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Terminal Sedation and Euthanasia
A Comparison of Clinical Practices
Judith A. C. Rietjens, PhD;
Johannes J. M. van Delden, MD, PhD;
Agnes van der Heide, MD, PhD;
Astrid M. Vrakking, MSc;
Bregje D. Onwuteaka-Philipsen, PhD;
Paul J. van der Maas, MD, PhD;
Gerrit van der Wal, MD, PhD
Arch Intern Med. 2006;166:749-753.
Background An important issue in the debate about terminal sedation is the extent to which it differs from euthanasia. We studied clinical differences and similarities between both practices in the Netherlands.
Methods Personal interviews were held with a nationwide stratified sample of 410 physicians (response rate, 85%) about the most recent cases in which they used terminal sedation, defined as administering drugs to keep the patient continuously in deep sedation or coma until death without giving artificial nutrition or hydration (n = 211), or performed euthanasia, defined as administering a lethal drug at the request of a patient with the explicit intention to hasten death (n = 123). We compared characteristics of the patients, the decision-making process, and medical care of both practices.
Results Terminal sedation and euthanasia both mostly concerned patients with cancer. Patients receiving terminal sedation were more often anxious (37%) and confused (24%) than patients receiving euthanasia (15% and 2%, respectively). Euthanasia requests were typically related to loss of dignity and a sense of suffering without improving, whereas requesting terminal sedation was more often related to severe pain. Physicians applying terminal sedation estimated that the patient's life had been shortened by more than 1 week in 27% of cases, compared with 73% in euthanasia cases.
Conclusions Terminal sedation and euthanasia both are often applied to address severe suffering in terminally ill patients. However, terminal sedation is typically used to address severe physical and psychological suffering in dying patients, whereas perceived loss of dignity during the last phase of life is a major problem for patients requesting euthanasia.
Author Affiliations: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands (Drs Rietjens, van der Heide, and van der Maas and Ms Vrakking); University Medical Center Utrecht, Julius Center for Health Sciences, Utrecht, the Netherlands (Dr van Delden); and Department of Public and Occupational Health and Institute for Research in Extramural Medicine, Vrije Universiteit University Medical Center, Amsterdam, the Netherlands (Drs Onwuteaka-Philipsen and van der Wal).
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