Medische besluiten rond het levenseinde in 6 Europese landen: België, Denemarken, Italië, Nederland, Zweden en Zwitserland

To determine the prevalence and main background characteristics of end-of-life medical decisions in six European countries: Belgium (Flanders), Denmark, Italy (four regions), the Netherlands, Sweden and Switzerland (German speaking part).

Design

Questionnaire study.

Methods

In all participating countries, deaths that were reported to death registries were stratified for cause of death (except in Switzerland) and samples were drawn from each stratum. The reporting physicians received a mailed questionnaire about the medical decision-making that had possibly preceded the death of the patient involved. The data-collection procedure precluded identification of any of the physicians or death cases. All deaths occurred between June 2001 and February 2002. The data were weighed to correct for the effect of stratification and to make them as representative as possible for all cases of death; the results are presented as weighed percentages.

Results

The response was 75 for the Netherlands, 67 for Switzerland, 62 for Denmark, 61 for Sweden, 59 for Belgium and 44 for Italy. The total number of deaths studied was 20,480. Death occurred suddenly and unexpectedly in about one third of deaths in all countries. The percentage of deaths that were preceded by any end-of-life decision varied between 23 (Italy) and 51 (Switzerland). The administration of drugs with the explicit intention of hastening death occurred in all countries, but the rates varied: the incidence was about 1 or less in Denmark, Italy, Sweden and Switzerland, 1.82 in Belgium and 3.40 in the Netherlands. Large variations were found in the extent to which decisions were discussed with patients, relatives and other care providers. Patients and relatives were more frequently involved in the decision-making process in countries where the incidence was relatively high.

Conclusion

In all of the countries surveyed, end-of-life medical decisions were reported for a significant proportion of the deaths.