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End-of-Life Decision Making in Europe and Australia
A Physician Survey
Bregje D. Onwuteaka-Philipsen, PhD;
Susanne Fisher, PhD;
Colleen Cartwright, PhD;
Luc Deliens, PhD;
Guido Miccinesi, MD;
Michael Norup, MD, PhD;
Tore Nilstun, PhD;
Agnes van der Heide, MD, PhD;
Gerrit van der Wal, PhD; for the European End-of-Life (EURELD) Consortium
Arch Intern Med. 2006;166:921-929.
Background The frequencies with which physicians make different medical end-of-life decisions (ELDs) may differ between countries, but comparison between countries has been difficult owing to the use of dissimilar research methods.
Methods A written questionnaire was sent to a random sample of physicians from 9 specialties in 6 European countries and Australia to investigate possible differences in the frequencies of physicians' willingness to perform ELDs and to identify predicting factors. Response rates ranged from 39% to 68% (N = 10 139). Using hypothetical cases, physicians were asked whether they would (probably) make each of 4 ELDs.
Results In all the countries, 75% to 99% of physicians would withhold chemotherapy or intensify symptom treatment at the request of a patient with terminal cancer. In most cases, more than half of all physicians would also be willing to deeply sedate such a patient until death. However, there was generally less willingness to administer drugs with the explicit intention of hastening death at the request of the patient. The most important predictor of ELDs was a request from a patient with decisional capacity (odds ratio, 2.1-140.0). Shorter patient life expectancy and uncontrollable pain were weaker predictors but were more stable across countries and across the various ELDs (odds ratios, 1.1-2.4 and 0.9-2.4, respectively).
Conclusion Cultural and legal factors seem to influence the frequencies of different ELDs and the strength of their determinants across countries, but they do not change the essence of decision making.
Author Affiliations: Department of Social Medicine (Drs Onwuteaka-Philipsen and van der Wal) and Institute for Research in Extramural Medicine (Dr van der Wal), VU University Medical Centre, Amsterdam, the Netherlands; Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland (Dr Fisher); Aged Services Learning & Research Collaboration, Southern Cross University, Coffs Harbour, Australia (Dr Cartwright); End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium (Dr Deliens); Epidemiology Unit, Center for Study and Prevention of Cancer, Florence, Italy (Dr Miccinesi); Department of Medical Philosophy and Clinical Theory, University of Copenhagen, Copenhagen, Denmark (Dr Norup); Department of Medical Ethics, University of Lund, Lund, Sweden (Dr Nilstun); and Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands (Dr van der Heide).
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