In 73.9% of all cases of euthanasia or assisted suicide in 2005, life was ended with the use of neuromuscular relaxants or barbiturates; opioids were used in 16.2% of cases. In 2005, 80.2% of all cases of euthanasia or assisted suicide were reported. Physicians were most likely to report their end-of-life practices if they considered them to be an act of euthanasia or assisted suicide, which was rarely true when opioids were used. CONCLUSIONS: The Dutch Euthanasia Act was followed by a modest decrease in the rates of euthanasia and physician-assisted suicide. The decrease may have resulted from the increased application of other end-of-life care interventions, such as palliative sedation.
2007
van der Heide A; Onwuteaka-Philipsen BD; Rurup ML; Buiting HM; van Delden JJ; Hanssen-de Wolf JE; Janssen AG; Pasman HR; Rietjens JA; Prins CJ; Deerenberg IM; Gevers JK; van der Maas PJ; van der Wal G
The New England Journal Of Medicine
2007
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1056/NEJMsa071143" target="_blank" rel="noreferrer">10.1056/NEJMsa071143</a>
Using drugs to end life without an explicit request of the patient
Female; Humans; Male; Adult; Questionnaires; Aged; Middle Aged; Netherlands; Intention; Informed Consent; Ethics; Suicide; Medical; Belgium; Denmark; adolescent; 80 and over; decision making; Switzerland; Assisted/ethics/legislation & jurisprudence/psychology; Euthanasia/ethics/legislation & jurisprudence/psychology; Mental Competency/legislation & jurisprudence; Patient Participation/legislation & jurisprudence/psychology; Physician's Practice Patterns/ethics; Terminal Care/ethics/legislation & jurisprudence/psychology
A small proportion of deaths result from the use of drugs with the intention to hasten death without an explicit request of the patient. Additional insight into its characteristics is needed for evaluating this practice. In the Netherlands in 2001, questionnaires were mailed to physicians that addressed the decision making that preceded their patient's death. Cases of ending life without an explicit request of the patient were compared with similar cases from 1995 and with cases from Belgium, Denmark, and Switzerland. In the Netherlands in 2001, patients receiving life-ending drugs without their explicit request were most often 80+ years old and had cancer. Most of them were incompetent patients nearing death. Characteristics of this practice in 1995 were quite comparable, as were characteristics of this practice in Belgium, Denmark, and Switzerland. The use of drugs with the intention to hasten death without an explicit request of the patient is part of medical end-of-life practice in the studied countries, regardless of their legal framework, and it occurs in similar fashion.
2007
Rietjens JA; Bilsen J; Fischer S; van der Heide A; van der Maas PJ; Miccinessi G; Norup M; Onwuteaka-Philipsen BD; Vrakking AM; van der Wal G
Death Studies
2007
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Journal Article
<a href="http://doi.org/10.1080/07481180601152443" target="_blank" rel="noreferrer">10.1080/07481180601152443</a>
Physician-assisted deaths under the euthanasia law in Belgium: a population-based survey
Female; Humans; Male; Prevalence; Questionnaires; Aged; Middle Aged; Euthanasia; Age Factors; Sex Factors; Time Factors; Suicide; 80 and over; cause of death; Active; Neoplasms/therapy; Terminal Care/statistics & numerical data; Assisted/legislation & jurisprudence/statistics & numerical data; Home Care Services/statistics & numerical data; Belgium/epidemiology; Euthanasia/legislation & jurisprudence/statistics & numerical data; Voluntary/statistics & numerical data
BACKGROUND: Legalization of euthanasia and physician-assisted suicide has been heavily debated in many countries. To help inform this debate, we describe the practices of euthanasia and assisted suicide, and the use of life-ending drugs without an explicit request from the patient, in Flanders, Belgium, where euthanasia is legal. METHODS: We mailed a questionnaire regarding the use of life-ending drugs with or without explicit patient request to physicians who certified a representative sample (n = 6927) of death certificates of patients who died in Flanders between June and November 2007. RESULTS: The response rate was 58.4%. Overall, 208 deaths involving the use of life-ending drugs were reported: 142 (weighted prevalence 2.0%) were with an explicit patient request (euthanasia or assisted suicide) and 66 (weighted prevalence 1.8%) were without an explicit request. Euthanasia and assisted suicide mostly involved patients less than 80 years of age, those with cancer and those dying at home. Use of life-ending drugs without an explicit request mostly involved patients 80 years of older, those with a disease other than cancer and those in hospital. Of the deaths without an explicit request, the decision was not discussed with the patient in 77.9% of cases. Compared with assisted deaths with the patient's explicit request, those without an explicit request were more likely to have a shorter length of treatment of the terminal illness, to have cure as a goal of treatment in the last week, to have a shorter estimated time by which life was shortened and to involve the administration of opioids. INTERPRETATION: Physician-assisted deaths with an explicit patient request (euthanasia and assisted suicide) and without an explicit request occurred in different patient groups and under different circumstances. Cases without an explicit request often involved patients whose diseases had unpredictable end-of-life trajectories. Although opioids were used in most of these cases, misconceptions seem to persist about their actual life-shortening effects.
2010
Chambaere K; Bilsen J; Cohen J; Onwuteaka-Philipsen BD; Mortier F; Deliens L
Canadian Medical Association Journal
2010
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Journal Article
<a href="http://doi.org/10.1503/cmaj.091876" target="_blank" rel="noreferrer">10.1503/cmaj.091876</a>
Medical end-of-life decisions for children in the Netherlands
PedPal Lit; 21% by the alleviation of pain or symptoms with a possible life-shortening effect; Adolescent Child Child; Assisted/statistics & numerical data Terminal Care/; Decision Making Euthanasia/; Non-U.S. Gov't Retrospective Studies Suicide; Passive/statistics & numerical data Female Hospitals; Pediatric Humans Infant Interviews Male Netherlands/epidemiology Pediatrics/; Preschool Death Certificates; statistics & numerical data Euthanasia; statistics & numerical data Physician-Patient Relations Professional-Family Relations Questionnaires Research Support
2005
Vrakking AM; van der Heide A; Arts WF; Pieters R; van der Voort E; Rietjens JA; Onwuteaka-Philipsen BD; van der Maas PJ; van der Wal G
Archives Of Pediatrics & Adolescent Medicine
2005
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Journal Article
<a href="http://doi.org/10.1001/archpedi.159.9.802" target="_blank" rel="noreferrer">10.1001/archpedi.159.9.802</a>
Clinical problems with the performance of euthanasia and physician-assisted suicide in The Netherlands
Female; Humans; Male; Adult; Data Collection; Aged; Middle Aged; Euthanasia; Netherlands; Suicide; 80 and over; Empirical Approach; Death and Euthanasia; Active; Random Allocation; Euthanasia/statistics & numerical data; Empirical Research; Assisted/statistics & numerical data
BACKGROUND AND METHODS: The characteristics and frequency of clinical problems with the performance of euthanasia and physician-assisted suicide are uncertain. We analyzed data from two studies of euthanasia and physician-assisted suicide in The Netherlands (one conducted in 1990 and 1991 and the other in 1995 and 1996), with a total of 649 cases. We categorized clinical problems as technical problems, such as difficulty inserting an intravenous line; complications, such as myoclonus or vomiting; or problems with completion, such as a longer-than-expected interval between the administration of medications and death. RESULTS: In 114 cases, the physician's intention was to provide assistance with suicide, and in 535, the intention was to perform euthanasia. Problems of any type were more frequent in cases of assisted suicide than in cases of euthanasia. Complications occurred in 7 percent of cases of assisted suicide, and problems with completion (a longer-than-expected time to death, failure to induce coma, or induction of coma followed by awakening of the patient) occurred in 16 percent of the cases; complications and problems with completion occurred in 3 percent and 6 percent of cases of euthanasia, respectively. The physician decided to administer a lethal medication in 21 of the cases of assisted suicide (18 percent), which thus became cases of euthanasia. The reasons for this decision included problems with completion (in 12 cases) and the inability of the patient to take all the medications (in 5). CONCLUSIONS: There may be clinical problems with the performance of euthanasia and physician-assisted suicide. In The Netherlands, physicians who intend to provide assistance with suicide sometimes end up administering a lethal medication themselves because of the patient's inability to take the medication or because of problems with the completion of physician-assisted suicide.
2000
Groenewoud JH; van der Heide A; Onwuteaka-Philipsen BD; Willems DL; van der Maas PJ; van der Wal G
The New England Journal Of Medicine
2000
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Journal Article
<a href="http://doi.org/10.1056/NEJM200002243420805" target="_blank" rel="noreferrer">10.1056/NEJM200002243420805</a>